Disability Rights North Carolina has been working to support federal legislation that would establish new guidelines for the use of seclusion and restraint in public schools. If you are unfamiliar with our work in this area, please refer to our website. A House version of the bill was filed earlier in the session. Shortly before the break, the Senate filed its own version, S. 3895. There were two big differences in the Senate bill: 1) It has a Republican co-sponsor, our own Senator Richard Burr; and 2) It allows seclusion and restraint that complies with the standards set out in the bill to be included in a child's IEP when there is a documented history showing a series of behaviors in the past 2 years that has created an imminent danger of serious bodily injury in school and a comprehensive, data-driven functional behavioral assessment has been conducted, and a behavioral intervention plan implemented, by a qualified team of proffesionals. Depending on the outcome of the election, the first change may allow this bill to pass and become law this year. The second change has been very controversial in the advocate community. Many groups feel that the inclusion in the IEP will increase the use of seclusion and restraint and serve as an impediment to enforcing a child's rights when the use is inappropriate.
Our national organization, National Disability Rights Network (NDRN), has adopted the following recommendation with regard to teh pending Senate bill, which we at Disability Rights NC endorse:
This legislation responds to a critical need identified by the P&As and NDRN for strong, consistent national standards regarding the use of restraint and seclusion. While NDRN recognizes that there are reservations about allowing restraint and seclusion in an Individualized Education Program (IEP), we believe that the criteria contained in this legislation for when these interventions can be utilized or written into an IEP are sufficient to ensure this occurs only in very limited circumstances. On balance, the benefits of establishing national standards, together with creating a threshold for their enforcement, outweigh the ever present risks that restraint and seclusion will be misapplied. Therefore, we support this legislation and believe it should be passed.
Please let me know if you
Thursday, October 28, 2010
Wednesday, October 27, 2010
Opportunities to contribute to the future of cloud computing and to share your IDEA story
FCC PARTNERS WITH THE COLEMAN INSTITUTE AND RAISING THE FLOOR TO LAUNCH CLOUD COMPUTING CHALLENGE
The Federal Communications Commission (FCC), the Coleman Institute for Cognitive Disabilities, and Raising the Floor challenged the public to submit short multimedia presentations on how cloud computing will create new opportunities for people with disabilities. The Federal Communication's Commission will post the most innovative designs on its Accessibility and Innovation Initiative website, and they will be considered for the Chairman’s Awards for Advancement in Accessibility. The Coleman Institute for Cognitive Disabilities will award $1,000 to the presentation that best describes how cloud computing will improve communication for people with cognitive disabilities. Raising the Floor will award $1,000 for the best presentation that focuses on the needs of people in developing countries.
Submissions for the challenge will be accepted between October 22, 2010 and May 1, 2011. The winner or “popular choice” will be determined by the public on May 2-3, 2011. Individuals can vote by visiting challenge.gov.
You can find out more about the Chairman’s Accessibility and Innovation Initiative by visiting, http://www.broadband.gov/accessibilityandinnovation/
Share your IDEA story
To celebrate the 35th anniversary of IDEA the Office of Special Education and Rehabilitation Services (OSERS) is asking anyone, individual with a disability, parent, student, teacher, principal, researcher, teacher trainer, or advocate, who has been positively affected by IDEA to share his or her story. Individuals are encouraged to share art work, photography, and poetry to describe their experiences. Personal stories and other documents are due before November 8th and should be submitted to https://www.osep-meeting.org/idea35th/.
Monday, October 25, 2010
10/19/2010 Alternatives to Housing Task Force
This is the legislature-mandated task force formed by NC DHHS Secretary Cansler. The task force is charged with looking at measures that will reduce the numbers of individuals with mental illness hospitalized. Last time we reviewed the legislation and past studies. They have gathered data since last time but there are still a lot of holes. Below is a summary of the date presented at the meeting. Unfortunately, I missed the afternoon, which focused on housing model presentations.
All LME data is held in the Client Data Warehouse. 87% of clients served by LMEs are in a private residence (children and adults combined); 85% of adults are in a private residence, 5% homeless
• Those not in private residence – looked at NC TOPPS (MH/SA only): at most recent update, close to 20% not in a private residence once they enter treatment. 43% in private residence, 36% residential program, institution or other type of program; 21% in temporary housing or homeless.
o The task force is focusing is on that 21%
• For those in a residential program, over half receiving treatment (but nowhere near all)
• Co-occurring MH/SA has greater needs – housing status quite different from MH and SA alone
• Those not in housing have higher number of crises, ER trips, nights in hospital, jail and arrests.
o Questions about whether any indicators in data about services and outcomes? NC TOPPS doesn’t track services but could match claims data
o They were going to seek data from the chronic homeless population counts
o Wake county estimates high end users 1-5% of SPMI (Wake has 10% of state population)
Data from State Operated Services – HEARTS, Healthcare Enterprise Accounts Receivable Tracking System – tracks Medicaid and IPRS patients
o Different definitions used in HEARTS – if sleeping on a couch, considered private residence (LME considers temporary residence)
o Their data is adults and kids, chart is 91% of all discharges
5% to homeless shelter (would be higher if just looked at adults) – 8% cite homeless as a prior – state operated services is supposed to oversee discharges to homeless shelters – Wake Med rep says numbers much higher (1,000 he estimates)
Really low numbers across the board in community placements
A lot of MR/MI coming into hospitals
Their data indicates 56% to private residence but many task force members questioned that statistic, one reason being that many of those folks bounce out of there in a short period of time
Wake estimates 15% entering state hospistals are homeless
Identified issue - LMEs still not following up quickly enough
Shelters see people coming out with too few meds, can’t get into psychiatrist quickly enough – state operated services says they give people 1 week of meds
$20K in New Freedom funding to implement Olmstead
Don’t have recidivism numbers
The task force should start with group discharged to homeless shelters
Effective Use of State Hospitals from Community Systems Progress Report April – June 2010
o In that quarter only 34% with stays of 7 days or less, Wake Med says more people waiting in ERs – but clients are higher acuity
o Much improved since 2006
o Only 53% of consumers discharged from state psych hosp were seen within 7 days following discharge; we don’t know what service was billed within 7 days
o 7% readmission within 30 days; 18% readmission within 180 days
o There is a meeting next week (now this week) between LMEs and hospitals
• Must be coordination regardless of state hospital or private hospital
• Durham Center pilot project started in July – tracking 50 repeat consumers who touch multiple systems in community; serve 500+ through care coordination; have a whatever it takes fund focused on recovery; biggest challenge was getting providers to buy into it – bringing it to LMEs attention and tell them what the wraparound services are that the person needs; quarterly quality of life services; housing is the key factor for these individuals; doing one year of rental assistance
Crisis Services
o Walk-In Psych Centers – 66 centers served 110,296 Jan-June 2010: 3.7% referred from state facility, ER, community hospital psych bed; 1.1% referred to state facility, etc.
