Proposed Amendment to CAP-MR/DD Clinical Coverage Policy

The NC Division of Medical Assistance has posted a proposed amendment to the CAP-MR/DD Clinical Coverage Policy related to the Supports Intensity Scale.  The language is below but click here to view the entire proposed policy.  Comments may be submitted through the website (click here) by April 10, 2011.

The Proposed Language:
The Supports Intensity Scale™ (SIS) is an assessment tool that, when administered properly, measures an individual’s intensity of need for supports to participate fully in community life. SIS is used in person-centered planning to assist individuals in developing strength based, not deficit based, plans. The 3 sections of the SIS are:
a. Supports Needs Scale;
b. Supplemental Protection and Advocacy Scale; and
c. Exceptional Medical and Behavioral Supports Needs.

The SIS was piloted in seven Local Management Entity (LME) Catchment areas due to legislative mandate that the results of the SIS assessment be used to assign clients with developmental disabilities to one of the tiers within the CAPMR/DD Waiver and to other needed services, according to their relative intensity of need. A technical amendment will be submitted to CMS requiring that the completed SIS be done for individuals in all LME Catchment areas receiving CAP MR/DD funding in order to comply with the legislation and to begin work towards building a funding model to distribute funding based on intensity of need. Beginning with Initial Plans and Continued Need Reviews (CNRs) effective 7/1/11 and after, the SIS will be required to be submitted with the Initial Plan of Care or CNR to the appropriate Utilization Review (UR) Vendor for approval of CAP Waiver Services. Reassessment will occur every three years.

Bill Update for Week of February 21

Bills Previously Filed with Activity this week (Click on the bill number to link to the General Assembly website for full text and other information about the bill):



HB 2, Protect Health Care Freedom (Barnhart, Stam, Hollo, Murry sponsors).  This bill seeks to prevent the implementation of the Affordable Care Act (i.e., healthcare reform legislation) provision that mandates individual health insurance.  It also mandates that the Attorney General shall either join or bring a lawsuit challenging this provision.  The House concurred with the Senate committee substitute this week.  The bill now goes to the Governor.  Last Friday, the Governor indicated that she will not veto the legislation.  She may be reconsidering that decision in light of a letter from Attorney General Roy Cooper this week highlighting the financial implications to the Medicaid program that could result from the law's enactment. For more coverage of the Attorney General's letter click here.

SB 8, No Cap on Number of Charter Schools (Stevens sponsor).  This bill eliminates the existing cap of 100 charter schools and makes a number of changes to the existing statute governing charter schools.  The bill passed the Senate Finance committee and a full Senate vote this week.  Several amendments were proposed on the floor aimed at ensuring diversity and that charter schools are open to all students.  Most failed.  One amendment, advocated for by DRNC, was passed to add certain reporting requirements for the charter school commission to report to the Legislative Oversight Committee on Education.  The bill does now include language related to students with disabilities in several areas: a charter school's application must include a plan for identifying and successfully serving students with disabilities, among other student groups; nothing in the subsection related to admission requirements shall be interpreted to preclude the formation of a charter school whose mission is focused on serving students with disabilities, among other student groups; and the annual reporting requirements include annual data disaggregated by charter school on the gender, race and ethnicity and disability status of students enrolled in charter schools; testing data disaggregated by the purpose of the charter school, and by gender, race and ethnicity, and disability; the number of students long-term suspended and expelled; the number of students receiving a free and reduced meal plan through a federal subsidy program; the number of students receiving a free and reduced meal plan through means other than a federal subsidy program; and the number of students receiving special education services.  The current statute does also state that  schools must comply with policies adopted by the State Board of Education for charter schools relating to the education of children with disabilities.  However, the statute also includes language that states that schools shall not limit admission to students on the basis of intellectual ability, measures of achievement or aptitude, athletic ability, disability, race, creed, gender, national origin, religion, or ancestry EXCEPT as otherwise provided by law or the mission of the school as set out in the charter.  Disability Rights NC believes that this language could be interpreted to allow discimination against students with disabilities in the admissions process.  The bill now proceeds to the House, where we will continue to advocate for the removal of this language from the statute.

SB 13, Balance Budget Act of 2011, (Stevens, Brunstetter, Hunt sponsors).  SB 13 seeks to reduce the current year's budget by at least $400 million, and directs transfers from various funds. The Governor vetoed this bill this week.  The Senate has already filed another bill directing reductions, without specifically directing the transfer from various funds.  SB 109, Spending Cuts for the Current Fiscal Year (Stevens, R., Brunstetter, Hunt Sponsors) directs the Governor to reduce expenditures in the 2010-11 fiscal year in order to increase General Fund availability for the 2011 2012 fiscal year by $537,740,799 by taking all actions necessary and by identifying funds in non-General Fund accounts for transfer to the General Fund on June 30, 2011. It does not apply to funds available to the Judicial Branch or the Legislative Branch. The bill was filed in the Senate on February 22 and has not yet been referred to a committee.

SB 58, Modify FMAP Cuts/Authorize Use of Credit Balance (Brunstetter, Hunt, Stevens Sponsors). SB 58 seeks to prevent reductions in Medicaid provider rates and retirement system contributions to "backfill" the expiring funds from the temporary increased FMAP (the federal Medicaid match) received under the Recovery Act.  It also authorizes the use of $125 million of the funds in the unreserved credit balance on June 30, 2010 to address Medicaid liabilities incurred in the 2009‑2010 fiscal year.  The bill received a favorable report from the Senate Appropriations committee and passed 2d and 3d reading in the Senate this week.  It will now proceed to the House.

New Bills:

HB 154, Reform Medical Malpractice Evidentiary Rules (Faison Sponsor). This bill seeks to permit the introduction of evidence regarding the defendants’ insurance coverage in any civil action. It was filed in the House and has been referred to the House Judiciary Committee.



HB 183, HOA/Limit Foreclosures (Bryant, Hamilton, Gill, Moore, R. Sponsors). This bill prohibits Homeowners Associations from foreclosing on property where the debt securing the Association assessment lien consists solely of unpaid Homeowners Association dues or other costs associated with unpaid Homeowners Association dues. However, the Association may collect the lien as a money judgment. The bill was filed in the House on February 24 and has not yet been referred to a committee.  HB 183 could prevent a person with a disability who has been unable to pay HOA dues for reasons related to their disability for any number of reasons - waiting to be approved for SSI/SSDI, disputed HOA assessments based on fair housing discimination, etc. - from losing their home to foreclsoure.

SB 95, Fair Housing Act Amendment (Kinnaird Sponsor). This bill seeks to prohibit discrimination on the basis of receipt of housing assistance (such as a Housing Choice voucher). This is the same bill that Senator Kinnaird filed in 2009, which passed successfully through the Senate but not through the House. It was referred to the Senate Commerce committee. A recent report to HUD examines the positive effect of such laws on voucher utilization and locational outcomes.

SB 96, Prohibit Request to Disclose Expunction (Kinnaird, McKissick Sponsors). This bill seeks to clear the public record of any entry of any arrest or criminal charge that has been expunged so that (i) the person who is entitled to and obtains the expunction may omit reference to the charges to potential employers and others and (ii) a records check for prior arrests and convictions will not disclose the expunged entries. It also prohibits any public or private sector employer from requiring an applicant for employment or admission to disclose information concerning any arrest or criminal charge against the applicant that has been expunged. It has been referred to the Senate Judiciary II Committee.

