Administrative Procedure Oversight Committee Recommendations

The Joint Legislative Administrative Procedure Oversight Committee met on Wednesday, December 19th to discuss several reports, the committee recommendations, and areas of future study.  Of note:

• Judge Julian Mann, Chief Administrative Law Judge with OAH, and Melanie Bush, Assistant Director of Administration at DMA, reported that a decision on the waiver request for final decisions in Medicaid cases is expected by the end of the month.
• The committee is recommending a new proposal to eliminate unnecessary boards and commissions. In contrast to the legislation filed last year, this only recommends repeal of boards that have no members, no funds, and/or have not met in several years.  However, the committee also recommends that the Appropriations committees review the list of legislatively created boards and commissions in connection with their review of state agency budgets.  They should consider elimination, reduction, or consolidation of boards and commissions which are deemed unnecessary, too large, or redundant.
• There were also a few items of interest on the list of issues for future consideration: (1) Policies adopted by agencies that do not go through the rulemaking process: there was a discussion using DPI as an example; and (2) amending the APA to broaden the category of appeals that proceed to the Court of Appeals directly.

The committee voted to approve its draft recommendations, so that should be the last meeting until after the 2013 session.

Blue Ribbon Commission on Transitions to Community Living Final Report

The full Blue Ribbon Commission met on Wednesday, December 19th to approve its full committee report and recommendations. The subcommittees met last week to hear some last presentations and to approve the subcommittee reports to the full commission.  The full report (online here) incorporates all of these recommendations, which are briefly listed below:

Housing Subcommittee Recommendations:

1. Explore Alternatives for Large Adult Care Homes.
2. Mitigate the Loss of Medicaid Eligibility by those Exiting an Adult Care Home.
3. Establish a Long-Term Care Continuum Workgroup.
4. Explore establishing a process to allow payment to be paid on behalf of a resident who has last their eligibility for PCS.
5. Study Tiered PCS.
6. Study the State-County Special Assistance Rate Structure.
7. Establish Habilitation Services for IDD Adults using a 1915(i) option.
8. Explore service delivery options for individuals with mental illness.
9. Expand the number of CAP-IDD (Innovations) slots.

Adult Care Home Subcommittee Recommendations:

1. Direct expanded funding to the Housing Trust Fund, Key Program and other housing assistance programs to increase the number of permanent housing units.
2. Any funds unspent from the money allocated (e.g. the $10.3 million this year) should revert to the Housing Trust Fund, to be placed in a special reserve account, and be used to provide supportive housing to persons with mental disabilities.
3. Evaluate the capacity of the databases used by state agencies to monitor the inventory of available rental housing.
4. Explore the possibility of increasing the percentage of Targeted Units in new developments from 10% to a greater percentage.
5. Develop a plan to establish a tenant-based rental assistance program specifically designated for the 3,000 persons who must be transitioned to community-based housing as required by the US DOJ settlement agreement.
6. Encourage LMEs to form partnerships with existing non-profit and other agencies that currently provide supportive housing assistance and other services to persons with disabilities in home and community-based settings.
7. Directs DHHS and the LMEs to determine additional services and resources needed to support the tranistion of the 3,000 people with mental illness from adult care homes to community based settings by 2020.
8. Direct DHHS and LMEs to identify assistive technology that can be used to divert or transition people with mental disabilities from institutional settings; and a plan to maximize the use of assistive technology in the implementation of the US DOJ settlement agreement.

Reports to the HHS Committee

FYI - reports made to the Joint Legislative Oversight Committee on Health and Human Services are posted online.  It includes reports from certain non-profits that receive state funds as well as DHHS reports on LME Efforts in Mental Health Crisis Management and the MH/DD/SAS Statewide report.

Joint Legislative Subcommittee on Mental Health Meeting

The Joint Legislative Oversight Committee on Health and Human Services, Subcommittee on Mental Health met on Monday, December 10 to discuss the following items.  The committee also discussed proposed committee recommendations.