o Community Hospitals 887 persons served over 15 mos ending Sept 2010 (this is just the 3 way contracts and previously existing psych units)
o Can get more data for beds in 3 way contracts
DOC Data, John Carbone
o Started by distinguishing them from jail system
o DOC has an M grade system for prisoners (M1-M5)
o Depending on source, data is all over the place – different diagnoses, different definitions
o LME-prison liaisons? Not statewide. Dr. Carbone said that would be wonderful. This needs to be formalized. Laura Yates oversees everything in community, including housing, not a designated housing specialist
o They have a study draft looking at Dix patients and those in corrections to identify cross-over – should be finished by the end of this year.
o Placement in the community is becoming harder because of funding.
o Prisons give inmates 30 days of medication upon release. Virginia mails meds to inmate’s residence or where they are going to receive treatment.
LME Housing Needs Assessment
o Average number of additional units needed = 415 housing units per LME (23 LMEs) – includes mh/dd/sa
o LMEs identified needs – services and supports, housing top barriers
Those who are homeless are neediest – a group to target; less data on where people end up after discharge but can target those knowingly being discharged to homeless shelters
May recommend looking at matched data looking at individuals across the systems
Unfortunately, a constant theme is money. Any change to funding is seen as an expansion, even if the change will result in cost savings overall across systems.
Who are we serving and what are their living arrangements?
All LME data is held in the Client Data Warehouse. 87% of clients served by LMEs are in a private residence (children and adults combined); 85% of adults are in a private residence, 5% homeless
• Those not in private residence – looked at NC TOPPS (MH/SA only): at most recent update, close to 20% not in a private residence once they enter treatment. 43% in private residence, 36% residential program, institution or other type of program; 21% in temporary housing or homeless.
o The task force is focusing is on that 21%
• For those in a residential program, over half receiving treatment (but nowhere near all)
• Co-occurring MH/SA has greater needs – housing status quite different from MH and SA alone
• Those not in housing have higher number of crises, ER trips, nights in hospital, jail and arrests.
o Questions about whether any indicators in data about services and outcomes? NC TOPPS doesn’t track services but could match claims data
o They were going to seek data from the chronic homeless population counts
o Wake county estimates high end users 1-5% of SPMI (Wake has 10% of state population)
Data from State Operated Services – HEARTS, Healthcare Enterprise Accounts Receivable Tracking System – tracks Medicaid and IPRS patients
o Different definitions used in HEARTS – if sleeping on a couch, considered private residence (LME considers temporary residence)
o Their data is adults and kids, chart is 91% of all discharges
5% to homeless shelter (would be higher if just looked at adults) – 8% cite homeless as a prior – state operated services is supposed to oversee discharges to homeless shelters – Wake Med rep says numbers much higher (1,000 he estimates)
Really low numbers across the board in community placements
A lot of MR/MI coming into hospitals
Their data indicates 56% to private residence but many task force members questioned that statistic, one reason being that many of those folks bounce out of there in a short period of time
Wake estimates 15% entering state hospistals are homeless
Identified issue - LMEs still not following up quickly enough
Shelters see people coming out with too few meds, can’t get into psychiatrist quickly enough – state operated services says they give people 1 week of meds
$20K in New Freedom funding to implement Olmstead
Don’t have recidivism numbers
The task force should start with group discharged to homeless shelters
Effective Use of State Hospitals from Community Systems Progress Report April – June 2010
o In that quarter only 34% with stays of 7 days or less, Wake Med says more people waiting in ERs – but clients are higher acuity
o Much improved since 2006
o Only 53% of consumers discharged from state psych hosp were seen within 7 days following discharge; we don’t know what service was billed within 7 days
o 7% readmission within 30 days; 18% readmission within 180 days
o There is a meeting next week (now this week) between LMEs and hospitals
• Must be coordination regardless of state hospital or private hospital
• Durham Center pilot project started in July – tracking 50 repeat consumers who touch multiple systems in community; serve 500+ through care coordination; have a whatever it takes fund focused on recovery; biggest challenge was getting providers to buy into it – bringing it to LMEs attention and tell them what the wraparound services are that the person needs; quarterly quality of life services; housing is the key factor for these individuals; doing one year of rental assistance
Crisis Services
o Walk-In Psych Centers – 66 centers served 110,296 Jan-June 2010: 3.7% referred from state facility, ER, community hospital psych bed; 1.1% referred to state facility, etc.
o Community Hospitals 887 persons served over 15 mos ending Sept 2010 (this is just the 3 way contracts and previously existing psych units)
o Can get more data for beds in 3 way contracts
DOC Data, John Carbone
o Started by distinguishing them from jail system
o DOC has an M grade system for prisoners (M1-M5)
o Depending on source, data is all over the place – different diagnoses, different definitions
o LME-prison liaisons? Not statewide. Dr. Carbone said that would be wonderful. This needs to be formalized. Laura Yates oversees everything in community, including housing, not a designated housing specialist
o They have a study draft looking at Dix patients and those in corrections to identify cross-over – should be finished by the end of this year.
o Placement in the community is becoming harder because of funding.
o Prisons give inmates 30 days of medication upon release. Virginia mails meds to inmate’s residence or where they are going to receive treatment.