SB 108, Civil Litigation Costs Reform Act of 2011 (Rouzer Sponsor). This bill seeks to establish a general rule in civil actions that prevailing defendants be awarded attorneys’ fees. The bill was filed in the Senate on February 22 and has not yet been referred to a committee.

SB 115, Coverage for Treatment of Autism Disorders (Purcell, Garrou, Mansfield Sponsors). SB 115 seeks to require health benefit plans, including the State Health Plan, to provide coverage for treatment of Autism Spectrum Disorders. The bill was filed in the Senate on February 23 and has not yet been referred to a committee. The Autism Society of North Carolina is leading this effort, which would provide great benefit to families with health insurance seeking treatment for family members with autism.

 

SB 121, Eligibility Requirements/Public Assistance (Rouzer Sponsor). SB 121 seeks to require applicants for public assistance to undergo drug testing through the county department of social services before the applicant is eligible for public assistance. If an applicant fails to pass the substance abuse screening, the applicant would then be required to undergo substance abuse treatment. The bill also directs the Social Services Commission to adopt rules that establish requirements and policies for (i) substance abuse screenings of applicants, (ii) substance abuse treatment, when applicable, (iii) subsequent screenings of recipients after becoming eligible for public assistance, and (iv) any other requirements or policies the Commission deems relevant. The bill was filed in the Senate on February 23 and has not yet been referred to a committee. Disability Rights NC is very concerned about the implications of this bill. It provides additional requirements of applicants not included in federal law, and places a tremendous burden and expense on counties.

Week of February 21 Budget Update

House and Senate budget chairs released targets for budget subcommittees this week.  You can view the full document here.  Not suprisingly, the numbers are lower than those in the Governor's budget  - about $1.4 billion lower - and the subcommittees have been given lists of items to consider for cuts.

Education:

Base Budget (what it would likely take to continue services at current levels) - $11.913 Billion
Legislative Spending Target - $10.483 Billion
Difference - $1.43 Billion
Items to consider:

• Consolidate/eliminate Smart Start and More at Four. (In consultation with the HHS Subcommittee
• Determine alternative salary schedule based on performance. (Full Chairs item with Subcommittee Chair consultation).
• Cap university enrollment.
• Encourage more attendance at community colleges during freshman and sophomore years.
• Reduce or eliminate higher education funding for less essential classes/degrees.
• Fund higher education based on performance (i.e. graduation rates, measures of learning).
• Tuition waivers.
• Financial aid.

Health and Human Services:
Base Budget - $4.927 Billion
Legislative Spending Target - $4.336 Billion
Difference - $491 Million
Items to Consider:

• Consolidate/Eliminate Smart Start and More At Four. (In consultation with the Education Subcommittee)
• Provider Assessments.
• Managed Care.
• Maximize federal funds (block grants).
• Evaluate federal maintenance of effort requirements.
• Consolidation of divisions.
• Medicaid parity with State Health Plan/Health Choice.
• Copayments.
• Consider closing facilities.
• Eliminate structural redundancy (restructure the organization to streamline services).

The Health and Human Services committee heard two days of public comment this week.  Commenters included lobbyists for advocacy organizations, as well as individuals with disabilities and their caregivers.  The committee also heard from several vendors on cost-saving strategies today.  Handouts from today's presentation are available on the committee website here.  At this time, one presentation, from the ex-Georgia Medicaid Director is not posted (he discussed managed care in Georgia, which did not include Aged, Blind, Disabled).  The other presentations included a respresentative from the Amerigroup Corporation, who proposed a managed care program for a small subset of the Long-Term care population, low acuity nursing home residents; MedSolutions, a group that currently contracts with NC to provide prior authorizatuon for radiology and ultrasound services; Triad Healthcare, a group focused on reducing the cost of musculoskeletal care; and Value Options, who proposed competitive bidding for a statewide behavioral health managed care waiver.

Justice and Public Safety
Base Budget - $2.207 bil
Legislative Spending Target - $2.067 bil
Difference - $140 mil
Items to Consider:

• Justice Reinvestment Strategies.
• Eliminate/modify programs or services.
• Reduce inmate medical costs.
• Shift/consolidate medical/treatment to State Health Plan or DHHS.
• Close or consolidate facilities.
• Consolidation of departments proposed by the Governor.
• Policy changes to assure the lowest cost for housing misdemeanants.

Bill Update for Week of February 14

Bills of Interest to People with Disabilities.  Click on the bill number to link to the General Assembly site on the bill.

HB 2, Protect Health Care Freedom (Barnhart, Stam, Hollo, Murry sponsors).  This bill seeks to prevent the implementation of the Affordable Care Act (i.e., healthcare reform legislation) provision that mandates individual health insurance.  It also mandates that the Attorney General has the duty to bring an action on behalf of NC citizens to enforce the law.  The bill moved quickly through the House and received a favorable vote in the Senate on February 16.  Because the Senate made changes to the bill (adding a provision that "Any funds required by the Office of the Attorney General to fulfill the responsibilities under this subsection shall be provided by the Department of Justice from other funds appropriated to the Department and from other grants or funding that are available from other sources"), it will now go back to the House before it goes to the Governor. On Friday, the Governor indicated that she will not veto the legislation, stating "This kind of legislation is essentially unnecessary from my perspective," and "It's not worth a battle" during an interview with The Charlotte Observer.

HB 28, DHHS to Provide Law Enforcement Information (Burr, Guice, Randleman, Ingle sponsors).  This bill seeks to require NC DHHS to provide law enforcement officers with certain personal information of any individual receiving services from DHHS for the purposes of furthering an investigation or locating a fugitive.  HB 28 was discussed but not voted upon in the House Judiciary B Committee on Wednesday.  A Proposed Committee Substitute (PCS) was presented to the committee.  The PCS added locating a missing person as an additional ground upon which law enforcement may seek the information; and also added blood type as one category of information that may be obtained.  Language was also added to state that any additional information, which is authorized for release to law enforcement agencies under State or federal law shall also be provided upon specific request.  DHHS voiced concern about the availability of such information at the state level.  Advocates raised privacy concerns.  Disability Rights NC is working with other advocacy groups and the bill sponsor to limit the implications on private health information. 

HB 104, ACH Pilot on Crisis Intervention Training (Farmer-Butterfield, Earle, Weiss, Hurley Sponsors). HB 104 directs the Division of MH/DD/SAS to coordinate a pilot program in 10 adult care homes identified as having a significant percentage of residents with a primary diagnosis of "mental health problems" and where crisis management has been a concern in the past to evaluate the effectiveness of crisis intervention training. It also directs the Division to consider modification of the current North Carolina Interventions (NCI) Prevention training to a one-day training program appropriate for adult care home staff, including personal care aides, medication aides, and supervisors employed by the participants in the pilot program. The bill is based on Recommendation 5.2 from the North Carolina Institute of Medicine Task Force on the Co Location of Different Populations in Adult Care Homes and as Recommended by the North Carolina Study Commission on Aging. It has been referred to the House Committee on Health and Human Services.



HB 106, Direct Care Worker Wage and Benefit Study (Farmer Butterfield, Pierce, Weiss and Hurley Sponsors). HB 106 directs the Division of Health Service Regulation, to coordinate a study of direct care worker wages and benefits and the impact these have on the supply of prospective employees and employee turnover.  It has been referred to the House Committee on Health and Human Services.


