Thursday, September 30, 2010

Disability Political Action Committee Gears Up for November Elections

Disability Power & Pride Politicla Action Committee (PAC), a new non-partisan political fund-raising group, is thought to be one of the first groups to provide funding for candidates who are "disability friendly. " Their focus is on the Senate race in Kentucky; and the candidate they are supporting is Jack Cowan. His opponent, Rand Paul, has questioned if the ADA is an overextension of the federal government and has suggested other ways to attain accomodations. The PAC hope to raise $15, 000 for Cowan, and it seems it will with $10,000 secured in commitments. For more information please use the follwing link,

Monday, September 27, 2010

Welcome to a New Era in Health Care: Affordable Care Act Provisions Go into Effect

Six months after the Affordable Care Act was signed, many of its benefits are going into effect. According to the law, consumers enrolling in new plans are now guaranteed to receive cost-free preventive services, young adults may stay on parents’ policy until the age of 26, freedom to choose a primary care doctor, ob/gyn, or pediatrician without referral, and use the nearest emergency room without penalty. Insurers are not permitted to deny coverage to children with pre-existing conditions, place lifetime limits on benefits, cancel health insurance policy without proof of fraud, or deny claims without allowing for an appeal in any new or existing plan. For more information on the benefits use the following link.

Congressman Miller Seeks Report on Transition Programs for Students with Disabilities

On September 19, 2010, Congressman George Miller sent a letter to the Government Accountability Office concerning federal programs to help students with disability transition from high school to college or to the workforce. Because students with disabilities face academic, social, physical and economic challenges they struggle more and, unfortunately, have less successful transitions. Congressman Miller questioned whether or not the federal programs’ approach did enough to address all those obstacles. In his letter, he stated the GOA should identify the programs, and examine the challenges students face, the coordinated efforts established by the government and the barriers to those efforts, as well as, the program and performance data that is used to determine the effectiveness of the efforts. You can use the following link to read the full letter.

Alternatives to Hospitalization Task Force Meeting September 16

Beth Melcher, Assistant Secretary for Mental Health, Developmental Disabilities, and Substance Abuse Services Development and Flo Stein, Division of Mental Health, are co-chairing the task force. The task force is composed of LME staff, providers, consumers, public housing agencies, Department of Corrections, DHHS and Housing Finance Agency staff.

The purpose is to determine the cost-effectiveness of supportive housing as an alternative to institutionalization. Recommendations are due to the legislature by January 31, 2010, so proposed recommendations will be made to the department in December. Duties of the Task Force are listed in the Study Bill - SESSION LAW 2010-152, SENATE BILL 900, Section 18.

Overview of North Carolina Reports and National Studies

Angela Harper, housing specialist at DMH discussed how important it is to look at the service system. Angela reviewed past studies and recommendations, including: 2001 IOM Task Force on Long Term Care; MH/DD/SAS Commission Task Force on Housing in 2004 Housing for North Carolinians with Disabilities; 2005 Report of DHHS Study Group to NC Study Commission on Aging - Study of Issues Related to Persons with Mental Illness in Long-Term Care Facilities; 2006 NC Institutional Bias Study Combined Report prepared for NC DHHS; 2007 Final Reports and Gaps Analysis submitted by consultant to MH/DD/SAS LOC; 2008 Study of Rules and Regulations Regarding Housing Individuals with MI in the Same Facility Vicinity as Individuals without MI, submitted by DHHS to NC Study Commission on Aging; 2008 DHHS & NCHFA Interim Plan for Efficient and Effective Use of State Resources in the Financing and Development of Independent and Supported living Apartments for Persons with Disabilities, presented to MH/DD/SAS LOC, and the 2009 final plan of the same title presented to the MH/DD/SAS LOC in 2009; Pilot Program to Reduce State Psychiatric Hospital Use and to Increase Local Services for Persons with MI through DHHS DMH in 2009 (4 LMEs); Housing for People with MI: Update of a Report to the President’s New Freedom Commission by TAC in 2007; Governor’s Association Supportive Housing in 2007; Permanent Supportive Housing: An Evidence-Based Practice by SAMHSA in 2010.

Presentation on Alternatives to Hospitalization Historical Data

The group discussed how to gather the data called for in the legislation, which calls for the gathering of data on frequent users of psychiatric beds (State and community) and emergency departments. CCNC has a grant to gather this data but it won’t be done in time for this study. Wake is doing its own study that can be used as a sample to help make the business case for alternatives to hospitalization. They define a frequent user as 3 or more hospitalizations to a state hospital (because that’s the info they have) or 10 or more in a lifetime.

Group Discussion:
•The group discussed shared living options. John Owen discussed a program in West Virginia. The group would like to see any other helpful reports.
• DOC members discussed transition issues, criminal record history and special issue of sex offenders.
• Simply Home in Asheville uses technology to monitor people at home. Through telehealth we can do supportive services like medication management. Studies in Wisconsin were done. Arc is looking at some of the same applications.
• Must look at start-up costs for services, telehealth, etc. With current rates, can’t ever recoup start-up costs.
• Use peer support as a bridge, extension of ACTT teams. How do you support the services?
• Host homes were a good model – people in recovery hosted others. A lot of people connected through AA.
• Need to address the issues of silos in the report.
• Must consider transportation and transportation costs – tied to isolation, employment, etc.
• Can also consider pilot programs.