LME Housing Needs Assessment
o Average number of additional units needed = 415 housing units per LME (23 LMEs) – includes mh/dd/sa
o LMEs identified needs – services and supports, housing top barriers
Those who are homeless are neediest – a group to target; less data on where people end up after discharge but can target those knowingly being discharged to homeless shelters
May recommend looking at matched data looking at individuals across the systems
Unfortunately, a constant theme is money. Any change to funding is seen as an expansion, even if the change will result in cost savings overall across systems.
White House Call re Georgia Olmstead Settlement, a Template to be used across the Nation
There was a White House Conference Call on Friday, October 22 regarding the Georgia Olmstead settlement signed last week. It is being hailed as the most comprehensive Olmstead settlement to date. Kareem Dale, Associate Director, White House Office of Public Engagement & Special Assistant to the President for Disability Policy, began the call with an overview of the administration's position on community living. President Obama launched the Year of Community Living more than a year ago. HHS, HUD and the DOJ have come together on improving Community Living, including the new housing vouchers and other initiatives.
Tom Perez and Sam Bagenstos from the DOJ then spoke about the case - The case has been going on for a long time so this was a landmark week for the department and people with disabilities. This is a textbook example of partnership at its best - between government agencies, and between agencies and advocacy organizations. He thanked all of the people involved, including HHS (funding) and HUD (housing). Tom says to implement the Olmstead mandate, states must answer 2 questions: 1) who in institutions doesn't need to be there; and 2) for those remaining in institutions how can we ensure the conditions are safe and constitutional. This is the framework for all of their Olmstead work. In this case, they were able to reach this agreement.
For full details, please refer to the OCR site. Some highlights: GA will stop admitting people with DD to state institutions by July 1, 2011. They will transfer all people with DD out of state facilities by July 1, 2015. They will provide support coordination services to ensure access to necessary community supports (medical, transportation, nutrition, etc.). They will provide supports to 9,000 people with MI to be served in community. They will establish 24 hour crisis centers and crisis teams to respond to individuals anywhere in community. They will create 1,150 waiver slots by July 2015. 750 of those are to help transition people from the hospital to the community, and 400 to prevent people returning to institutions. The amount of supports in the mental health setting is noteworthy - ACT, CST, intensive case management, crisis centers, and community based crisis beds. The DOJ has earned from movements of past decades - Need to give attention to wide ranging community supports that must be in place. This can be a template for work they will do across the nation.
During the Q&A, they were asked, does it cost alot of money? This agreement not only fulfills legal and moral obligations, but is also in economic self-interest. In GA, estimate for state DD hospitals $147,000 compared to $47,000 in their home.
Where do we go from here? Tom said this is a critical milestone because it is the most comprehensive settlement to date. It will be their template. They are involved across the country. There are 2 sections involved - special litigation and disability rights sections. They have been involved in the DAI case in NY, Haddad case in FL, in CA advocating that you can't use budget crisis as an excuse to shirk Olmstead responsibilities, statements of interest across the country, and just completed trial in Arkansas. They are also establishing a body of case law to ensure P&A's, and others, have standing to file on behalf of people with disabilities. They need both aggressive leadership and also private attorneys to ensure we have the capacity to assist people. Want to share this settlement with other states. They need continuing assistance to let them know about complaints.
Sam Bagenstos, a DOJ attorney, wrote the book on disability rights. Sam talked about what this is all about - the fundamental value that people with disabilities can live their life like everyone else does. They can choose where to live, when to eat, where to go for work, etc. This is what they are trying to enforce across disabilities. This also applies to people with physical disabilities in nursing homes - that's what they are working on with Alabama and Florida. There is a new paradigm in enforcement - they made a commitment in the way they enforce Olmstead. It was about institutions, very process-focused. The new pieces added: focused intensively on services in community (!) including housing, employment, crisis, etc.; focusing on people at risk of institutionalization, not just those in institutions; close collaboration with people in disability rights community and people in local community. They are looking for relief that looks like the Georgia.
During the Q&A, they addressed the state perception that deinstitutionalization would be costly. A NJ case claimed they didn't have the funding. The record showed that they would save a substantial amount of money. Litigation becomes necessary to get inertia. They want to use this settlement with the assistance of HHS, etc. to show it is in the state's self-interest. In addition to DD stats, they want to give a reminder that states get the medicaid match for adults with MI served in the community (but not in institutions). The need to draw down federal dollars is in the state's self-interest.
It seems that a budget crisis may be an opportunity to seek more community living arrangements for people with disabilities.
Tom Perez and Sam Bagenstos from the DOJ then spoke about the case - The case has been going on for a long time so this was a landmark week for the department and people with disabilities. This is a textbook example of partnership at its best - between government agencies, and between agencies and advocacy organizations. He thanked all of the people involved, including HHS (funding) and HUD (housing). Tom says to implement the Olmstead mandate, states must answer 2 questions: 1) who in institutions doesn't need to be there; and 2) for those remaining in institutions how can we ensure the conditions are safe and constitutional. This is the framework for all of their Olmstead work. In this case, they were able to reach this agreement.
For full details, please refer to the OCR site. Some highlights: GA will stop admitting people with DD to state institutions by July 1, 2011. They will transfer all people with DD out of state facilities by July 1, 2015. They will provide support coordination services to ensure access to necessary community supports (medical, transportation, nutrition, etc.). They will provide supports to 9,000 people with MI to be served in community. They will establish 24 hour crisis centers and crisis teams to respond to individuals anywhere in community. They will create 1,150 waiver slots by July 2015. 750 of those are to help transition people from the hospital to the community, and 400 to prevent people returning to institutions. The amount of supports in the mental health setting is noteworthy - ACT, CST, intensive case management, crisis centers, and community based crisis beds. The DOJ has earned from movements of past decades - Need to give attention to wide ranging community supports that must be in place. This can be a template for work they will do across the nation.