HB 107, GAST Training Pilot (Farmer Butterfield, Earle, Weiss, Hurley Sponsors). HB 107 seeks to establish a pilot training program in Adult Care Homes on preventing the escalation of behaviors leading to crisis based on Recommendation 5.1 from the North Carolina Institute of Medicine Task Force on the Co Location of Different Populations in Adult Care Homes and as recommended by the North Carolina Study Commission on Aging. The pilot training programs would utilize the existing Geriatric/Adult Mental Health Specialty Teams (GAST). It also seeks to amend G.S. § 131D 4.9 on Adult Care Home staff training to mandate that licensed Adult Care Homes permit the GASTs to conduct staff training. It has been referred to House Committee on Health and Human Services.

HB 108, DHHS Study of IOM Task Force Recom 3.1 (Farmer-Butterfield, Weiss, Earle, Hurley Sponsors). HB 108 directs the DHHS to study Recommendation 3.1 of the North Carolina Institute of Medicine Task Force on the Co Location of Different Populations in Adult Care Homes to assess the feasibility and implementation time line of a pilot program aimed at transitioning Adult Care Home residents to independent community based housing. DHHS is directed to evaluate and report on such elements as the feasibility of a Medicaid 1915(i) state plan amendment or a 1915(c) Home and Community Based Services waiver; a process to evaluate residents of adult care homes to determine whether they can live independently in the community with services, supports, counseling, and transition services; policy implications, impact on current programs, and cost of developing and implementing an additional Special Assistance program option that would be similar to the existing Special Assistance in home program; and the existence of statutory and regulatory barriers to independent living for people with disabilities. The bill has been referred to the House Committee on Health and Human Services.


HB 110, Task Force on Fraud Against Older Adults (Farmer Butterfield, Weiss, Pierce and Hurley Sponsors). HB 110 directs the Consumer Protection Division of the NC Department of Justice to coordinate a task force on fraud against older adults, as recommended by the North Carolina Study Commission on Aging. It has been referred to the House Committee on Health and Human Services.


HB 114, Assistance to Voters in Family Care Homes (Setzer Sponsor). HB 114 seeks to amend the state statute governing assistance to voters to limit assistance to persons with disabilities living in Family Care Homes to assistance from a legal guardian. This would be an unnecessary and discriminatory barrier to voting for individuals who reside in Family Care Homes. It has been referred to the House Election Law Committee.


HB 115, North Carolina Health Benefit Exchange Act (Dockham, Brubaker, Wray, Murry Sponsors). HB 115 seeks to establish a Health Benefit Exchange to make available qualified health benefit plans beginning in 2014. Under the Affordable Care Act, states must either create their own state exchange or opt in to the federal exchange. This bill creates a version of the exchange that is governed by a board that includes insurers as voting members and less consumer protections than another version of the bill also filed this week, HB 126. This bill sets up an exchange very different from anything discussed at the NC Institute of Medicine Health Benefit Exchange workgroup. Disability Rights NC is working with other health advocates to oppose this bill. This bill has been referred to the House Committee On Health and Human Services.



HB 126, Health Benefit Exchange (Insko, Hall, Fisher Sponsors). This version of the Health Benefit Exchange more closely aligns with a number of aspects developed through the NC Institute of Medicine workgroup process. It does not allow insurers to serve as voting board members and contains more consumer protections. It was filed in the House on February 16 and has not yet been referred to a committee.


HB 127, Expand Capitated Waiver (Insko, Barnhart, Alexander Sponsors). HB 127 allows DHHS to expand the 1915(b)/(c) Medicaid waiver to any additional local management entity catchment area upon demonstrating to the satisfaction of the General Assembly that the expansion (i) is allowable under Medicaid, (ii) will result in savings to the State, and (iii) will provide outcomes equal to or better than those that could be achieved without the proposed expansion. It was filed in the House on February 16 and has not yet been referred to a committee.


HB 143, ACH and 122C Screening & Assessment Funds (Farmer-Butterfield, Weiss, Earle, Pierce Sponsors). HB 143 seeks funding to support implementation and use of standardized preadmission screening, resident assessment, and care plan development for adult care homes and facilities licensed under Chapter 122C of the General Statutes. It is based on recommendation 4.1 from The North Carolina Institute of Medicine Task Force on the CoLocation of Different populations in adult care homes, and as recommended by the North Carolina Study Commission on Aging. It was filed in the House on February 17 and has not yet been referred to a committee.


SB 8, No Cap on Number of Charter Schools (Stevens sponsor). This bill eliminates the existing cap of 100 charter schools. SB 8 received a favorable vote from the Senate Education committee this week, after adopting a new Proposed Committee Substitute, different from the version adopted in the subcommittee last week. The bill was then referred to the Senate floor but was pulled from the calendar on Thursday and will be heard in the Finance committee on Tuesday, February 22. The bill still has objectionable language that Disability Rights NC fears will allow discrimination against students with disabilities.


SB 70, Expunge Nonviolent Crimes (Kinnaird). SB 70 seeks to allow expunction of convictions for certain nonviolent criminal offenses upon application and a fee, to allow disclosure of expunged information to law enforcement agencies and other specified agencies for employment and licensing purposes, and to require those agencies to maintain the confidentiality of the expunged information. The bill has been referred to Senate Judiciary I, and if favorable to Finance.



SB 72, Social Security Increase (Kinnaird). SB 72 seeks to allow an income disregard to maintain Medicaid eligibility when Social Security cost of living increases put a recipient slightly over the federal poverty level. This bill was also filed in 2009 and was successfully voted out of the Senate but did not proceed through the House. It has been referred to the Senate Health Care committee, and to Finance if favorable.

Governors Budget

The Governor released her proposed budget today.  It is available online here.  Her staff presented an overview to the House and Senate this afternoon and joint House and Senate appropriation meetings will continue next week.  The Governor's budget includes a continued sales tax increase of 5.5%, something Republican members quickly took issue with.  During the budget overview, her staff did make sure to say that Medicaid is doing great, with 2.2% decrease from last year at this time. Because Medicaid is coming in under-budget, the budget will not need to increase for enrollment growth in the first year, a very positive sign for maintaining services.  Below are highlights:

Health and Human Services

• Current year $17.9 bil total budget, $12.9 in receipts and federal funds, $4.9 in state approps; 2011-12 $18.3 bil, 2.2% growth, but state approps reduced by 4%; 2012-13 $19.1 bil second year.
• Medicaid spending accounts for 67.3% of total general fund appropriations to DHHS; 15.1% is Mental Health, then Child Development, followed by DSS at 4% = Health agencies are over 87% of DHHS spending
• Medicaid overall state appropriations down 3.4%
• Division of Central Management and Support Reductions: retirement incentives; department wide administrative efficiencies reducing budget by $1 mil and eliminating 25 positions; reduces special appropriations and nonprofit funding by $2.3 mil; $9.6 mil INCREASE for NC FAST development and implementation
• Division of Aging and Adult Services: Use civil monetary penalty proceeds assessed against nursing homes to replace state funds for the Long-Term Care Ombudsman program ($200,000); $500,000 in funding to continue Project CARE, which provides respite for caregivers of people with dementia
• Division of Social Services: Eliminate vendor payments for new special needs adoptions ($550,963 reduction); eliminate pilot funding to local DSS offices for Child and Family Team support ($420,804); prioritize Adult Day Care services received through the State Adult Day Care Fund for adults who are 18 to 59 (adults 60 and over may receive through the Home and Community Care Block Grant) ($1.1 mil reduction)
• Division of Medical Assistance: Assessments up to 5.5% on willing medical providers, which may include hospitals, CABHAs, CAP MR providers and others (rates are increased to offset the assessment) ($60 mil reduction); Targeted rate adjustments where NC rates are disproportionate to regional rates or where analysis indicates a rate adjustment is necessary (examples used are payment differential for RN/LPNs providing private duty nursing) ($8.4 mil reduction); Health homes for individuals with chronic conditions, including mental health conditions (90% federal match for 8 calendar quarters ($16 mil reduction); fraud, waste, abuse, overuse savings, "improving program integrity" ($16 mil reduction); modifying drug pricing and prescription coverage ($3.6 mil reduction); modifying optional and mandatory services to save $16 mil in first year and $25 mil in second - flexibly managed by secretary, adjustments based on best practice, clinical appropriateness, comparison to other medicaid programs and private health insurance (study coming in April will show comparison of medicaid program to other states - benefits and rates); Medical Home - Pregnancy initiative ($528,960 reduction); no increase necessary in 2011-12 for Medicaid rebase because program is under-budget
• NC Health Choice: Targeted rate adjustment ($225,000), strengthening Program Integrity ($500,000 reduction); Modify services on same ground as in Medicaid program ($650,000); align Health Choice and Medicaid services ($125,000 reduction), care coordination ($4.3 mil reduction); a $3.2 mil "adjustment" for rates, actual enrollment.
• Division of Services for the Blind: Reduce Medical Eye Care program ($190,961)
• Division of MH/DD/SAS: Eliminate Child and Family Support Team pilot that provides a dedicated contact for low wealth schools to the local mental health system ($523,638 reduction); Reduce LME administration funds by 5% ($3.3 mil); Earmark $75 mil from the Mental Health Trust Fund to increase community based services, such as local in-patient beds and housing, support integrated electronic health records, and promote integration of physical and mental health.
• Division of Vocational Rehabilitation: Eliminate Recreational Therapist Services ($284,501 reduction and eliminates 5 positions); Reduce financial eligibility criterion for receiving Independent Living services from 125% to 100% of the Federal Poverty Level ($1.8 mil reduction); Reduces Basic Support program by $2 mil, says the availability of unspent federal funds will mitigate the impact on service delivery

Public Education:

• Residential Deaf/Blind Schools: The transfer includes 543 staff positions to DPI, a 5% reduction recommended (22 positions)
• EC Headcount adjusted annually to reflect actual headcount - $7 mil reduction
• 3 things to become local responsibility - school bus replacement, tort claims and workers comp, reduction in non-instructional support
• Transportation - 10% reduction (40 mil)
• $40 mil reduction in textbook funding - 34.6% reduction
• Central Office 10% reduction, instructional support reduced by 5%, school building administration funds reduced by 7.5%, noninstructional support reduced 15% and 10% reduction at DPI
• Retirement incentives for LEAs and DPI
• 5% reduction to More at Four
• Funds increase in instructional costs associated with enrollment growth

Universities  

• 8% reduction, netting tuition out about 6% reduction
• Reducing the UNC Hospital subsidy - eliminates 25% of the subsidy for charity care, noting an operating income of $56.7 mil and $98.2 mil overall net income
• Provides funding for instructional support for 2300 increased enrollment and operation and maintenance costs for new buildings

Community Colleges

• Funds 9700 student enrollment growth
• Restructuring of existing formulas recommended, tuition increase
• 8 specialized centers and programs eliminated

General Government

• Consolidating Department of Administration, Office of State Personnel, Office of the State Controller, and Office of Information Technology Services to a Department of Management and Administration
• Of note in the Department of Administration: Eliminate Youth Advocacy Referral functions (and 3 staff), says the information and referral functions will be distributed among constituent services staff; another "middle management" position is eliminated from the Youth Advocacy and Involvement Office

Justice and Public Safety

• Recommends consolidation of Juvenile Justice, Corrections and Crime Control and Public safety into a new Department of Public Safety, eliminating 60 positions
• Department of Corrections: 4% decrease year 1, 3% decrease DOC: Reduce funding for Summit House, Wome at Risk, Harriet's House by 10%; reduce operating reserves for the new health facilities; reduce inmate costs through polciy changes to  for sentence reduction credits and to create 2 release dates per month ($3 mil); potential savings from the Justice Reinvestment Act recommendations of $12.4 mil in the first year and $27 mil in the second year;seek Mecdicaid reimbursement for qualifying inmate medical expenditures ($3 mil reduction);
• Daprtament of Juvenmile Justice and Delinquency Prevention 7% reduction in year one, 8% in year 2: Eliminate 4 admin positions ($272,927); Eliminate Camp Woodson ($970,000); Reduce Direct Care contracts, inclduing Eckerd Wilderness Camp and closing one  multi-purpose home operated by Methosit Home for Children; reduce Juvenile Crime Prevention Council and Project Challenge funding ($2.2 mil); close Swannanoa Youth Development Center ($1.4 mil reduction)
• Judicial Branch: 9% reduction to non-constitutionally mandated court programs, including family and drug treatment courts, dispute resolution, mediation and arbitration programs, and conference of DAs and Clerks Conference; IDS held harmless, facing a shortfall this year
• Department of Justice: Eliminates NC LEAF state appropriations for a reduction of $356,250

Bill Update for Week of February 7

Action on Bills of Interest to People with Disabilities – February 7 - February 10, 2011
Click on the Bill Number at the beginning of the paragraph to view the bill in full on the General Assembly website.

HB 2, Protect Health Care Freedom (Barnhart, Stam, Hollo, Murry sponsors). This bill seeks to prevent the implementation of the Affordable Care Act (i.e., healthcare reform legislation) provision that mandates individual health insurance. It also mandates that the Attorney General shall either join or bring a lawsuit challenging this provision. HB 2 was debated in the Senate Judiciary II committee on Tuesday, and received a favorable report in the Thursday Senate Judiciary II committee.  The bill will now proceed to the full Senate.

HB 41, Tax Fairness in Education (Stam, Brawley, Collins and Hager sponsors). This bill creates an income tax credit of $1,250 per semester for families whose dependent children are educated in a nonpublic school. For initial eligibility, the child shall have been enrolled in and attended at least 2 semesters in a public school in the preceding tax year. Taxpayers must meet taxable income criteria to qualify: $100,000, Married, filing jointly, $80,000 Head of Household, $60,000 Single and $50,000 Married filing separately. The bill also permits boards of county commissioners to appropriate funds (up to $1,000 per child per year) for the expenses of children educated in nonpublic schools. This is NOT the bill that was filed during the last session related to tax credits for students with disabilities. Since the bill was filed last week, it has been referred to the Education Committee, and to the Finance Committee if it receives a favorable report in Education.

HB 70, Compensate Eugenics Sterilization Survivors (Sponsors Womble and Parmon).  This bill seeks to provide monetary compensation to persons sterilized by the Eugenics Sterilization Program ($20,000 each).   This bill was filed in the House on February 10 and has not yet been referred to a Committee.  The bill requires a budget allocation of over $18 million, so it does not have a great likelihood of success, but it is heartening that Representatives Womble and Parmon continue to focus on this issue.

HB 71, Housing Funds for Individuals with Disabilities (Weiss, Farmer Butterfield, Earle and Pierce Sponsors). This bill seeks $10 million for the North Carolina Housing Trust Fund to increase housing options for people with disabilities, based on a recommendation from the NC Institute of Medicine Task Force on the Co Location of Different Populations in Adult Care Homes, and as recommended by the NC Study Commission on Aging. The bill was filed on February 10 and has not yet been referred to committee. In this budget year, the chances of achieving this appropriation is slim, but this is a good opportunity to talk about the great need for affordable housing for people with disabilities.