• Laura White, Division of State-Operated Healthcare Facilities, presented on the history and process of determining facilities' catchment areas.  In the past, the Division attempted to keep all counties served by a single LME in the same region and thus served by a single state  facility.  However, the increased size of LMEs will prevent this in the future.
• Beth Melcher presented on Three-way contract Payments, in follow-up to questions raised at the last committee meeting.  They are proposing that hospitals that have had trouble being paid promptly can submit an alternative claim directly to state (the claims must go through the LME now).  The LMEs still need to manage and pay long-term but this will help with cash flow issues for now.  There was also discussion about using a higher rate for higher acuity patients to be served in certain units (but not numbers or specifics).  They are due to review the rates in 2013.
• Sheila Davies from the Albemarle Hospital Foundation and Edward Spencer from the South Carolina Division of Mental Health discussed the use of Telepsychiatry.  Ms. Davies spoke about a grant-funded expansion in NC that is showing reduced length of stay, reduced readmissions, patient satisfaction on surveys, and reduction of unnecessary Involuntary Commitments (223 IVCs overturned). She also discussed their challenges to growth: credentialing/privileging with multiple LMEs, navigating the Medicaid waiver with LMEs, sustainability (indigent care reimbursement), limited resources (bed availability, lengthy wait times for outpatient referrals, and law enforcement strain).  Mr. Spencer discussed the expansion of telepsychiatry in South Carolina. They have reduced length of stay by 50%; 43% of patients are discharged the same day as the consult; and reduced involuntary commitments by 60%.
• Mark Botts from the School of Government gave an overview of the Involuntary Commitment process in North Carolina.  Mr. Botts highlighted the laws and procedures, as well as areas where there are issues or a lack of knowledge, including underutilization of outpatient commitment (vs. inpatient); the stress of law enforcement for transportation, particularly when no beds available; and the need for better communication between LMEs and magistrates.
• Finally, there were presentations from the NC IOM, Durham Veterans Administration, and National Guard regarding services for members of the military and veterans with PTSD.

Proposed Findings and Recommendations to HHS Oversight were discussed:

• To direct DHHS to determine the cost to increase the number of beds in state psych hospitals, explore creating a south central mental health region, and investigate the possibility of placing a new psych facility in that region.
• Work with community hospitals to develop a plan to revise three- way contract payments from a single rate model to a tiered rate structure based upon the patient's acuity level.  Submit a plan by October 1, 2013.
• Direct DHHS to investigate, develop and provide incentives to increase the overall supply of psychiatrists, psychologists and other MH professionals, especially in rural and underserved areas of the state.  Submit a written report by Oct 1, 2013.
• Members also mentioned adding recommendations  around training on Veterans' issues and telepsychiatry.

Legislative Meetings Week of November 12

Lots of meetings related to disability issues at the General Assembly this week!  See below for a brief summary from HHS Oversight and the Blue Ribbon Commission on Transitions to Community Living Housing and Adult Care Home subcommittees.

November 13 HHS Joint Legislative Oversight Committee

The committee discussed NC PreK, the status of the Medicaid budget, the 1915 b/c waiver update and midwife licensure.  Here are some highlights:

• Handouts are available online here.
• During the NC PreK discussion, there was surprisingly little discussion about the programs from which funds were taken for additional PreK funds.  Secretary Delia did comment on the funds taken from the AIDS Drug Assistance Program - he stated that they have eliminated the waitlist and expanded the program back to previous levels, covering people up to 300% of the Federal Poverty Level.  The committee focused its comments on the effect of the court's decision invalidating copays, arguing that the copay structure would allow 3,000 additional slots.
•   Like last month's report on the Medicaid budget, the Department reports that they are on track.
• During the Update on the 1915 b/c waiver expansion, it was reported that 56 counties are now operating under the 4 existing LME/MCOs (Cardinal Innovations (PBH), Western Highlands, ECBH and Smoky Mountain Center).  Sandhills  is set to begin December 1, with Guilford County to be added in April 2013.  Readiness reviews are scheduled for November and December for Partners BHM, Alliance BHC, CenterPoint HS, Eastpointe, Coastal Care (anticipated start 2/1/13), and MeckLink (anticipated start 2/1/13).  If any LME is not prepared to start by 2/1/13, they will be transitioned to another LME-MCO.  With regards to Western Highlands, Mercer performed an on-site audit on October 4, identifying several needs but also areas of progress.

