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.