Wednesday, September 15, 2010

Handouts from 9/8 MH/DD/SAS LOC

The Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, & Substance Abuse Services met on September 8, 2010. The agenda is online here. The handouts from the committee are posted on the legislature's website here.

During the Secretary's remarks, he discussed the state psychiatric facilities. An October 1 groundbreaking is scheduled for the new Cherry hospital in Goldsboro. The groundbreaking on the new Broughton hospital in Morganton is scheduled for the Spring. Although the legislature will technically have a chance to veto the decision to close Dix hospital in Raleigh, he discussed the plans to close that facility. The department is increasing the number of beds at Cherry and Broughton to maintain the current number of beds. A 26 bed minimum forensic unit will remain open at Dix.

New NC DHHS Resource on Supported Housing

This publication explains how local, state, and federal agencies or departments can collaborate to help individuals with disabilities access permanent supportive housing. By appropriately using local, state, and federal funds these services will help people live successfully within their communities. Please follow the link for more information. accomplishments/housing spotlight2010.pdf

Wednesday, September 1, 2010

From the 8/16 and 9/1 NC Register

August 16, 2010 North Carolina Register

The NC Medical Care Commission published notice (Pages 390-391) to amend 10A NCAC 13B .3302, Minimum Provisions of Patient's Bill of Rights, to ensure that all persons, regardless of sexual orientation or gender identity, have the right to medical and nursing treatment. The rule currently includes the right to medical and nursing services without discrimination based upon race, color, religion, sex, sex preference, national origin or source of payment. Disability status is not included. Comments are due October 15, 2010. There will also be a public hearing October 8.

The Rules Review Commission considered the proposed rules from the Commission for Mental Health on the NCI QA committee at its July 15 meeting (Pages 506-507). The Commission objected to the proposed rules based on lack of statutory authority and ambiguity. In particular, the Commission based its objections on the following:

10A NCAC 27E .0301 - The Commission objected to this rule based on lack of statutory authority and ambiguity. In (b), there is no authority cited for this agency to create another agency and grant it the authority to adopt rules (establish policy). It is also not clear who, if anyone, is required to have NCI training.
10A NCAC 27E .0302 - The Commission objected to this rule based on lack of statutory authority and ambiguity. In (5), there is no authority cited for the agency to create a committee and give it exclusive authority to certify training. Even if there is authority it is not clear what standards the committee will use in certifying trainers. There is also no authority cited for the agency to create an agency and give that agency the authority to adopt rules (establish guidelines and policies). In (6), it is not clear what the qualifications are for NCI (North Carolina Interventions). The only things listed are parts of a curriculum and it is not clear how that is a qualification. There is no authority cited for the agency to grant others exclusive authority to certify instructors. In (9), it is not clear what standards the Curriculum Review Commission is to use in approving techniques. It is also not clear what populations are referred to.
10A NCAC 27E .0303 - The Commission objected to this rule based on lack of statutory authority and ambiguity. In (1), there is no authority cited for the agency to create an agency and give it authority to adopt rules (establish policies and procedures). There is the same issue in (3) with "develop guidelines." In (4), it is not clear what is meant by "direct the certification." In (5), it is not clear what is meant by "maintain inter rater reliability." In (7), it is not clear what records are to be maintained. In (9), there is no authority for the committee to adopt rules(enact guidelines).
10A NCAC 27E .0304 - The Commission objected to this rule based on ambiguity. Since apparently this is a new program providing for the certification of Instructor Trainers, it is not clear how the committee that certifies them can be made up of people already certified. In (12), it is not clear what is meant by "licensed clinicians."

The proposed rules will again be on the Rules Commission agenda on September 16, 2010. See the September 1, 2010 North Carolina Register (Page 665).

September 8 MH/DD/SAS LOC Agenda

Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, & Substance Abuse Services AGENDA

September 8, 2010 10:00 A.M.; Room 643, Legislative Office Building
Representative Verla Insko, Co-Chair, Presiding

Welcome and Opening Comments Senator Martin Nesbitt, Co-Chair
Representative Verla Insko, Co-Chair

Secretary's Remarks Lanier Cansler, Secretary, Department of Health and Human Services

Overview of 2010 Legislative Actions Lisa Hollowell, LOC Staff
Joyce Jones, LOC Staff

Expenditures and Utilization Tracking Update Craigan Gray, MD, Medical Director, Division of Medical Assistance, DHHS

Community Supports Information Michael Watson, Deputy Secretary, DHHS

CABHAs Update Michael Watson, DHHS


Status Report on the Changes to Level III and IV Mark O’Donnell, Program Manager Facilities for Children DMHDDSAS, DHHS

Second Mile Project – LME Presentation Roy Wilson, Director, East Carolina
Behavioral Health (ECBH)
Lisa Bonnett, Executive Director of the Recovery Education Unit, ECBH

Wrap Up and Discussions