Friday, November 16, 2012

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!