During the Q&A, they were asked, does it cost alot of money? This agreement not only fulfills legal and moral obligations, but is also in economic self-interest. In GA, estimate for state DD hospitals $147,000 compared to $47,000 in their home.
Where do we go from here? Tom said this is a critical milestone because it is the most comprehensive settlement to date. It will be their template. They are involved across the country. There are 2 sections involved - special litigation and disability rights sections. They have been involved in the DAI case in NY, Haddad case in FL, in CA advocating that you can't use budget crisis as an excuse to shirk Olmstead responsibilities, statements of interest across the country, and just completed trial in Arkansas. They are also establishing a body of case law to ensure P&A's, and others, have standing to file on behalf of people with disabilities. They need both aggressive leadership and also private attorneys to ensure we have the capacity to assist people. Want to share this settlement with other states. They need continuing assistance to let them know about complaints.
Sam Bagenstos, a DOJ attorney, wrote the book on disability rights. Sam talked about what this is all about - the fundamental value that people with disabilities can live their life like everyone else does. They can choose where to live, when to eat, where to go for work, etc. This is what they are trying to enforce across disabilities. This also applies to people with physical disabilities in nursing homes - that's what they are working on with Alabama and Florida. There is a new paradigm in enforcement - they made a commitment in the way they enforce Olmstead. It was about institutions, very process-focused. The new pieces added: focused intensively on services in community (!) including housing, employment, crisis, etc.; focusing on people at risk of institutionalization, not just those in institutions; close collaboration with people in disability rights community and people in local community. They are looking for relief that looks like the Georgia.
During the Q&A, they addressed the state perception that deinstitutionalization would be costly. A NJ case claimed they didn't have the funding. The record showed that they would save a substantial amount of money. Litigation becomes necessary to get inertia. They want to use this settlement with the assistance of HHS, etc. to show it is in the state's self-interest. In addition to DD stats, they want to give a reminder that states get the medicaid match for adults with MI served in the community (but not in institutions). The need to draw down federal dollars is in the state's self-interest.
It seems that a budget crisis may be an opportunity to seek more community living arrangements for people with disabilities.
Friday, October 22, 2010
Election Protection for November Elections
It is possible that on Election Day (Tuesday, November 2, 2010) some Americans with disabilities will be at risk for disenfranchisement because of poorly trained poll workers, inaccessible voting sites, and malfunctioning or inaccessible voting machines. AAPD joined the Election Protection coalition, as a way to ensure that voting sites are accessible to people with disabilities. The goal of the Election Protection coalition is to make sure the rights of all registered voters are protected. The coalition has a hotline with hundreds of lawyers ready to answer questions and give resources. Building field programs have also been established in 20 states.
Disability Rights North Carolina is a point of reference about voting issues affecting people with disabilities for the Election Protection coalition in North Carolina. Disability Rights North Carolina staff’s efforts to lessen disenfranchisement began before Election Day and will continue until November 2nd. We have been providing voter rights information on our regular monitoring visits to Adult Care Homes in North Carolina. We engaged in education and information sharing with disability advocacy groups across North Carolina. DRNC staff is also providing information to State and Local Boards of Elections to educate volunteer poll workers on issues related to voters with disabilities. We have even used the media to highlight the importance of voting and voter’s rights. Our Public Service Announcements aired on over 250 North Carolina radio stations and we have promoted of voters rights for people with disabilities via public access television. Our staff is also performing accessibility surveys of OneStop and Election Day voting sites.
You can learn more about the Election Protection coalition and their efforts on Election day by visiting the following website, http://jfactivist.typepad.com/jfactivist/2010/10/election-protection-for-november-elections.html
If you trouble voting call 1-866-OUR-VOTE (866.687.8683) or report your problems at www.866OurVote.org
Tuesday, October 19, 2010
Secretary Cansler Gives Official Notice of Dix Closing to Legislature Today
The Education and Health & Human Services Subcommittee of the Joint Legislative Commission on Governmental Operations ("Gov Opps") met today. The first agenda item was HHS notice to the legislature of the closure of Dix hospital. Secretary Cansler gave the committee background information about the budgetary reasons for the closure of the hospital. Specifically, with no money designated for the continued operation of Dix, DHHS has been forced to pull money designated for community services. Additionally, they have been about $30 mil over budget in the facilities budget. Even though additional beds are opening at Cherry and Broughton, the closure will still result in a net savings of $17 mil. The plan for closure and official letters will be sent to legislators in next few weeks. The closure also has to go to the Council of State.
There were no questions or comments from the committee members. When the Committee voted to accept the report and submit it to the full committee, Senators Stevens and Blue voted No.
The Secretary then went on to discuss the HHS budget status. Of particular note:
• Total HHS budget is 23% state dollars, 77% federal dollars (most need state match or MOE)
• Can’t reduce staffing because we are at the bare minimum in facilities staffing now. They are implementing technology to better manage facility budgets.
• Outside of state facilities, only 4% of the budget is staffing. If include facility staffing, still only 7% goes to personnel.
• 86% of budget goes to provision of services.
• 60% of appropriations go to Medicaid. 54% is mandatory services. 17% of optional services goes to children. 29% is adult services (17% of overall budget).
• MH/DD/SAS is 10.76% of the total DHHS budget
• Enrollment growth rate about 4.25%, less than 6% projected (under-budget by about $140 mil, which will offset overspending last year)
• 2014 500-700K in increased Medicaid enrollment
• We will have over one million applicants in 2014 – need to update technology
• There are 14 outstanding State Plan Amendments.
