Stop "managed care" waiver that stomps on disabled people

Ellen Perry's picture

Developmental disability civil rights are getting stomped on. I emplore you all to read this and act on it quickly if you all really care about people. Our rights are being taking away.

I am asking you all to read the email I sent to Governor Perdue asking for her to VETO the first of many "managed care" 1915(b)(c) Waiver expansion bills, S316/H424.  Please forward or copy and paste my email into your own email to the Governor along with "cc" copies to DHHS/DMA/DMHDDSAS as in my email listed below. 
 
On Tuesday, H916 is to be heard in the House Health & Human Services Committee ... although, it may be the Tuesday after Memorial Day ... what matters is that this is also a 1915(b)(c) Waiver expansion bill.  I want you all to be clear on the facts and the urgency of your contacting Gov. Perdue, DHHS Sec. Cansler, DMA Director Dr. Graigan Gray, and DMHDDSAS Director Steve Jordan.  Send a copy to your elected representatives, too.  If any of these statewide expansion bills pass and are signed by the Governor, the The NC Innovations Waiver WILL REPLACE the CAP-MR/DD Waiver.  Please call or write me if you have any questions.  Thanks.  I may be going to Raleigh on whichever Tuesday H916 is set to be heard in committee.  I will let you know if I decide to go ... and which Tuesday ... and may ask any of you to attend along with me.  Thanks.
 
Mary K. Short
828-632-5888 or 704-451-4144 (cell)
 

From: MaryKShort@aol.com
To: governor.office@nc.gov
CC: lanier.cansler@dhhs.nc.gov,craigan.gray@dhhs.nc.gov,steve.jordan@dhhs.nc.gov,
 MaryKShort@aol.com
BCC: 
Sent: 5/19/2011 11:48:15 A.M. Eastern Daylight Time
Subj: S316/H424 VETO
 
Your Honorable Governor Perdue,
 
I have sent "cc" copies of my emails to your office in the past several months with regard to this particular bill, S316/H424.  I now request that you VETO this particular version when presented.  I am requesting your VETO specifically on this bill because of its provision to repeal the previous legislation (see below ... highlighted in red/underline) and its sponsor's (Sen. Hartsell) representation that it is only intended for 5 counties and yet the 5 counties are not NAMED in the bill.
 
There are two other bills, H127/S337 and H916, that are not through committees that also repeal the previous legislation.  And I will take this opportunity to request your VETO of those bills, too.
 
I have repeatedly contacted all of the leadership and members of the HHS Appropriations and HHS committees of both the Senate and the House in an attempt to gain a "carve out" of the NC Innovations Waiver from the expansion of the 1915(b)(c) waivers.  I have tried as hard as I can to prove that the NC Innovations Waiver is NOTthe PBH Innovations Waiver as there are completely new sets of services definitions, utilization guidelines, supports needs matrix, and reimbursement rates.  Even assuming PBH is correct in its assertion that it "saved" money with the PBH Innovations Wavier, the NC Innovations Waiver being implemented statewide is a completely NEW waiver!  Truly.  By the way, if PBH was/is required to serve the waiver population and there was/is a waiting list of waiver eligibles, then how is that a real savings?
 
Additionally, there is even a reincarnation of the "40 Hour Rule" that is written into the NC Innovations Waiver as part of the policy for payment of waiver services performed by family members or guardians of ADULTS.  I hope you recall that very issue surfaced in the CAP-MR/DD waiver back in 2006/2007!  DMA/DMHDDSAS eventually agreed to 50 hours and then, in the 2008 CAP-MR/DD Waiver, family members/legal guardians were required to work all 24 hours a day by a service definition called Home Supports or no hours at all.
 