HB 73, Eugenics Program Support and Education (Womble and Parmon Sponsors).  HB 73 seeks to mandate several activities related to eugenics survivors, many of whom were people with disabilities.  It would provide counseling benefits to eugenics survivors, establish a database of eugenics program participants, direct the State Board of Education to include information about the program in its K-12 History curriculum, and direct the Board of Governors of the University of North Carolina to direct appropriate faculty and students to conduct interviews with survivors.  It was filed on Friday in the House and has not been referred to a committee yet.

House Bills 75 through 86 are recommendations of the MH/DD/SAS Legislative Oversight Committee.  Most require future reports to the Legislative Oversight Committee.

HB 75, Report on Transfer of CAP-MR/DD UR to LMEs (Earle, Farmer Butterfield, Alexander, M. and Brisson Sponsors).  HB 75 seeks to require a report of DHHS to the Legislative Oversight Committee on MH/DD/SAS on the implementation of Utilization Review by designated LMEs for services provided under the CAP-MR/DD program.  The report is to include a cost comparison and a report on accountability measures used by the LMEs to ensure the accuracy of the decisions.  The bill was filed on February 10 in the House and has not yet been referred to a committee.

HB 76, Revise DD Waiting List Process (Earle, Farmer Butterfield, Alexander, M. and Brisson Sponsors).  HB 76 requires the DHHS to report to the MH/DD/SAS Legislative Oversight Committee by September 1, 2011 on a revised process for collecting data to develop a waiting list of persons with intellectual or developmental disabilities who are waiting for specific services. The revised process shall ensure all of the following: (1) A simple, nonduplicated count of children and adults with intellectual or developmental disabilities across the State who are waiting for federally and State‑funded services.  (2) A research‑based waiting list supported by data that accurately reflects the number of individuals waiting for categories of services currently available in this State.  (3) Data showing the number of individuals who are potentially eligible to receive services under the CAP‑MR/DD Waiver.  The bill also cals for an annual report on the waiting list data and (i) an analysis of any service gaps revealed by the data, broken down by geographic location, age, and disability and (ii) plans to address these service gaps.  This bill was filed on February 10 and has not yet been referred to a committee.

HB 77, Apply for TBI Medicaid Waiver (Insko, Earle, Alexander, M. Sponsors).  HB 77 is another recommendation of the MH/DD/SAS Legislative Oversight Committee.  It directs the DHHS to apply for a 1915(c) Medicaid waiver, in consultation with the North Carolina Traumatic Brain Injury Advisory Council, shall develop and apply to the Centers for Medicare and Medicaid Services (CMS) for a 1915(c) waiver to permit persons who sustain traumatic brain injuries to access home and community‑based Medicaid services. The Department shall not submit the application to CMS unless the General Assembly identifies a source of funding sufficient to provide the match for this proposed waiver from State appropriations earmarked for persons with traumatic brain injury. In determining the number of slots and the slot allocation formula for this proposed waiver, the Department shall consider the amount of funding identified by the General Assembly for this purpose.

HB 78, Evaluate Efficacy of CABHA Model (Insko, Earle, Alexander, M., Brisson Sponsors).  HB 78 seeks to require DHHS to report on the criteria and processes used by the Division to evaluate the fiscal, organizational, and programmatic efficacy of implementing  of the Critical Access Behavioral Health Agency (CABHA) model, as recommended by the MH/DD/SAS Legislative Oversight Committee.  The bill was filed on February 10 and has not yet been referred to a committee.

HB 79, Report on MH Services Provided by Hosp. ERs (Earle, Farmer Butterfield, Brisson, Insko Sponsors).  This bill seeks report from the Division of MH/DD/SAS by September 1, 2011 on the utilization of hospital emergency departments by individuals with mental illness. The report shall include a comprehensive statewide analysis of the number of times between January 1, 2011, and June 30, 2011, individuals diagnosed with a mental illness utilized hospital emergency departments, broken down by geographic location, average length of stay, and range in lengths of stay. The report shall also include a comprehensive plan for reducing the length of stay for individuals with mental illness admitted to hospital emergency departments.  The bill was filed on February 10 and has not yet been referred to a committee.

HB 80, Evidence Based Pract. in Psych. Hospitals (Earle, Farmer Butterfield, Brisson, Insko Sponsors).  HB 80 call for a DHHS report by September 1, 2011, and annually thereafter, to HHS Appropriations committees and the MH/DD/SAS Legislative Oversight Committee on the progress achieved in implementing and utilizing uniform evidence‑based practices across all State psychiatric hospitals.

HB 81, Develop Plan for Allocating DD Resources (Insko, Farmer Butterfield, Alexander, M. Sponsors).  HB 81 seeks a plan "for the fair and equitable allocation of resources for all individuals eligible for developmental disability services" from the Division of MH/DD/SAS comprehensive statewide plan. The plan sought shall contain: A resource allocation model based on the results of the Supports Intensity Scale (SIS) or another standardized, reliable, and valid assessment tool for the determination of intensity of need; and  a "standardized formula" for the use of the results of the SIS or other assessment tool data to determine eligibility for type, degree, and array of services, including services provided through State developmental centers and private intermediate care facilities for individuals with mental retardation.  The bill also seeks implementation of this plan statewide by July 1, 2013 and directs DHHS to renew the CAP‑MR/DD Waiver with the two "tiers" currently in operation, applying for additional "tiers" only with the approval of the MH/DD/SAS Legislative Oversight Committee. The bill was filed on February 10 and has not yet been referred to a committee.

HB 82, Funds for Step Down Unit for BART Program (Insko, Alexander, M., Brisson, Farmer Butterfield Sponsors).  HB 82 directs Division of MH/DD/SAS, in consultation with the leadership and advisory committee of the Murdoch Developmental Center, to identify funding sources available to establish a unit providing step‑down services from the Behaviorally Advanced Residential Treatment (BART) Program, and to report to the MH/DD/SAS Legislative Oversight Committee. The bill was filed on February 10 and has not yet been referred to a committee.

HB 83, Modify MHDDSAS Reporting Requirements (Insko, Farmer Butterfield, Earle Sponsors).  HB 83 seeks to modify the DHHS reporting requirements to the MH/DD/SAS Legislative Oversight Committee to include information on the balance of the Mental Health Trust Fund and expenditures, and on the equitable allocation of resources, prevention and early intervention, statewide system of crisis response for adults and children, and management of the utilization of State facilities.  This bill was filed on February 10 and has not yet been referred to a committee.

HB 84, Expand Inpatient Psychiatric Beds/Funds (Insko, Farmer Butterfield, Brisson Sponsors).  HB 84 seeks $39 million for the expansion of local inpatient psychiatric beds or bed days, as recommended by the MH/DD/SAS Legislative Oversight Committee.  This bill was filed on February 10 and has not yet been referred to a committee.

HB 85, Evaluate DD Residential Options for Children (Insko, Earle, Farmer Butterfield Sponsors).  HB 85 requires DHHS to conduct a comprehensive review of current congregate residential placements for children from birth to six years of age who have a developmental delay, intellectual disability, or developmental disability, including beds transferred from State developmental centers to private intermediate care facilities for individuals with mental retardation and an overview of all services available for this population of children (i) through age six and (ii) after age six; and to submit a report of its findings to the MH/DD/SAS Legislative Oversight Committee by September 1, 2011. This bill was filed on February 10 and has not yet been referred to a committee. 