There were no questions or comments from the committee members. When the Committee voted to accept the report and submit it to the full committee, Senators Stevens and Blue voted No.
The Secretary then went on to discuss the HHS budget status. Of particular note:
• Total HHS budget is 23% state dollars, 77% federal dollars (most need state match or MOE)
• Can’t reduce staffing because we are at the bare minimum in facilities staffing now. They are implementing technology to better manage facility budgets.
• Outside of state facilities, only 4% of the budget is staffing. If include facility staffing, still only 7% goes to personnel.
• 86% of budget goes to provision of services.
• 60% of appropriations go to Medicaid. 54% is mandatory services. 17% of optional services goes to children. 29% is adult services (17% of overall budget).
• MH/DD/SAS is 10.76% of the total DHHS budget
• Enrollment growth rate about 4.25%, less than 6% projected (under-budget by about $140 mil, which will offset overspending last year)
• 2014 500-700K in increased Medicaid enrollment
• We will have over one million applicants in 2014 – need to update technology
• There are 14 outstanding State Plan Amendments.
Opportunity for young musicians with disabilities (under 25)!
The VSA International Young Soloists Program has made it application for the International Young Soloists Award available. The award is given to four musicians, two from the United States and two international applicants. Each recipient will earn $ 5,000 and a performance in Washington D.C. VSA affiliates in the United States implement their own International Young Soloist Award and entry materials should be sent to the corresponding address for each state. International applicants must submit their recording, application, and biographical information to :
VSA International Young Soloists Award
818 Connecticut Avenue, NW
Suite 600
Washington, D.C. 20006
To learn more about VSA International Young Soloists Program and the International Young Soloists Award, you can visit the following website, http://www.vsarts.org/x22.xml.
Friday, October 15, 2010
October 1 NC Register
The October 1 Register is available here. Of particular note are the following:
The 2011 Low-Income Housing Tax Credit Qualified Allocation Plan for the state of North Carolina is published at pages 756-802. The low-income housing tax credits are allocated in compliance with the plan.
The North Carolina Psychology Board published a proposal to amend the rule 21 NCAC 54 .2001 to require supervisors to obtain three hours of training in licensing act and rules concerning supervision. The proposal is based upon the following reason: The Board believes that this change is important because of the abundance of supervision rules infractions in recent years. Often, psychologists have appeared not to comply with supervision requirements because of ignorance of the law. The Board intends to reduce this problem by instituting the supervision training requirement. The proposed effective date is February 1, 2011. There will be a public hearing on December 2 and written comments are also due the same day.
The 2011 Low-Income Housing Tax Credit Qualified Allocation Plan for the state of North Carolina is published at pages 756-802. The low-income housing tax credits are allocated in compliance with the plan.
The North Carolina Psychology Board published a proposal to amend the rule 21 NCAC 54 .2001 to require supervisors to obtain three hours of training in licensing act and rules concerning supervision. The proposal is based upon the following reason: The Board believes that this change is important because of the abundance of supervision rules infractions in recent years. Often, psychologists have appeared not to comply with supervision requirements because of ignorance of the law. The Board intends to reduce this problem by instituting the supervision training requirement. The proposed effective date is February 1, 2011. There will be a public hearing on December 2 and written comments are also due the same day.
Major events of the week 10/3-/10/9
Before Congress took a break for the election it made several decisions on the budget, tax cuts, healthcare, and housing. Congress will reconvene November 15.
Members of Congress passed a Continuing Resolution Act regarding the budget. This will keep the federal government operating at the current level until December 3. Because of the deadline, Congress will need to address the budget during a lame duck session after the election.* Upon their return, Congress will also decide whether or not to extend some or all of the tax cuts set in place during the Bush Administration.
On September 29, the House of Representatives passed H.R. 3421, “Medical Debt Relief Act” and H.R. 758, “Pediatric Research Consortia Establishment Act”. The Medical Debt Relief Act excludes from consumer credit reports medical debt seen as delinquent, charged off, or debt in collection that has been paid in full or settled. This can be a problem for individuals who have serious medical conditions and disabilities, and affect insured and uninsured consumers. The Pediatric Research Consortia Establishment Act will grant funding to establish up to 20 national pediatric research consortia to conduct clinical, behavioral, social, and translational research. Funds will also cover trainings and demonstrations of advanced diagnostic and treatment methods relating to pediatrics. The bills now go to the Senate.
The Senate also passed the S. 1481, the Frank Melville Supportive Housing Investment Act, which creates new standards for leases to tenants with disabilities. It requires HUD to provide housing assistance through local authorities and allows HUD to take administrative control if housing authorities fail to meet the established guidelines. It also directs the HUD secretary to provide technical support to ensure public housing agencies to administer housing voucher program for people with disabilities.
*When Congress reconvenes in an even-numbered year following the November general elections to consider various items of business. Some lawmakers who return for this session will not be in the next Congress. Hence, they are informally called "lame duck" Members participating in a "lame duck" session.
You can learn more about Capital Insider by visiting the following link, http://www.ucp.org/ucp_generalsub.cfm/1/8/11981.
Wednesday, October 13, 2010
October 13 NC Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services
Below are some highlights from the meeting today of the Legislative Oversight Committee for MH/DD/SAS. The handouts are on the LOC website at http://www.ncleg.net/gascripts/DocumentSites/browseDocSite.asp?nID=20&sFolderName=\LOC Minutes and Handouts\Minutes and Handouts 2010\October 13, 2010 (Note that they did not get to the CAP-MR/DD Update).
