Notes from the MH/DD/SAS Legislative Oversight Committee Last Week

The Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services met last Tuesday, November 9th.  Co-chair Representative Insko presided over the committee meeting.  Her senate co-chair, Senator Nesbitt, was absent.  All of the handouts from the meeting are available on the committee website here.   Highlights from the meeting are below.

Secretary’s Comments

Secretary Cansler gave an update on the budget and the closure of Dix (very similar to those made to the Governmental Operations subcommittee - see previous post here). He discussed the Dix closure plan (available here) which was provided to all of the members the week before. He also talked about expanding the 1915 (b)/(c)waivers and measures the department will be seeking in the coming session. Mecklenburg LME will be delaying their implementation of the 1915(b)/(c) waiver by a year. Smokey LME is interested in pursuing the (b)/(c) waiver as well. He also noted that counties are still interested in joining PBH but the concerns about non-contiguous counties joining as one LME remain.

Expenditures and Utilization Tracking Update

The handout is on the website here.  Of particular note, Intensive In-Home for children is up, Day Treatment for children is down, Multisystemic Therapy is up, Community Support Team is down 28%, Assertive Community Treatment Team is up, Psychosocial Rehabilitation is up (200 more adults per month),  I/DD Targeted Case Management is down (CAP and non-waiver).

LME Presentation on TASC (Treatment Alternatives for Safer Communities)

There is a handout on website here.  East Carolina Behavioral Health presented.  The program operates under a Memorandum of Agreement between DHHS, the Department of Corrections and the Administrative Office of the Courts regarding the offender management model to ensure all agencies are connected.

Three-Way Contracts Update

The handout is on the website here.  Of particular note: The three-way contract beds are paid at a bundled rate of $750/day, which compares to about $1100-1200/day in state hospitals.  The hospitals with these contracts have  priority in transferring patients to state hospitals.  The total funding for these contracts is now a little over $29 million.  This is helping to stop the trend of closing community inpatient beds.  The LME Contract Responsibilities include authorization of admissions, collecting patient data, facilitate discharge planning, and paying hospitals.  Last year 100% of the funding allocated was used – 26,829 bed days purchased, 98 beds across the state. 

There are 20 contracts with 1 pending currently, added Pitt Memorial, Western Highlands did not renew 1 contract because of low utilization.  They needed to put additional money into existing contracts this year because of utilization, projecting 38,829 bed days, projected beds at 75% utilization=142.  The handout shows allocation by hospital and region. 

State hospital stays of 7 days or less have decreased to 27% of total (in part because of reduction in admissions).
At the start, 22 LMEs had these contracts without the state contract and funding.  There is a need to shore up these relationships as well. There is still $13-14 million in LME funded contracts, Mecklenburg being a good example (they use county funds).
ICF-MR Cost Analysis and Comparison with CAP-MR/DD Services

The handout is on the website here.  DMH/DD/SAS Director Steve Jordan presented a comparison of NC's ICF-MR services which include the state developmental centers (3), community ICF-MRs (327) and CAP-MR/DD services offered statewide.  Of particular note:

• Must be 18 years or older to be admitted to developmental center except for time-limited programs for children
• Average of 1517 people served in state DD Centers last year
• In NC, 30% of recipients live in ICF-MRs, 15% nationally
• 70% in waiver in NC, 85% nationally
• The handout details the total expenditures in state, community ICF-MRs and waiver services and cost per recipient (includes soc security, etc.) – the level of acuity in state facilities varies – generally those recipients are older, profound, feeding tubes, partial or total assistance with dressing, and nonverbal.
• Tennessee is going to close a large DD Center – moving people into community ICF-MRs

Update on CAP-MR/DD Tiered Waivers and Waitlist

The handout is on the website here.  Rose Burnette provided a general update on the status of the CAP-MR/DD waivers.  The Comprehensive Waiver is now serving 9798 and the supports waiver is serving 853 recipients.  Last year NC spent $493 mil in waiver services and $112 mil in other Medicaid services for Comprehensive Waiver recipients; and about $2.5 mil in waiver services and about $2.5 mil in other Medicaid services for supports waiver recipients.
With regard to the support waiver, they are doing trainings on the supports waiver this month.  They are estimating serving 126 participants on self- direction – these costs are outside of the waiver costs and are not in individual budget, (case management outside of waiver as well because it is Medicaid funded and not a waiver service) average cost $4000 per participant.

They are planning major revisions to the comprehensive waiver. They want to create a new Community Intensive Waiver – for those with the highest behavioral and medical supports needs. There will not be banding within a waiver – need to have a very specific plan for determining need and level of care within a band. They will have stakeholder workgroup meetings and then larger public forums to seek input.  The plan is to submit the new waivers in March or April to get approved in time for implementation (expire 11-1-11).

Waiting List Update: 8191 people are potentially eligible for CAP-MR/DD: 4,481 people waiting for residential (independent, group home); 4800 not receiving any service; 1785 waiting for support to work; people in Adult Care Homes may be on this list.  In the short term they continue to use a spreadsheet.  They are evaluating the feasibility of a web-based solution, and are meeting next month with LME IT staff to talk about possibilities. 

Res Supports Level V Update: expected staffing is 1:1 24 hours per day, plus specific experience and supervision;  PAG reviewed twice, last time in October; will be posted for 45 day public comment, review and revise as needed, hoping to implement early next year.