November 14 Blue Ribbon Commission on Transitions to Community Living Adult Care Home Subcommittee Meeting

• Handouts are available online here.
• Tara Larson from DMA addressed the status of Adult Care Home IMD designations and Personal Care Service changes in response to a series of questions posed by the subcommittee. The complete document is posted at the link above.  Of particular note: the PCS SPA is expected to be approved by CMS by late November, and notices of reductions and terminations will be sent by January 1; and a draft outline for a 1915(i) option for personal assistance for adults with I/DD will be submitted to CMS by November 30, with a target implementation date of July 1, 2013.  From Jan to June, the department will plan for more accurate predictions of costs and number served; explore 2 additional services, meaningful day activity and respite; seek legislative approval; and consider the inclusion of the 1915(i) under the 1915 (b)/(c) waiver.  It was also reported that a denial of the 1915(i) application to cover Special Care Units is expected.
• There was also a report on the state/county Special Assistance (SA) program.  It was reported that approximately 27% of all SA recipients in licensed facilities have income above the federal poverty level and will not qualify for Medicaid in a private living setting.  Of the estimated 9,322 individuals in licensed facilities who will no longer qualify for PCS, approximately 2500-2900 will not qualify for Medicaid and SA-in-home outside of the facility.
• Fiscal Research staff reported on a survey of 14 other states that license facilities similar to adult care homes and provide state funding for such facilities.  North Carolina has the highest number of residents, and the highest number of facilities.  States that have comparable numbers of facilities and residents are not funded by the state.
• Janet O'Keeffe from RTI addressed the committee about options for the future from the perspective of someone who has performed research in the area of long-term care.  She discussed how licensing rules and level of care criteria can be used to develop a mix of care options.  For example, she discussed how the lowering of nursing home level of care criteria can drive the expansion of a home  and community based waiver, creating more community options.  

November 14 Blue Ribbon Commission on Transitions to Community Living Housing Subcommittee Meeting

• Beth Melcher presented the draft plan for the DOJ settlement implementation, including budget estimates.  The budget projections begin at $6.95 mil for the partial '12-'13 fiscal year and increase gradually to $56.95 mil in fiscal year '19-20 (state dollar expenditures).
• There was also a presentation from the LME perspective about their needs in the DOJ implementation, including the results of a survey of all of the LMEs.  Among other items, the survey asked for an estimated annual cost to provide services to support community based housing for individuals with mental illness.  Some LMEs did not have an answer but several provided very specific cost information.
• The NC Housing Coalition also presented to the committee, recommending that the state support and expand existing state housing resources, create a well-funded state tenant based rental assistance program, elevate the visibility and priority of the Office of Housing and Homelessness at DHHS, and provide adequate funding to support proper staffing at all levels. 

If you have any questions, please let me know!

Disability Rights NC Applauds Settlement

North Carolina has settled with the US DOJ to resolve violations of the ADA statement here. http://disabilityrightsnc.org/sites/default/files/2012-8-23%20Press%20Release.pdf

Final 2012 Budget Summary

HB 950, Adjustments to the 2011 Budget

The budget was passed largely along party lines in June.  On June 29, the Governor vetoed the budget.  On July 2d, the Senate and House voted to override the Governor’s veto, with 6 House democrats joining Republican lawmakers for the override vote: Reps. Brandon, Crawford, Hill,  Brisson, Jackson and McLawhorn.  Several modifications to the budget were also passed in the Technical Corrections (SB 847) and Budget Technical Corrections (SB 187) bills.  The summary below reflects these modifications.

Education Budget

• ·         Raises the amount allocated per student with a disability to $3,709 per child (was $3,585.88/child).  Allotment cap of 12.5% of an LEA’s ADM remains in place.
• ·         LEA Adjustment Reduction - $143 mil to reduce cuts to LEAs, still leaves huge shortfall from expiring federal funds used to curb previous cuts.
• ·         Residential Schools - None will be closed.  Restores $4.7 mil of cuts. Section 7.3 discusses School Improvement Plans, Section 7.8 repeals consolidation.
• ·         Excellent Public Schools Act (Section 7A): $27 mil: developmental screening and Kindergarten entry assessment; elimination of social promotion; reading development for retained students; school performance grades; establishes NC Teacher Corps; allows for local plans for performance pay.

