NC Joint Legislative Oversight Committee on MH/DD/SAS

The Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services convened at the Legislative Office Building on Wednesday, Jan. 19,2011. The LOC is charged with examining system-wide issues that affect the development, financing, administration, and delivery (including service quality) of mental health, developmental disabilities, and substance abuse services.

Discussion of Draft Recommendations
The committee discussed and voted on the 2010-2011 Draft Recommendations.  The majority of the draft recommendations relate to reports the committee would like from DHHS (on topics such as the TBI waiver, implementation of CABHA, deaths in facilities, etc.), but also includes a recommendation to appropriate an additional $10 million for local inpatient psychiatric beds, and the identification of funding for a BART step-down unit.  Additions to existing recommendations and new recommendations were discussed.

• Recomendation #6 relating to expansion of the 1915 (b)/(c) Medicaid Waiver raised discussion as to whether the State may separate out developmental disability services (i.e., the 1915(c) portion). The consensus was that this should be determined at a later date.
• Recommendation #8 relating to equitable allocation of resources for all persons with developmental disabilities raised a discussion as to whether to add permissive language to give DHHS discretion to expand the current two-tier structure into a greater number of tiers (the recommendation calls for the renewal of the 2 current tiers (the comprehensive and supports waivers) but not an expansion into additional tiers, as the committee has previously called for). Members discussed concern about delegating too much authority to DHHS, and how more tiers could ultimately increase the overall cost of services, so the recommendation remained as-is.
• The two new recommendations discussed were: 1. Request a report on clubhouses, more specifically service definitions, rates of reimbursement, etc. Sen. Kinnaird requested this recommendation, stating that its omission was an oversight pursuant to discussions at previous meetings. The motion for the addition of this recommendation passed upon a vote.  2. Request that if the Dorothea Dix property is sold, that the General Assembly consider placing the proceeds of the sale in the State’s Mental Health Trust Fund. Sen. Allran requested this recommendation. The motion for the addition of this recommendation failed upon a vote.

CABHA Update, Beth Melcher, Assistant Secretary for MH/DD/SAS Development, DHHS

• Handout here
• The temporary rules on CABHAs (Critical Access Behavioral Health Agency) were approved in December 2010, and the program structure took effect on Jan. 1, 2011.
• Over 600 agencies applied for CABHA certification in 2010, and 177 have been certified to deliver services.
• Although current data show that nearly all 100 counties in NC are served by a CABHA—particularly because many provide services across county lines—the Department of Health and Human Services will be assessing the distribution of CABHAs by county to identify any deficiencies.
• Other “next steps” will include monitoring the transition of individuals from non-CABHA agencies to CABHAs; reviewing the new model for regulatory compliance and fiscal stability; and conducting regional meetings with Local Management Entities (LMEs).

Local Management Entity Medicaid Utilization Review, Anna North of Eastpointe and Ellen Holliman of The Durham Center

• Handout here
• Legislation in 2008 mandated the return of Medicaid utilization review from ValueOptions, to LMEs.
• To date, CAP (Community Alternatives Program / Medicaid home and community based services waivers) utilization review has cost 15% less via The Durham Center and Eastpointe as compared to the rates that were paid to ValueOptions.
• Beginning Jan. 20, 2011, Eastpointe, The Durham Center, Crossroads LME and Pathways LME will be doing CAP MR/DD utilization review statewide.

Residential Options for Children with Intellectual / Developmental Disabilities Ages 0 – 6 years, Rose Burnette, a Project Manager in the Division of MH/DD/SAS

• Handout here
• Nearly 23,000 individuals with intellectual and developmental disabilities received services in FY2010 in NC. Approximately 5% (1,115) of those individuals were ages 0 – 6 years.
• 28 children ages 0 – 6 residing within Medicaid funded, ICF-MR (Intermediate Care Facility for People with Mental Retardation) facilities across the state. A typical child in this category has “significantly high and complex, chronic medical needs and intellectual disabilities” which exceed a family’s ability to care for the child within the family home.
• Another 27 children are residing in foster homes; 9 are residing in State or private funded residential facilities; and 1051 are receiving services in the family home (with 1 child receiving CAP-MR/DD home supports). 

Early Intervention Program for Children Ages 0 – 3, Deborah Carroll, Head of the Early Intervention Branch in the Division of Public Health

• Handout here
• The program serves children with existing or established risk for developmental disabilities or delays. Developmental delays can be cognitive, physical, socio-emotional, or relate to activities of daily living. Title V Maternal and Child Health Block Grant funding provided $21 million in funding last year. However, enrollment has been limited since 2006, so a child’s developmental delay must be “significant” versus “mild” or “moderate.” Nonetheless, more than 18,000 children were enrolled in FY2009-2010.
• Anyone can refer a child to the program. However, program staff then conducts a developmental evaluation. Children who do not qualify for the Intervention Program can be referred to local health department services. Children who receive services undergo therapies but do not take medications. Each county’s Children’s Developmental Services Agency must provide the necessary services (and services coordination, such as linking a family to Medicaid and WIC) for a qualifying child even if no qualified provider is accessible. Services are to be provided in the “natural environment” of the child’s home or daycare. However, no residential services are available (e.g., for the aforementioned 0-6 population institutionalized in an ICF-MR). Once a child is 2 and one half years of age, the Early Intervention Program develops a transition plan for the child to enter into special education in the public school preschool disability program.

Thanks to our volunteer attorney, Sarah Pfau, for attending the committee meeting and providing this summary.