HB 86, Report on NC Clubhouse Programs (Insko, Earle Sponsors).  HB 86  seeks to require DHHS to report on the services provided by Clubhouse Programs, including a description of the types of clubhouse programs available; the specific services available in each type of clubhouse program, actual cost of services provided by each type of clubhouse program,  and the current reimbursement rate for services provided by clubhouse programs.  This bill was filed on February 10 and has not yet been referred to a committee.

HB 87, Sunshine Amendment (LaRoque, Moore, T. Sponsors).  HB 87 seeks to put a proposed Constitutional Amendment on the November, 2012 ballot that would add an amendment to the state Constitution regarding access to public records and meetings.  The bill was filed on February 10 and has not yet been referred to a committee. 

SB 8, No Cap on Number of Charter Schools (Stevens sponsor). This bill eliminates the existing cap of 100 charter schools with a number of modifications to the charter school statute. As discussed in last week's bill update, a subcommittee of the Senate Education committee met on Wednesday to discuss the bill and debate amendments.  A number of amendments to the bill were adopted.  Of particular note, an amendment to the bill by Senator Soucek changes the commission proposed in the prior Proposed Committee Substitute to an advisory body to the State Board of Education, rather than an independent entity.  Several proposed amendments were discussed but not voted on, many of which contained language that would strengthen the protections for students with disabilities.  Disability Rights NC continues to advocate for modified language to ensure inclusion of students with disabilities of all socioeconomic levels in charter schools.

SB 13, Balance Budget Act of 2011 (Stevens, Brunstetter, Hunt sponsors). SB 13 seeks to reduce the current year's budget by at least $400 million, and directs transfers from various funds. It passed the House and Senate this week and is on its way to be vetoed or signed by the Governor.


SB 22, APA Rules: Increasing Costs Prohibition (Brown, Rouzer sponsors). SB 22 seeks to limit new agency rules by amending GS 150B-19 to add that an agency may not adopt a rule that results in additional costs on persons subject to the rule unless the rule adoption is required to respond to a serious and unforeseen threat to the public health, safety, or welfare, an act of the General Assembly or United States Congress that expressly requires the agency to adopt rules, a change in federal or State budgetary policy, a federal regulation, or a court order. The bill received a favorable report from the Senate Committee on Agriculture/Environment/Natural Resources, and was voted on favorably in the full Senate.  The bill will now be go to the House.

SB 53, Disapprove Closure of Dorothea Dix Hospital (Stein, Blue Sponsors).  This is the Senate version of the earlier filed House bill, HB  4, to disapprove the closure of Dorothea Dix psychiatric hospital.  the bill was filed on February 9 and referred to the Senate Committee on Mental Health and Youth Services.


SB 58, Modify FMAP Cuts/Authorize Use of Credit Balance (Brunstetter, Hunt, Stevens Sponsors). SB 58 seeks to prevent reductions in Medicaid provider rates and retirement system contributions to "backfill" the expiring funds from the temporary increased FMAP (the federal Medicaid match) received under the Recovery Act.  It also authorizes the use of $125 million of the funds in the unreserved credit balance on June 30, 2010 to address Medicaid liabilities incurred in the 2009‑2010 fiscal year.  SB 58 was filed on February 9 and has been referred to the Senate Appropriations committee.


SB 60, Lupus Awareness Month  (Robinson Sponsor).  SB 60 seeks to designate May as Lupus Awareness Month.  It was filed on February 10 and has not yet been referred to a committee.

NC Budget Update Week of February 7

From legislation directing the governor to make changes to the current year's budget to daily Appropriations meetings, the budget continued to be a hot topic this week.  House and Senate Appropriations subcommittees (i.e., HHS, Education, Justice & Public Safety, etc.) met Tuesday, Wednesday and Thursday to hear an overview of each department's budget and began hearing presentations from department and division heads about where the money goes and implications of budget reductions in the coming year.  Highlights from the Health and Human Services subcommittee meetings are below, after a summary of the budget planning calendar and subcommittee guidance and along with a summary of relevant legislative action.
House and Senate Appropriations 2011 Budget Planning Calendar

• February 8, 9, 10, 15: Departments present to Subcommittees (exact schedule varies by sub-committee)
• February 16: Full Appropriations Meeting to hear Governor's budget
• February 17: Review of Governor's Proposed HHS Budget
• (Depending on subcommittee - on HHS subcommittee calendar) February 22 and 23 Interested Parties Public Hearing
• (Depending on subcommittee - on HHS subcommittee calendar) February 24 Presentations by Various Groups by Invitation
• Joint budget meetings and process continues through March
• April 4-15: House Budget developed
• April 17: Publish House budget
• April 20-22: House Readings and votes on House Budget
• April 25 - May 6 Senate Budget developed
• May 8: Publish Senate Budget
• May 11-13 Senate Readings and votes on budget
• May 14 - 26 Conference Committee meets on budget
• May 27: Publish Conference Committee Report
• May 30 - June 1: Readings and votes on final budget

House and Senate Appropriations Subcommittee Guidance
Subcommittees were given guidance for developing the budget.  I will not go through all 13 points, but of particular note are the following:

• Focus funding on the core functions of each agency (Constitutional requirements, state and federal mandates, prioritize other programs)
• Manage growth in mandatory programs
• Consider reduction strategies that, among other listed strategies, streamline and consolidate departments, programs, offices, and services; reduce non-profit funding; minimize the loss of non-state revenues; utilize privatization and restructure contracting practices
• Subcommittee reports should not include expansion funding and should not include negative reserves or "management flexibility" reductions

Highlights of HHS Appropriations Meetings

Tuesday began with an overview of the HHS budget by the Fiscal Research division

• HHS is 20.83% of the General Fund budget (2d to Education, which is 57% of the budget)
• Make-up of the DHHS $3.9 billion budget: 60% Medical Assistance; 18% MH/DD/SAS (community based services and state-operated facilities); Child Development 6%; Social Services 5%; Public Health 4%

On Wednesday, DHHS Secretary Lanier Cansler provided an overview of the department and the consequences of any further reductions.  He emphasized how far-reaching DHHS services are, Maintennace of Effort requirements, and the importance of leveraging federal funds.  Reports from divisions began with the Division of Medical Assistance (Medicaid).  Of particular note:

• 60-70% of residents of nursing homes, adult care homes and assisted living facilities receive services through DHHS.
• Payments for services account for 98% of total expenditures in Medicaid.  Of that 98% for services, the breakdown is: 30% acute medical; 26% foundation services(physician, prescription drugs, case management and transportation); 23% behavioral health; 15% long term residential; and 6% premiums
• Children account for 55% of total enrollment but their expenditires only represent 26% of payments made for services.
• Medicaid spends an average of $6300 per enrollee per year.

On Thursday, reports from the DHHS divisions continued, with the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS), Division of Public Health and the Division of State Operated Healthcare Facilities (DSOHF) presenting.