Health and Human Services Budget

Division of Medical Assistance

• ·         Makes several adjustments to savings to be achieved: $59 mil in additional CCNC savings; Reduced savings expected from 1915 b/c waiver transition by $1.7 mil due to delays in implementation; $3.8 mil savings from fraud, waste and abuse prevention; Restructure Fee for Service for $2 mil savings; $14 mil CHIPRA bonus; $15 mil for cost settlements with providers and fraud, waste and abuse initiatives; $6 mil reduction associated with changes to PCS program (see below); and Management flexibility reductions across other departments to achieve savings for Medicaid program.
• ·         Limits on Speech Therapy, Physical Therapy and Occupational Therapy for adults are repealed.
• ·         Cost of Living Adjustment (COLA) disregard (Section 10.6):  Income disregard for Medicaid effective January 1, 2013, with a sunset of December 31, 2017.
• ·         Medicaid Non-Emergency Medical Transportation: directs DMA, in consultation with DOT, to develop and issue a Request for Proposal (RFP) for the management of nonemergency medical transportation services for Medicaid recipients.
• ·         Pharmacy services (Section 10.8): $24 mil in projected savings from increased use of generics, and adds expanded prior authorization to save $5.3 mil; special pharmacy program for hemophilia drugs.
• ·         State Auditor Audit of DMA (Section 10.9A)
• ·         PED/FRD Study of Medicaid Organization (Section 10.9B): The Program Evaluation Division and the Fiscal Research Division of the General Assembly shall jointly study the feasibility of creating a separate Department of Medicaid and make a joint recommendation on this issue to the 2013 Regular Session of the General Assembly no later than February 15, 2013.
• ·         Removes DHHS authority to reduce provider rates or services.
• ·         Special Care and Memory Care Units: Directs DMA to submit to CMS by September 15 an application for a home- and community-based services program under 1915(i) for individuals who (i) are typically served in special care and memory care units that meet the criteria of the State-County Special Assistance Program  and (ii) have been diagnosed with a degenerative, irreversible disease that attacks  the brain and results in impaired memory, thinking, and behavior.
• ·         Changes to Personal Care Services: Directs implementation of PCS for recipients who have a medical condition, disability, or cognitive impairment and demonstrates unmet needs for, at a minimum, (i) three of the five qualifying activities of daily living (ADLs) with limited hands-on assistance; (ii) two ADLs, one of which requires extensive assistance; or (iii) two ADLs, one of which requires assistance at the full dependence level.   The five qualifying ADLs are eating, dressing, bathing, toileting, and mobility.  The recipient resides either in a private living arrangement, a residential facility licensed by the State of North Carolina as an adult care home, a combination home as defined in G.S. 131E-101(1a), a 122C group home, or supervised living facility for individuals with MH/DD/SA.
• ·         Appropriations Contingent upon adequacy of funding for Medicaid budget (Section 10.9G): DHHS shall not expend funds appropriated for the following purposes until January 1, 2013, pending a determination by the Office of State Budget and Management that there is adequate funding for the Medicaid budget for the 2012-2013 fiscal year: (1) Funds appropriated to DCDEE for the NC Partnership for Children; (2) DMH/DD/SAS funds for additional psychiatric care beds at Broughton Hospital and additional local inpatient psychiatric beds or bed days available to LMEs and MCOs under the State-administered three-way contracts ($9 mil additional); and (3) funds appropriated to DPH for local community health and wellness initiatives.
• ·         Examination of the state's delivery of MH Services (Section 10.11): Directs the HHS Oversight committee to appoint a subcommittee to examine the State's delivery of mental health services.
• ·         AIDS Drug Assistance Program Pilot (Section 10.16)
• ·         Special Assistance In-home (Section 10.23) - keeps 15% cap (although can be waived by the Secretary) but equalizes the amount, all counties shall participate, a formula will be established.

Division of Child Development and Early Education

• ·         PreK - NO increase in final budget.  Directs DCDEE to continue implementation of the NC Pre-K program.  Includes chronic health and developmental disabilities as factors for eligibility requirements along with 75% of the state median income

Division of Central Management

• ·         $2.7 mil reduction for administrative efficiencies
• ·         Non-state entity pass-through funds - makes NR and mandates a 10% match for entities like Arc, Autism Society, and Easter Seals.  There is also a $5 mil reduction to nonprofits (Section 10.18), with language directing to minimize reductions to funds allocated to nonprofit organizations for the provision of direct services and shall not reduce funds allocated to nonprofit organizations to pay for direct services to individuals with developmental disabilities.