The IDD community is such a tiny percentage of our state population and the families and/or direct service workers have very little time to devote to calling or writing their elected representatives and/or DHHS/DMA/DMHDDSAS with their concerns and fears.  I have an email list of 200 +/- families and some of them forward my emails to other contacts.  Please believe me when I tell you that families are just being disregarded.  LME's, provider agencies, traditional IDD advocacy groups ... they all are simply looking to preserve their business models and are "negotiating" away everything that the IDD families I know are working to preserve.  Please don't misunderstand me.  The IDD families I know do not "like" the current CAP-MR/DD Waiver(s) and the goofy tiers idea.  We never did.  The IDD families that I know completely understand the dire budget situation and are willing to accept our fair share of "rate reductions" as a way to reduce the costs of serving the IDD population.  But the NC Innovations Waiver and its supports needs matrix appears to reduce costs by curing the IDD individual of hours (or 15 minute increments) of direct service, including direct service by Residential Supports providers and dramatic rate reductions of 20% for Residential Supports providers.  It appears to leave these very, very vulnerable people at the mercy of volunteers.  There also is a very real concern that the ICF-MR's and particularly the State Developmental Centers will be forced to move their current residents and close those facilities if the NC Innovations Waiver expands statewide.
 
Again, I ask for your support of the 20,000 +/- IDD children and adults receiving funded (whatever source) services and the 10,000 +/- IDD children and adults on waiting lists for funded (whatever source) services with your VETO of S316/H424 (and H127/S337 and H916).  Thank you.  Please feel free to contact me.
 
Mary K. Short
365 Old Wilkesboro Road
Taylorsville, NC 28681
828-632-5888 or 704-451-4144 (cell)
 
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2011
S 2
SENATE BILL 316*
Mental Health & Youth Services Committee Substitute Adopted 3/24/11
Short Title: Add'l Section 1915 Medicaid Waiver Sites. (Public)
Sponsors:
Referred to:
March 14, 2011
*S316-v-2*
A BILL TO BE ENTITLED

AN ACT TO AUTHORIZE DHHS TO IMPLEMENT ADDITIONAL 1915(B)(C) MEDICAID WAIVER SITES AND TO ALLOW STATE FACILITIES TO DISCLOSE CERTAIN INFORMATION FOR PURPOSES OF COLLECTING PAYMENT AND TO DIRECT THE DISTRIBUTION OF A FUND BALANCE UPON THE DISSOLUTION OF AN AREA AUTHORITY.

The General Assembly of North Carolina enacts:

SECTION 1. Section 10.24 of S.L. 2010-31 is repealed.
And here is the Section to be REPEALED BY S316/H424:
STATEWIDE EXPANSION OF CAPITATED 1915(B)/(C) BEHAVIORAL HEALTH
WAIVERS
SECTION 10.24.(a) The Department of Health and Human Services (Department)
shall select up to two additional Local Management Entities (LMEs) to implement the capitated 1915 (b)/(c) Medicaid waiver as a demonstration program during the 2010-2011 fiscal year.  The waiver program shall include all Medicaid-covered mental health, developmental disabilities, and substance abuse services. Expansion of the waiver to additional LMEs shall be contingent upon approval by the Centers for Medicare and Medicaid Services.

SECTION 10.24.(b) The Department shall conduct an evaluation of the capitated
1915(b)/(c) Medicaid waiver demonstration program sites to determine the programs' impact on consumers with developmental disabilities.
 The evaluation shall include a satisfaction survey of consumers. The Department shall consider the impact on ICF/MR facilities included in the waiver to determine and, to the extent possible, minimize potential inconsistencies with the DMA-ICF/MR rate plan and the requirements of G.S. 131E-176 and G.S. 131E-178 without negatively impacting the viability and success of the waiver program. The Department shall consult with stakeholders and evaluate all other waiver options, including the possibility of a waiver without a 1915(b)/(c) combination. The Department shall report to the House of Representatives Appropriations Subcommittee on Health and Human Services, the Senate Appropriations Committee on Health and Human Services, the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services, and the Fiscal Research Division no later than April 1, 2012, after which time the Department may expand the capitated 1915(b)/(c) Medicaid waiver to additional LMEs.

The Department shall not approve any expansion of the Piedmont Behavioral
Healthcare LME (PBH) beyond its existing catchment area until after the Department has completed its evaluation and made its report pursuant to this subsection.
 
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