• Of the 281,699 people served by the DMH/DD/SAS, 196,319 are served through the state's Medicaid program.
• DMH/DD/SAS total expenditures $578,825,453 = $446,896,775 (state) + $131,928,678 (federal)
• DSOHF budget breakdown: Psychiatric hospitals (53% of DSOHF total budget & 80% of DSOHF appropriated budget, 51% receipts, 49% state appropriations); Alcohol and Drug Abuse Treatment Centers (5% of DSOHF total budget & 15% of appropriated budget, 10% receipts, 90% state appropriations); Neuro-medical Treatment Centers (13% of DSOHF total budget & 1% of appropriated budget, 97% receipts, 3% state appropriations); Wright and Whitaker Schools (1% of DSOHF total budget & 2% of DSOHF appropriated budget, 57% receipts, 43% state appropriations); Developmental Disability Centers (28% of DSOHF total budget & 2% DSOHF appropriated budget, 98% receipts, 2% state appropriations).
• The state psychiatric hospitals served 7188 individuals in FY 10.  Length of stay of 7 or fewer days has decreased from 50% in FY07 to 27% in FY10. On ER wait times, it was stated that the average wait is over two days and 60% waiting for a bed are eventually admitted. The readmission rate has gone from 10% to 3-4%.
• The Developmental Centers served 1323 individuals in FY10.
• The Wright and Whitaker schools served 91 children and adolsecents in FY10.

Senate Bill 13, Balance Budget Act of 2011


This bill, summarized in last week's budget post, passed the House and Senate this week and is on its way to be vetoed or signed by the Governor.  SB 13, sponsored by Senators Stevens, Brunstetter and Hunt, seeks to reduce the current year's budget by at least $400 million, and directs transfers from various funds.

NC Division of MH/DD/SAS Implementation Update #85

Implementation Update #85 contains information about the following:


Implementation of the NCCI

CABHA Electronic Commerce Requirements

Auth/Billing prior to CABHA Enrollment

CST, IIH, DT after January 1, 2011

Endorsement Triple Time Frames

CABHA: Changes of Ownership

Billing "Incident to" the MD

Revision to Level III/IV Discharge Plan

FAQ Regarding MST Implementation

6-Hour PCT/Recovery Training elements

Medicaid Policy Updates

Prior Approval Additional Information Request

CAP/MR-DD UR by LMEs FAX Numbers

Supports Intensity Scale Update

CAP-MR/DD Update: Self Direction

T1999 Supplies for CAP-MR/DD

Post-Payment Reviews by PCG

Bill Update for Week of January 31, 2011

Action on Bills of Interest to People with Disabilities – Janury 31 - February 3, 2011
HB 2, Protect Health Care Freedom (Barnhart, Stam, Hollo, Murry sponsors). This bill seeks to prevent the implementation of the Affordable Care Act (i.e., healthcare reform legislation) provision that mandates individual health insurance. It also mandates that the Attorney General shall either join or bring a lawsuit challenging this provision. This bill was filed on the first day and heard in the Judiciary I committee on the second day of the session. It passed the House on February 2, 2011 after lengthy debate and largely partisan vote (Reps. William Brisson (D-Bladen) and Jim Crawford (D-Granville) voted with the Republican majority, 3 Republican Members had excused absences and Speaker Tillis did not vote).  The bill has now been referred to the Senate Judiciary II committee, where it will be heard in committee on Tuesday, February 8 at 10 am. (There was a companion bill filed in the Senate on February 1, SB 23, Protect Health Care Freedom (Rouzer, Clary, Pate sponsors), but the Senate will be proceeding on the House bill.)

For more on HB 2 - See Health Access Coalition piece here.
And for more information on the latest court ruling related to other states' challenges to the individual mandate under the ACA, see this piece from NHeLP.

HB 4, Disapprove Closure of Dorothea Dix Hospital (Weiss, Ross, Jackson sponsors). This bill disapproves the closure of Dorothea Dix Hospital. It does not address where the funds to operate the hospital would come from. This bill was re-referred to the House Committee on Government last week but has not been scheduled.

HB 28, DHHS to Provide Law Enforcement Information (Burr, Guice, Randleman, Ingle sponsors). This bill seeks to require NC DHHS to provide law enforcement officers with certain personal information of any individual receiving services from DHHS for the purposes of furthering an investigation or locating a fugitive. The bill does state that information prohibited by federal law from being released (such as protected health information) is not subject to disclosure. The bill was filed in the House on February 1 and referred to the House Judiciary Subcommittee B.

HB 41, Tax Fairness in Education (Stam, Brawley, Collins and Hager sponsors). This bill creates an income tax credit of $1,250 for families whose dependent children are educated in a nonpublic school. For initial eligibility, the child shall have been enrolled in and attended at least 2 semesters in a public school in the preceding tax year. Taxpayers must meet taxable income criteria to qualify: $100,000, Married, filing jointly, $80,000 Head of Household, $60,000 Single and $50,000 Married filing separately. The bill also permits boards of county commissioners to appropriate funds (up to $1,000 per child per year) for the expenses of children educated in nonpublic schools. This is NOT the bill that was filed during the last session related to tax credits for students with disabilities. The bill was filed in the House on February 3 and has not yet been referred to a committee.

SB 8, No Cap on Number of Charter Schools (Stevens sponsor). This bill eliminates the existing cap of 100 charter schools. A 23-page Proposed Committee Substitute for SB 8 was heard in the Senate Education committee on Wednesday, February 2. The committee members debated the bill, with many questions concerning the constitutionality of the newly proposed oversight commission, the funding provisions and concerns about diversity in the charter schools. Because of a lack of time, the public comment was limited to 4 people, 2 “for” and 2”against.” The committee did not vote on the bill at that time and the bill has been referred to a sub-committee consisting of Senators Preston, Tillman, Soucek, Stevens, Graham and Stein, which will meet on Wednesday, February 9 at 10 am. Disability Rights NC is working with the School Boards Association, the State Board of Education, the NC Justice Center, the NC Association of Educators, NC Association of School Administrators and the NC Public School Forum to advocate for modified language to ensure inclusion of students with disabilities of all socioeconomic levels in charter schools.

SB 13, Balance Budget Act of 2011 (Stevens, Brunstetter, Hunt sponsors). SB 13 seeks to reduce the current year's budget by at least $400 million, and directs transfers from various funds. Any savings realized from this year’s budget would offset next year’s projected deficit, but our Constitution doesn’t allow the Governor to change approved appropriations except when there are threats the budget will be out of balance at year’s end. Thus, in an effort to reduce the budget gap for the coming year, legislators are seeking to direct the Governor to make further reductions. The bill is expected to be passed by the Senate on Monday. It will then go to the House.

SB 22, APA Rules: Increasing Costs Prohibition (Brown, Rouzer sponsors). SB 22 seeks to limit new agency rules by amending GS 150B-19 to add that an agency may not adopt a rule that results in additional costs on persons subject to the rule unless the rule adoption is required to respond to a serious and unforeseen threat to the public health, safety, or welfare, an act of the General Assembly or United States Congress, a change in federal or State budgetary policy, a federal regulation, or a court order. This bill was filed in the Senate on February 1 and referred to the Senate Committee on Agriculture/Environment/Natural Resources.

SB 33, Medical Liability Reforms (Rucho, Apodaca, Brown sponsors). SB 33 seeks to limit medical liability claims through several reforms including a higher standard for liability when providing emergency medical care, ordering bifurcation upon motion of any party, and limiting the amount of noneconomic damages that may be awarded. The bill was filed in the Senate on February 2 and referred to the Senate Judiciary I committee. Disability Rights NC does not represent individuals in any type of personal injury or medical malpractice actions. However, this bill will likely be of interest to the disability community, so this summary is provided for informational purposes.