Division of Aging and Adult Services

• ·         Transitions to Community Living Initiative (10.23A): Provides $10.3 mil to support DHHS in its plan for transitioning individuals with severe and persistent mental illness into community living arrangements, including establishing a rental assistance program.  It also states that if the State executes an agreement with the USDOJ these funds shall be used to implement the requirements of the first year of the agreement or the plan, with a recurring appropriation to fully implement it.
• ·         Creates a Blue Ribbon Commission on Transitions to Community Living.
• ·         $39.7 mil for Short Term Assistance to Adult Care Homes for residents who no longer qualify for Personal Care Services.  It will provide a monthly stipend amount that will be reduced after three months and then phased out by June 30, 2013.

Division of Mental Health

• ·         No restoration of MH community service funds - $20 mil cut
• ·         3 way contracts - $9 mil increase Jan 1, 2013 contingent upon Medicaid
• ·         LME Admin Funds reduced by $8.5 mil
• ·         Cherry Hospital - funding for increased bed capacity (124 beds) at the new Cherry hospital $3.5 mil
• ·         Broughton Hospital - 19 additional psych beds $3.5 mil after Jan 1, 2013 if money not needed for Medicaid
• ·         Drug Treatment Courts - $2.3 mil eliminated

Division of Public Health

• ·         Medication Assistance Program - $1.7 mil NR in House budget
• ·         $4.9 mil to county health departments for community health and wellness initiatives, contingent upon Medicaid

Justice and Public Safety Budget

• ·         Department of Public Safety Management Flexibility Reductions – $26.3 mil – In implementing, the department shall NOT close the Bladen Correctional Center, reduce community program funding in either the Division of Adult Correction or Juvenile Justice, or eliminate any district level state highway trooper position
• 
  
• Juvenile Justice
• ·         Close Edgecombe YDC Jan 1, 2013.  Transfer 10 youth counselor associate positions, 5 to Chatham and 5 to Lenoir to increase their bed capacity.  Also directs a study of the use of the facility.
• ·         Multipurpose Group Home Funds (Section 14.6) - $550,000 for a multipurpose group home in Craven county.

Justice

• ·         $1.8 mil reduction to eliminate state funding to Consumer Protection division.
• ·         AGs must begin doing itemized bills for their work for agencies, must also do biannual reports.

General Assembly

• ·         Program Evaluation Division shall study the duties and services of the NC Human Relations Commission (which now handles fair housing complaints, among other civil rights issues) and the Civil Rights Division of OAH to determine whether there is unnecessary overlap and duplication of services and recommend the placement of the Commission and Division in the appropriate agency or agencies.

State Board of Elections

• ·         HAVA Funds/Disability Access:  Directs the State Board of Elections to retain HAVA Title II funds until MOE funds are appropriated, EXCEPT for voting accessibility funds under Section 261 of HAVA.

Salaries and Benefits

• ·         State employee and public school employee 1.2% salary increases

Office of the Governor – Housing Finance Agency

• ·         Housing Trust Fund - eliminates General Fund appropriation and appropriates $7.9 mil from Mortgage Settlement Agreement

General Government

• ·         Nonrecurring funding appropriated for the continued operation of the NC Sterilization Victims Foundation.

Budget Summary

Summary of 2012 Budget

The NC House and Senate came to an agreement this week on the 2012 budget. The total budget spends 2.5% more than the budget as approved last year.  Unfortunately, the budget does not include compensation for victims of North Carolina’s sterilization program.  The Governor now has 10 days to veto the budget.  The budget was approved by a veto-proof majority in both chambers so any veto would likely be overridden.  The legislature plans to adjourn as soon as possible after a veto override, which would be Monday, July 2d at the latest.

Below is a brief summary of the budget items related to the work of Disability Rights NC.  The full budget is online here.  The money report is online here.

Education Budget

·      LEA Adjustment Reduction - $143 mil to reduce cuts to LEAs, still leaves huge shortfall from expiring federal funds used to curb previous cuts

·      Residential Schools - None will be closed.  Restores $4.7 mil of cuts. Section 7.3 discusses School Improvement Plans, Section 7.8 repeals consolidation.

·      Section 7A Excellent Public Schools Act: $27 mil: developmental screening and Kindergarten entry assesement; elimination of social promotion; reading development for retained students; school performance grades; establishes NC Teacher Corps; allows for local plans for performance pay.