Rep. Insko chaired the meeting, Sen Nesbitt absent
Secretary Cansler not there so he did not make remarks
Dr Gray Expenditures & Utilization (Handout)
• Child Day treatment down, stricter policy criteria and increased staffing reqs
• Moving in more clinically oriented direction
• CST: 25-40% denial rate by VO per month per clinical criteria
• Mobile Crisis – is it really diverting people from ER? They will f/u with data
• CAP Waiver recipients have increased by 7%, non-waiver TCM recipients have decreased by 5% - providers now billing by weekly rate, hopefully will give more flexibility
• Braxton: how do we decide who gets care – from dollar standpoint or needs standpoint? Insko: how do we know we are doing more appropriate services? (My note: you need to assess need, design services to meet needs and plan within budget) Watson: can put max amount on services for adults and adjust rates
• Cost of CST should drop below the cost of ACT
• In context of ACA need to think about moving toward case rate rather than fee for service – case rate allows for more flexibility, and also looks at outcomes
SIS Pilot Project – Rose Burnette (Handout)
• FT staff person at DDTI working on pilot project
• 20 SIS assessors have been trained
• As of Oct 11, 895 assessments have been completed but have not met the numbers in the legislation
• An additional 175 children have been assessed by the tool is not normed for children – data is being included in the norming process
• All participants are volunteers
• Data so far indicates NC recipients have higher support needs as compared to other states
• Insko: 1 LME did a study on patient need and the amount of $ for their services – that study did not show a correlation
• Waiver TA to require SIS but would still do SIS and SNAP?
• Medicaid funding for assessment, negotiating fee for licensing and assessment tool
• Legislation says to assign people to waivers based on SIS assessment but LMEs don’t assign people to waivers, the state does
Independent Assessment – Beth Melcher (Handout)
• FY10 had over 40K new service recipients (Medicaid and iprs)
• Placed assessment within CABHA core services so no infrastructure for IA outside of CABHAs
• Proposed how to implement the legislation in a way that would not interfere with care – at point of service order, review of providers
• Draft plan focuses on duration or frequency for ACTT, CST, PSR, IIH, day treatment, inpatient or crisis (i.e., ACTT for greater than 18 months) – submitted to PAG, will be posted for 45 day comment period
Dix Update – Luckey Welsh (handout)
• To CRH: 60 dult admission, 11 adult long term; 54 forensic med/max and pretrial beds
• To Cherry: 30 long term
• Side note: Secretary plans to give official notice of hospital closure at Gov Ops committee meeting next week
• Reviewed budget shortfall info from last time – about $29 mil
• Insko: Dix appropriations a topic of much discussion during the budget process, in order to fund would have had to take money from other essential services
• Timeline for patient transfers – have moved patients in adult long term to CRH; Oct/Nov move patients in adult long term to Cherry, move clinical research unit (recent development), stop admission to inpatient pretrial eval (but continue outpatient evals – most are already outpatient); Dec move forensic max, stop admissions to DDH, move pretrial eval, move patients in forensic med, move remaining patients in adult admission – working with all hosps, DRNC on moves
• Goal to have completed by December 23
• Cost to operate remaining units on Dix – Child Outpatient and Forensic Min - $9 mil
• Additional 19 adult admission beds at Broughton $2.9 mil
• Division estimates $16.9 mil savings by closing Dix beds
• Investigating employee transportation from Raleigh to CRH
• Insko: HHS budget chairs met with Cansler yesterday and he said that they are maintaining enough at the hospital to bring back up if GA says they want to remain open; discussed how NC overutilizes inpatient beds in large institutions
• Watson – moving toward plan to have 3 regions with 3 hospitals
• Barnhart: Another $3-4 bil shortfall this year; Effects Wake county more than other places; losing jobs everywhere – employees may have to commute but most jobs preserved; have to make hard decisions the next few years; not losing beds
• Braxton: need to consider increasing population (my note: not taking into account current overutilization); Luckey: new Cherry and Broughton have additional capacity
• Had been a plan to open forensic beds at Broughton and that hasn’t happened.
Health Reform – Pam Silberman, IOM (Handout)
• Good Overview for DRNC folks
• Pam highlighted:
o special outreach requirements to people with mental health or addictive disorders
o prevention and wellness – funds for a prevention and public health fund – mh, behavioral health and substance abuse disorder included priority areas
o Efforts to expand health professional workforce, including specifically mh and addiction licensed health professionals
o Expand National Health Service Corps
o Quality Improvement; comparative effectiveness research
o New models of care to improve quality and efficiency, i.e., reverse co-location (primary care provider in community mental health agencies), Medicaid emergency psychiatric coverage in IMDs
o Expansion of community health centers (NC has applied for funding to expand community health centers)
o CLASS
o Options to expand HCBS to achieve an enhanced match rate – Community First Choice Option and state balancing initiative
• Impact on People with MH/DD/SAS Conditions
o Expanded insurance coverage
o Essential benefits plans should include preventative services related to MH/SA
o Many people now receiving state funded services through LME will now have Medicaid or private insurance coverage – LMEs still have role in authorizing services to people who lack insurance coverage, authorizing wrap-around services and in UM
o There will still be a role in state financing for gaps
o Question: what is the role of the LME in the new system?