February 3 US HHS Secretary Letter to State Medicaid Directors

Secretary Sebelius reminds state Medicaid Directors of the flexibility of the Medicaid program and where cost savings can be achieved, without reducing eligibility or eliminating services altogether.  Read the letter here and the Enclosure with more detailed information here.  Of particular note, she states the following:

•Managing Care for High-Cost Enrollees More Effectively. Just one percent of all Medicaid beneficiaries account for 25 percent of all expenditures. Initiatives that integrate acute and long-term care, strengthen systems for providing long-term care to people in the community, provide better primary and preventive care for children with significant health care needs, and lower the incidence of low-birth weight babies are among the ways that States have improved care and lowered costs. For example, children’s hospitals adopting a medical home model to manage the care of chronically ill children have accomplished impressive improvements in health and reductions in cost. One Florida children’s hospital reduced emergency room visits by more than one-third, and reduced hospital days by 20 percent. These delivery models and payment strategies can be implemented by hospitals and States without seeking a Federal waiver, and we are exploring ways that we might provide further support for such initiatives.


In addition, the Affordable Care Act offers new Medicaid options that provide States with additional Federal matching funds. For example, States can now benefit from a 90 percent Federal matching rate for coordination of care services provided in the context of a health home for people with chronic conditions. Additionally, the Community First Choice Option, available in October, will offer States a six percent increase in the Federal matching rate to provide certain person-centered long-term care services and supports to enhance your efforts to serve beneficiaries in community-based settings.

and

Beyond these areas of flexibility that could produce short-term savings, we are actively moving forward in areas that could lower costs in the long run. In particular, we are focused on how to help States provide better care and lower costs for so called “dual eligibles,” seniors and people with disabilities who are eligible for both Medicaid and Medicare. These individuals represent 15 percent of Medicaid beneficiaries but nearly 40 percent of all Medicaid spending. This population offers great potential for improving care and lowering costs by replacing the fragmented care that is now provided to these individuals with integrated care delivery models. The new Federal Coordinated Health Care Office has already released a solicitation for up to 15 States to receive Federal support to design new models for serving dual eligibles. We also plan to launch a Department-wide effort to reduce the costs of health care by improving patient safety in Medicare, Medicaid and throughout the private health care system, and States will be critical partners in this effort. We welcome other ideas on new models of care, including new ways to deliver care that encourage investment and yield savings.


Her letter is getting mixed responses from the disability community.  Click here for an article on Disability Scoop.

NC Budget Update - Week of January 31, 2011

It's early February and we are already focused on the budget down at the NC General Assembly.  Joint Senate and House Appropriations and Finance committees met this week.  Appropriations has already set an ambitious schedule to complete the 2011-12 budget by June, and the Senate took up a bill to restrict the 2010-11 budget. 
The full House and Senate Appropriations committees met on Tuesday, February 1.
Staff (Barry Boardman) gave an overview of the General Fund very similar to that given in December 2010. (See previous blog post and Fiscal Research Division handout here)

• He again discussed the state tax structure - personal income tax proportion has grown, sales tax base shrinking, rates have increased; corporate income tax and non-witholding tax volatile
• We usually use a consensus revenue process for the budget – forecasters develop forecast but a revised forecast can be requested in early May
• 2010-11 revenues so far – right on target for meeting the $9.4 billion target, key resources have started to rebound
• Sales tax collections have improved

Staff (Richard Bostic) gave an overview of the state budget, again, like the presentation given back in December. 

• Areas of Budget Growth: Medicaid caseload grew 62.6% from 2000 - 2010; UNC and community colleges grew; Increases for 2011-12 in state retirement, state health plan, education enrollment growth, medicaid - est $21.6 billion budget
• Budget drivers - Education: (increased enrollment, 99% of budget goes to LEAs) already $305 mil in Recurring cuts, Options for reduction: class sizes, optional spending like salary supplements and capital but must still provide uniform syatem of public schools; Universities: $170 mil cuts to universities but allowed tuition increases, funded $180 mil in enrollment growth to community colleges, cut $29 mil via management flexibility cuts, increased tuition costs; Medicaid - 12% of general fund; 98% of budget goes to providers, already reformed and reduced services, reduced provider rates, Options for reduction: eliminate, restructure or reduce $1.1 bil in optional services, or institute new payment and performance strategies BUT there are legal entitlement issues, almost impossible to reduce eligibility, Affordable Care Act implications; Corrections - $1.3 bil operating budget, 7% of General Fund, 3.9% growth rate, prison personnel 66% of budget, have already closed 7 prisions, eliminated 1,033 positions, reduced inmate medical costs, expanded in-house inmate medical capacity, Option for reduction: reform sentending policies and laws for misdemenanats and habitual felons, reform probation polciies/ procedures (reduce revocations), constrained by current and projected shortage of prison beds, costs of use of local jail beds are mounting ($11.8 mil/year)
• Other spending pressures - rainy day fund, transportation (highway maintenance budget short each year), unemployment debt to federal government
• Other states - 29 states cut medicaid serices.
• Estimated budget reductions for 2009-2010: $5.7 bil cut over the two years, but there were ARRA funds, fund transfers - estimated $1.4 bil actual cuts.

February 2 Meeting of Budget Chairs
On Wednesday morning Appropriations Committee Chairs released a timeline for crafting the budget and instructions for the sub-committee chairs. Sub-committee chairs are not allowed to include any expansion items or new spending in proposed budgets. ‘Management flexibility’ cuts will not be allowed; this means that legislators will have to articulate exactly what programs they plan to cut, rather than asking departments to hit large spending reduction goals.


Here’s the timeline:

• 4/22 – House passes its budget proposal
• 5/14 – Senate passes its budget proposal
• 6/1 – Conference Report is approved by both chambers and sent to the Governor

Appropriation sub-committees start meeting next week on Tuesday, February 8
8:30 AM Appropriations on Department of Transportation (Senate) 1327 LB


8:30 AM Appropriations Subcommittee on General Government (House) 1425 LB

8:30 AM Appropriations on General Government and Information Technology (Senate) 1425 LB

8:30 AM Appropriations on Justice and Public Safety (Senate) 415 LOB

8:30 AM Appropriations Subcommittee on Transportation (Joint) 1327 LB

8:30 AM Appropriations Subcommittee on Justice and Public Safety (Joint) 415 LOB

8:30 AM Appropriations Subcommittee on Education (Joint) 421 LOB

8:30 AM Appropriations Subcommittee on Natural and Economic Resources (Joint) 424 LOB

8:30 AM Appropriations Subcommittee on Health and Human Services (Joint)


Senate Bill 13, Balance Budget Act of 2011
On Thursday morning, the Senate debated SB 13, sponsored by Senators Stevens, Brunstetter and Hunt, seeking to reduce the current year's budget by at least $400 million, and directs transfers from various funds. Any savings realized from this year’s budget would offset next year’s projected deficit, but our Constitution doesn’t allow the Governor to change approved appropriations except when there are threats the budget will be out of balance at year’s end. Thus, in an effort to reduce the budget gap for the coming year, legislators are seeking to direct the Governor to make further reductions.  At this point, no one knows where the money will come from - finding $400 million over the next three months is going to be awfully difficult.

SB 13 also identifies some $165 million in savings from about 20 accounts, including $67.5 million from the Golden Leaf Foundation, $11.7 million from the Health and Wellness Trust Fund, $13.6 million in various unspent appropriations, $3 million from Job Development Investment Grants and $5.2 million from the One North Carolina Fund.
The bill is expected to be passed by the Senate on Monday evening after some further adjustments.