Health and Human Services Budget

Division of Medical Assistance

• $59 mil in CCNC savings
• Reduced savings expected from 1915 b/c waiver transition by $1.7 mil, due to delays
• $3.8 mil savings from fraud, waste and abuse prevention
• Restructure Fee for Service for $2 mil savings
• $14 mil CHIPRA bonus
• $15 mil for cost settlements with providers and fraud, waste and abuse initiatives
• $6 mil reduction associated with changes to PCS program
• Section 6.12 – Requires Medicaid disclosures to fiscal research (Senate budget item)
• Management flexibility reductions across departments to achieve savings for Medicaid program (Section 6.14): In order to provide adequate funds to cover any potential shortfall in the 2012-2013 Medicaid budget while minimizing the impact on State government services, the Director of the Budget shall ensure that cost savings required through the management flexibility reductions in this act are realized so that at least fifty percent (50%) of the cost savings are realized by December 31, 2012.
• Limits on ST/OT/PT repealed.
• COLA disregard (Section 10.6):  Income disregard for Medicaid effective January 1, 2013.  Sunset of December 31, 2017.
• Medicaid Non-Emergency Medical Transportation - develop an RFP for management.  House had $1 mil in associated savings, that amount is not in final budget.
• Pharmacy services (Section 10.8): keeps $24 mil in projected savings from increased use of generics.  Adds expanded prior authorization to save $5.3 mil; special pharmacy program for hemophilia drugs.
• Section 10.8A - Study electronic prior authorizations for prescriptions
• Section 10.9 Smart Card Pilot Program - $1 mil to implement
• Section 10.9A State Auditor Audit of DMA: The audit shall examine the program's effectiveness; results of the program; the utilization of outside vendor contracts, including the number, cost, and duration of such contracts; fiscal controls and Medicaid forecasting; and compliance with requirements of the Centers for Medicare and Medicaid Services and the requirements of State law.
• Section 10.9B PED/FRD Study of Medicaid Organization: The Program Evaluation Division and the Fiscal Research Division of the General Assembly shall jointly study the feasibility of creating a separate Department of Medicaid and make a joint recommendation on this issue to the 2013 Regular Session of the General Assembly no later than February 15, 2013.
• Section 10.9C: No authority to reduce provider rates or services:  DHHS shall not reduce Medicaid provider payment rates or Medicaid optional services except as otherwise provided to achieve Medicaid pharmacy program savings.
• 10.9E Special Care and Memory Care Units: DMA shall develop and submit to CMS an application for a home- and community-based services program under 1915(i) for elderly individuals who (i) are typically served in special care  and memory care units that meet the criteria of the State-County Special Assistance Program  and (ii) have been diagnosed with a progressive, degenerative, irreversible disease that attacks  the brain and results in impaired memory, thinking, and behavior. The home- and  community-based services program developed by the Department pursuant to this section shall  focus on providing these elderly individuals with personal care services necessary to ameliorate  the effects of gradual memory loss, impaired judgment, disorientation, personality change,  difficulty in learning, and loss of language skills.
• PCS 10.9 F added limited assistance with 3 ADLs: Directs implementation of PCS  for recipients who have a medical condition, disability, or cognitive impairment and demonstrates unmet needs for, at a minimum, (i) three of the five qualifying activities of daily living (ADLs) with limited hands-on assistance; (ii) two ADLs, one of which requires extensive assistance; or (iii) two ADLs, one of which requires assistance at the full dependence level.   The five qualifying ADLs are eating, dressing, bathing, toileting, and mobility.  The recipient resides either in a private living arrangement, a residential facility licensed by the State of North Carolina as an adult care home, or a combination home as defined in G.S. 131E-101(1a).
• Appropriations Contingent upon adequacy of funding for Medicaid budget (Section 10.9G): DHHS shall not expend funds appropriated for the following purposes until January 1, 2013, pending a determination by the Office of State Budget and Management that there is adequate funding for the Medicaid budget for the 2012-2013 fiscal year: (1) Funds appropriated to DCDEE for NCPC; (2) DMH/DD/SAS funds for additional psychiatric care beds at Broughton Hospital and additional local inpatient psychiatric beds or bed days available to LMEs and MCOs under the State-administered three-way contracts ($9 mil additional); and (3) funds appropriated to DPH for local community health and wellness initiatives.
• Examination of the state's delivery of MH Services (Section 10.11): Directs the HHS Oversight committee to appoint a subcommittee to examine the State's delivery of mental health  services. As part of its examination, the subcommittee shall review all of the following:  (1)  The process for determining the catchment areas served by the State's psychiatric hospitals, with consideration of both of the following:   (a) Factors used in assigning the geographic groupings of local management areas and managed care organizations into catchment areas. (b) Alternatives to the current process for determining the catchment areas served by the State's psychiatric hospitals, including a determination of whether there is a more efficient and equitable manner of assigning hospital catchment areas. The subcommittee shall report its findings and recommendations to the Joint Legislative Oversight Committee on Health and Human Services  on or before January 15, 2013, at which time it shall terminate.
• AIDS Drug Assistance Program Pilot (Section 10.16)
• $5 mil reduction to nonprofits (Section 10.18), minimizing reductions to funds allocated to nonprofit  organizations for the provision of direct services and shall not reduce funds allocated to  nonprofit organizations to pay for direct services to individuals with developmental disabilities.
• SA In-home (Section 10.23) - keeps 15% cap (although can be waived by the Secretary) but equalizes the amount, all counties shall participate, a formula will be established