o No mention of the revised 1915(i) waiver option
• Youth Villages Transitional Living Program, Youth Villages & Guilford Center (Handout)
o Program targets kids coming out of foster care with behavioral health issues
o In NC average daily census 55 kids/day; target number about 400 kids/year
o 10 locations across NC
o Doing clinical trials in TN to compare outcomes; now can compare to national outcomes
Public Comment Portion
• Union member discussed OAH decisions overturning employee terminations, Dix closure, disproportionate effect on black workers
• Louise Jordan spoke in favor of keeping Dix open, no part of discussion is person-centered, only budget centered
• Beverly Moriarty, Dix nurse – declining admissions because all hospitals on delay; reform didn’t happen, we don’t have community services, patients not being treated, building new hospitals in wrong places and staffing shortage
• Current temp psychiatrist at Dix – Dix long term care has better outcomes than other hospitals
Effectiveness of Single Stream Funding, Steve Jordan (Handout)
• Report submitted to GA August 31, 2010
• Put monitoring in place to ensure some maintenance of effort for individual disability services
• Allows LMEs to use funds for projects to fill gaps
• Looking at expenditure comparisons, LMEs spending closer to allocation, increased SA spending significantly
• Majors programming – managing access for juvenile justice – 15 year old JJ initiative to screen, identify and provide treatment for young people with SA issues
Next Meeting November 9th
Rep. Insko chaired the meeting, Sen Nesbitt absent
Secretary Cansler not there so he did not make remarks
Dr Gray Expenditures & Utilization (Handout)
• Child Day treatment down, stricter policy criteria and increased staffing reqs
• Moving in more clinically oriented direction
• CST: 25-40% denial rate by VO per month per clinical criteria
• Mobile Crisis – is it really diverting people from ER? They will f/u with data
• CAP Waiver recipients have increased by 7%, non-waiver TCM recipients have decreased by 5% - providers now billing by weekly rate, hopefully will give more flexibility
• Braxton: how do we decide who gets care – from dollar standpoint or needs standpoint? Insko: how do we know we are doing more appropriate services? (My note: you need to assess need, design services to meet needs and plan within budget) Watson: can put max amount on services for adults and adjust rates
• Cost of CST should drop below the cost of ACT
• In context of ACA need to think about moving toward case rate rather than fee for service – case rate allows for more flexibility, and also looks at outcomes
SIS Pilot Project – Rose Burnette (Handout)
• FT staff person at DDTI working on pilot project
• 20 SIS assessors have been trained
• As of Oct 11, 895 assessments have been completed but have not met the numbers in the legislation
• An additional 175 children have been assessed by the tool is not normed for children – data is being included in the norming process
• All participants are volunteers
• Data so far indicates NC recipients have higher support needs as compared to other states
• Insko: 1 LME did a study on patient need and the amount of $ for their services – that study did not show a correlation
• Waiver TA to require SIS but would still do SIS and SNAP?
• Medicaid funding for assessment, negotiating fee for licensing and assessment tool
• Legislation says to assign people to waivers based on SIS assessment but LMEs don’t assign people to waivers, the state does
Independent Assessment – Beth Melcher (Handout)
• FY10 had over 40K new service recipients (Medicaid and iprs)
• Placed assessment within CABHA core services so no infrastructure for IA outside of CABHAs
• Proposed how to implement the legislation in a way that would not interfere with care – at point of service order, review of providers
• Draft plan focuses on duration or frequency for ACTT, CST, PSR, IIH, day treatment, inpatient or crisis (i.e., ACTT for greater than 18 months) – submitted to PAG, will be posted for 45 day comment period
Dix Update – Luckey Welsh (handout)
• To CRH: 60 dult admission, 11 adult long term; 54 forensic med/max and pretrial beds
• To Cherry: 30 long term
• Side note: Secretary plans to give official notice of hospital closure at Gov Ops committee meeting next week
• Reviewed budget shortfall info from last time – about $29 mil
• Insko: Dix appropriations a topic of much discussion during the budget process, in order to fund would have had to take money from other essential services
• Timeline for patient transfers – have moved patients in adult long term to CRH; Oct/Nov move patients in adult long term to Cherry, move clinical research unit (recent development), stop admission to inpatient pretrial eval (but continue outpatient evals – most are already outpatient); Dec move forensic max, stop admissions to DDH, move pretrial eval, move patients in forensic med, move remaining patients in adult admission – working with all hosps, DRNC on moves
• Goal to have completed by December 23
• Cost to operate remaining units on Dix – Child Outpatient and Forensic Min - $9 mil
• Additional 19 adult admission beds at Broughton $2.9 mil
• Division estimates $16.9 mil savings by closing Dix beds
• Investigating employee transportation from Raleigh to CRH
• Insko: HHS budget chairs met with Cansler yesterday and he said that they are maintaining enough at the hospital to bring back up if GA says they want to remain open; discussed how NC overutilizes inpatient beds in large institutions
• Watson – moving toward plan to have 3 regions with 3 hospitals
• Barnhart: Another $3-4 bil shortfall this year; Effects Wake county more than other places; losing jobs everywhere – employees may have to commute but most jobs preserved; have to make hard decisions the next few years; not losing beds
• Braxton: need to consider increasing population (my note: not taking into account current overutilization); Luckey: new Cherry and Broughton have additional capacity
• Had been a plan to open forensic beds at Broughton and that hasn’t happened.
Health Reform – Pam Silberman, IOM (Handout)
• Good Overview for DRNC folks
• Pam highlighted:
o special outreach requirements to people with mental health or addictive disorders
o prevention and wellness – funds for a prevention and public health fund – mh, behavioral health and substance abuse disorder included priority areas
o Efforts to expand health professional workforce, including specifically mh and addiction licensed health professionals
o Expand National Health Service Corps
o Quality Improvement; comparative effectiveness research
o New models of care to improve quality and efficiency, i.e., reverse co-location (primary care provider in community mental health agencies), Medicaid emergency psychiatric coverage in IMDs
o Expansion of community health centers (NC has applied for funding to expand community health centers)
o CLASS
o Options to expand HCBS to achieve an enhanced match rate – Community First Choice Option and state balancing initiative
• Impact on People with MH/DD/SAS Conditions
o Expanded insurance coverage
o Essential benefits plans should include preventative services related to MH/SA
o Many people now receiving state funded services through LME will now have Medicaid or private insurance coverage – LMEs still have role in authorizing services to people who lack insurance coverage, authorizing wrap-around services and in UM
o There will still be a role in state financing for gaps
o Question: what is the role of the LME in the new system?
