Report- NC Children with Complex Disabilities

Disability Rights North Carolina has released a new report on our state's failure to adequately serve children with complex mental health care needs. Check it out on our website: http://www.disabilityrightsnc.org/.

Week of March 7 Budget Update

HHS Appropriations
Medicaid and Piedmont Behavioral Health
On Tuesday, Craigan Gray and Steve Owen finished up a presentation on Medicaid and Pam Shipman from PBH presented.  The Medicaid handout is online here.  The PBH presentation is online here.  The PBH presentation was not much different from other presentations they have done.  Some points that were made that I would like to note:

• The slide that states that the PBH model has management of all public resources, including Medicaid funds, state/federal funding and state institution funds, is misleading.  PBH only covers behavioral health.  Other Medicaid services (primary care, etc.) are covered under the Southern Piedmont Community Care Plan (the local CCNC affiliate).
• State funds account for 20% of the PBH budget.
• Although the slides related to comparative costs for certain types of services are not clear as to scale, they demonstrate no significant cost differential for ICF-MR, 1915(c) services (Innovations and CAP-MR/DD), and possibly outpatient and inpatient psychiatric care (without further explanation of their numbers it is impossible to know if the difference is statistically significant).

Division of Mental Health and the Division of State Operated Healthcare Facilities
On Wednesday, legislative staff  (NOT DHHS staff as was done for Medicaid) presented reduction options related to the Division of Mental Health and the Division of State Operated Healthcare Facilities.  Of particular note:

• It was stated that the cost of ICF-MRs is mostly medicaid, with only a small amount in the DMH and DMA budgets for state dollars, so there wouldn't be much savings to close the DD Centers.
• Total funds spent through the LMEs - $533 mil (state and federal) - $350 mil to community services ($350 mil) and $115 mil in administrative funding (22% of the money allocated to LMEs, $65 mil state and $50 mil federal).  Staff discussed the high percentage of administrative costs (according to the Mercer report the national average is 10-15%) and laid out options to consolidate and reduce the number of LMEs.  For community services funds, staff suggested standardizing the service package of benefits among LMEs, creating a standard benefits package among LMEs, and instituting a co-payment as reduction options.  There were alse questions about the LME fund balances.
• Staff put forth closing the Wrights School as an option.
• ADATCs – there is not really an option for this, but could see if there is a private market.
• Advocacy staff - $3.5 mil in salaries/fringe (both state and federal cost) – 40 positions to serve 15 facilities, 23 throughout communities.  In his response, Secretary Cansler pointed out that the advocacy staff is crucial to the facilities, and the amount saved in state dollars would be minimal.
• CRH Hospital Administrator Contract – could save $30K by hiring as an employee.  Cansler also responded to this point in his response.

Education Appropriation
K-12 Education Reduction Options - handout here.  Some options discussed include:

• Eliminating $9 mil in support for Child and Family Support Teams
• Children with Disabilities Reductions: 2 reductions are discussed: 1)  3.4, 4.2 and 5% reductions to the state allocation for children with disabilities ($23,964,707, $29,042,061, and $34,694707 reductions to $693,894,148).  Staff is further investigating this option regarding federal Maintenance of Effort requirements for IDEA funding.  These options were not in the Governor's budget.  2) The Governor's budget included a $7 mil reduction in anticipation of a reduced headcount.
• Reduce funding for the Residential Schools for the Deaf and Blind by 5 and 10% ($1.6 mil and $3.3 mil out of $32.6 mil budget).
• There are also proposals to reduce funding for teacher assistants, local school district central office administration, principal and assistant principals, instructional support (guidance counselors, social workers, etc.), eliminate funding for staff development, retirement incentives for LEAs and to eliminate the More at Four/DPI Office of School Readiness.

MH/DD/SAS Rules Commission Meeting Thursday May 27

The Commission meets next Thursday from 8:30-4:15 at the Clarion Hotel State Capital in Raleigh. On the agenda:

• Division Director's Report, including 2 requests for waiver of a rule: 10A NCAC 27G .3806, Authorization: Facilities Providing SA Services to DWI Offenders, and 10A NCAC 27I .0606, Hearing Schedule and Composition of the Panel (for non-medicaid appeals)
• Rules Committee Report
• Advisory Committee Report
• Proposed Adoption of 10A NCAC 27E .0301-.0304, NCI QA Committee (this has already been published for public comment, and through the Rules committee)
• Proposed Amendment/Adoption of 10A Subchapter 26D, NC Department of Correction: Standards for Mental Health and Mental Retardation: Rules .0103 - .0906

Let me know if you would like the Commission materials emailed to you.

2/10/2010 MH/DD/SAS LOC

The Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities and Substance Abuse Services met on 2/10. The handouts are online here. I have a few additional notes below.

Secretary Cansler's Remarks
The Secretary is seeking more consumer input from the community. Related to this, they are working on changes to the state and local CFACs (no details were given).

He also discussed the staffing difficulties raised by the non-recurring nature of the funds for Dix hospital - they are running a $30 mil deficit on the facilities.

He also spoke about Joshua S., the boy with a developmental disability who sat at the Wake LME Crisis unit for days waiting for a bed in a psychiatric hospital. He addressed the inappropriate nature of a psychiatric facility for this boy, and announced that they are converting 6 beds at Murdoch for a crisis respite unit (short-term respite only).

Plans for Development & Implementation of the Tiered CAP-MR/DD Waiver
Instead of four waivers, the Department is now planning to implement three waivers, with one waiver having two "bands": Supports (up to $17,500), Comprehensive (Band A - $17,501 - $45,000; Band B - $45,001 - $75,000), and Community Intensive ($75,001 $135,000). The handouts at the link above have information about the intensity of need and services available in each waiver.