DCDEE

·      PreK - $15 mil increase in House - NO increase in final budget.  Directs DCDEE to continue implementation of the NC Pre-K program.  Includes chronic health and developmental disabilities as factors for eligibility requirements along with 75% of the state median income

• $3.5 mil to NCPC for early literacy and TA re grant and fundraising - after January 1 only if not needed for Medicaid

Div of Central Management

·      $2.7 mil reduction for administrative efficiencies

·      Non-state entity pass-through funds - makes NR and 10% match to entities like Arc, Autism Society, Easter Seals

Div of Aging and Adult Services

·      Transition to Community Living $10.3 mil (10.23A) - Blue Ribbon commission, DOJ same

·      Short Term Assistance $39.7 mil monthly rate for residents while they "transition," Sets out amount per resident that may be paid, steps it down after 3 months, expires June 30, 2013.

DMH

• No restoration of MH community service funds - $20 mil cut
• 3 way contracts - $9 mil increase Jan 1, 2013 contingent upon Medicaid, was increase of $18.5 mil in House budget
• LME Admin Funds reduced by $8.5 mil
• Cherry Hospital - funding for increased bed capacity (124 beds) at the new Cherry hospital $3.5 mil
• Broughton Hospital - 19 addnl psych beds $3.5 mil after Jan 1, 2013 if money not needed for Medicaid
• Drug Treatment Courts - $2.3 mil eliminated

Div of Public Health

·      Medication Assistance Program - $1.7 mil NR in House budget

·      $4.9 mil to county health departments for community health and wellness initiatives, contingent upon Medicaid

Justice and Public Safety

·      DPS Management Flexibility Reductions – $26.3 mil – In implementing, the department shall NOT close the Bladen Correctional Center, reduce community program funding in either the Div of Adult Correction or Juvenile Justice, or eliminate any district level state highway trooper position

Corrections

·      Revised the Inmate Medical Costs special provision

Juvenile Justice

·      Close Edgecombe YDC Jan 1, 2013.  Transfer 10 youth counselor associate positions, 5 to Chatham and 5 to Lenoir to increase their bed capacity.  Also directs a study  of the use of the facility.

·      Multipurpose Group Home Funds (Section 14.6) - $550,000 for a multipurpose group home in Craven county

Justice

·      $1.8 mil reduction to eliminate state funding to Consumer Protection division

·      IDS - no changes

·      AGs must begin doing itemized bills for their work for agencies, must also do biannual reports

General Assembly

·      Program Evaluation Division shall study the duties and services of the NC Human Relations Commission and the Civil Rights Division of OAH to determine whether there is unnecessary overlap and duplication of services and recommend the placement of the Commission and Division in the appropriate agency or agencies.

State Board of Elections

·      HAVA Funds/Disability Access:  Directs the State Board of Elections to retain HAVA Title II funds until MOE funds are appropriated, EXCEPT for voting accessibility funds under Section 261 of HAVA.

Salaries and Benefits

·      State employee and public school employee 1.2% salary increases

Office of the Governor – Housing Finance Agency

·      Housing Trust Fund - eliminates General Fund appropriation and appropriates $7.9 mil from Mortgage Settlement Agreement