o No mention of the revised 1915(i) waiver option
• Youth Villages Transitional Living Program, Youth Villages & Guilford Center (Handout)
o Program targets kids coming out of foster care with behavioral health issues
o In NC average daily census 55 kids/day; target number about 400 kids/year
o 10 locations across NC
o Doing clinical trials in TN to compare outcomes; now can compare to national outcomes
Public Comment Portion
• Union member discussed OAH decisions overturning employee terminations, Dix closure, disproportionate effect on black workers
• Louise Jordan spoke in favor of keeping Dix open, no part of discussion is person-centered, only budget centered
• Beverly Moriarty, Dix nurse – declining admissions because all hospitals on delay; reform didn’t happen, we don’t have community services, patients not being treated, building new hospitals in wrong places and staffing shortage
• Current temp psychiatrist at Dix – Dix long term care has better outcomes than other hospitals
Effectiveness of Single Stream Funding, Steve Jordan (Handout)
• Report submitted to GA August 31, 2010
• Put monitoring in place to ensure some maintenance of effort for individual disability services
• Allows LMEs to use funds for projects to fill gaps
• Looking at expenditure comparisons, LMEs spending closer to allocation, increased SA spending significantly
• Majors programming – managing access for juvenile justice – 15 year old JJ initiative to screen, identify and provide treatment for young people with SA issues
Next Meeting November 9th
Friday, October 8, 2010
President Obama signs the Twenty-First Century Communications and Video Accessibility Act of 2010
At 2:00 pm today, President Obama signed the Twenty-First Century Communication and Video Accessibility Act of 2010 into law. The signing took place in the East Room where President Obama commented on the importance of this law and Rosa's law on the lives of people with disabilities.
We will update more on the signing of this momentous law, as more information becomes available.
We will update more on the signing of this momentous law, as more information becomes available.
Thursday, October 7, 2010
Victory! 21st Century Communications and Video Accessibility Legislation Passes
The Twenty-first Century Communications and Video Accessibility Act was passed by the House of Representatives on September 28, 2010 and is expected to be signed by President Obama. According to the law, captioned television shows will be captioned when they are aired on the Internet. Video description will be available on television for people who have low vision and $10 billion per year was earmarked for communication equipment used by individuals who are deaf-blind. The bill guarantees that emergency information will be accessible to people who are blind or have low vision, mandates “accessible user interfaces on mobile browsers that connect to the Internet”, and requires that “smart phones” be hearing aid compatible. The passage of The Twenty-first Century Communications and Video Accessibility Act is due to the five-year collaborative efforts of the American Association of People with Disabilities, Coalition of Organization of Accessible Technology, other non-profit groups, government, and industry. We are grateful for their commitment and the important change it helped create.
For more information use the following link, http://jfactivist.typepad.com/jfactivist/2010/10/victory-21st-century-communications-and-video-accessibility-legislation-passes.html
For more information use the following link, http://jfactivist.typepad.com/jfactivist/2010/10/victory-21st-century-communications-and-video-accessibility-legislation-passes.html
Monday, October 4, 2010
Disability Employment Awareness Month-President Obama's Kickoff Speech
The President asserted we must improve accessibility in the workplace, ensure that assistive and workplace technologies are available to improve everyone’s experience at work, and ensure each employee has the chance to collaborate and contribute in the workplace.
Non-federal agencies also are working hard to eliminate employment discrimination that individuals with disabilities face. Disability Rights North Carolina provides legal advocacy to SSDI and SSI beneficiaries with disabilities who have been denied access to work training programs and reasonable accommodations, or who otherwise face barriers to gaining and maintaining employment and employment skills. We advocate that every North Carolinian, including those with disabilities, should have access to gaining the skills and knowledge they need to be successful in the workforce.
President Obama reminded his audience that people with disabilities are “a vital and dynamic part of our Nation.” He encouraged everyone to take advantage of October to focus on ensuring equal access at work and value and use the diversity, talents, skills each employee has to offer. Of course, the ADA requires that this be a year-round goal.
To read more about President Obama's speech use the foliwing link, http://jfactivist.typepad.com/jfactivist/2010/10/president-kicks-off-national-disability-employment-awareness-month.html
Major Events of 9/20-9/26
Capital Insider recently highlighted several main events that took place the week of 9/20-9/26.
A new program, Medicaid/CHIP Payment and Access Commissions (MACPAC) was created as part of the Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111-3) and was expanded through the Patient Protection and Affordable Care Act (P.L. 111-148). MACPAC’s first meeting was held last week. The commission’s responsibilities, as outlined in the Affordable Care Act, are to discuss a variety of issues affecting eligibility, enrollment and retention policies, coverage policies and quality of care, and access to covered services, such as payment policies. Research and recommendations made by MACPAC will concern access to Medicaid/CHIP. All findings will be discussed among the commission and submitted to Congress. The first report will be released on March 15, 2011.
A turning point in terminology was reached on September 30, 2010 when the U.S House of Representatives passed Rosa’s Law (S.2781). “Intellectual disability” will now be use instead of “mental retardation” in federal laws. Self-advocates and their families have tried to eliminate the term "mental retardation" for years. Eligibility and services guaranteed by the revised laws will not be affected. The bill, identical to the one passed on the Senate, will soon be signed by President Obama. Disability Rights North Carolina would like to thank Senator Burr and Senator Hagan for their co-sponsorship of the Senate bill.
Another bill passed by the House of Representative last week was The Training and Research for Autism Improvements Nationwide Act (H.R 5756). This bill will amend Title I of the Developmental Disabilities Assistance Act and Bill of Rights Act (The DD Act) and expand assistance to children and adults with autism. It will also guarantee $17 million annually for four years to University Centers for Excellence in Developmental Disabilities (UCEDDs) to provide training and services. Four new UCEDDs that work with minority institutions will be given grants to provide services and conduct research centered on facial and ethnic minorities. The bill is now being considered by the Senate Health, Education, Labor, and Pensions (HELP) Committee.
You can learn more about Capital Insider by visiitng the following link, http://www.ucp.org/ucp_generalsub.cfm/1/8/11981.
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