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North Carolina Action AlertPlease check back often and sign up for The Arc of North Carolina's E-Alert network. When action is needed, you will receive an e-mail that states the problem, presents talking points based on The Arc's position, and ways that you can respond so that your voice is heard. Note: You must have Adobe Reader to open PDF files. Some of the links below to memos link to PDF files. Visit www.adobe.com to get a free Reader. 2006 ACTION ALERTS COALITION 2001 2006 ADVOCACY DAY Tuesday, JUNE 6, 2006
8 am - registration opens 8:30 am - attend appropriations committee meetings All morning - visit with legislators in their offices - see Coalition 2001 message sheet 11 am - popcorn on the portico 12 noon - rally on Jones Street side of legislative building Afternoon - go to House and Senate galleries at start of session for introduction of Coalition 2001 members _____________________________________________________________________________________________________________ May 25, 2006 Legislative Update The Senate has passed its budget in record time. The budget includes over 100 million dollars for MHDDSA. We have attached the report that outlines this funding. While we are certainly pleased with the amount included, we are obviously disappointed that the Senate did not include any flexible funding for people on the waiting list with developmental disabilities. The Senate did include 7 million dollars for early intervention which is the same as the recommendation of the Governor. The budget does not include any new funding for Special Education. During the Senate floor debate, Senator Nesbitt introduced amendments to the budget bill that included many of the policy recommendations of the Legislative Oversight Committee. These recommendations are substantial. We have not had time to fully analyze all of these, but plan to have additional information for an alert on Tuesday. We anticipate the House to move fast beginning next week. We will have available for you on Tuesday a specific advocacy strategy. Please plan to attend the Coalition Rally on June 6th. This will be in the middle of the House efforts to craft their budget so the timing is great…but only if we have a large showing!! Please call if you have any questions
E-Alert May 15, 2006Legislative UpdateThe Senate intends to have preliminary budget proposals finished this week. It is critical that Senators know how important it is to fund services for Mental Health/Developmental Disabilities/Substance Abuse. Our goal is to have the Senate place at least 156 million dollars in new State funding in the Budget for Mental Health/Developmental Disabilities/Substance Abuse (this is the dollar figure recommend by the Legislative Oversight Committee on MH/DD/SA.) Our message is to ask Senators to place their highest priority on MH/DD/SA- Support Coalition 2001 proposal. Specific issues for people with disabilities are:
Funds for Developmental Therapy Tell them your story!! Please contact your Senator by phone, e-mail or fax no later than Wednesday this week!! Legislator can be reached in Raleigh by dialing 1-919-733-4111 or by e-mail through the North Carolina General Assembly website at www.ncga.state.nc.us. If you have any questions, please contact The Arc office at 1-800-662-8706. __________________________________________________________________________________________________________________
May 11, 2006 The 2006-2007 legislative session has begun with legislators pledging to have a budget by the end of the fiscal year. The Senate intends to have its budget passed by Memorial Day. Governors' Budget Expand Community
Services $16,000,000 Initiatives for Healthy Families $1,800,000 TOTAL $89,133,396 Additionally, the Governor's budget include 7 million dollars for Early Intervention, 700 thousand dollars for Assistive Technology and 800,000 dollars to assist with redesignation of the Governor's Advocacy Council for Persons with Disabilities (more on this at the end of the alert.) Legislative Oversight
Committee Item Recurring Non-Recurring
State service dollars for Developmental
Therapies $29,435,119 Consumer Advocacy Program $1,200,000 TOTAL $100,027,939 $56,295,830 This again is a great start for our issues. The Arc of North Carolina and others will continue to work with members to shift the Legislative Oversight Committee proposal to allow for new per capita funding to be used for developmental disabilities also. Additionally, we will work to have funds for First in Families included in this proposal. Medicaid Action Governor's Advocacy
Council for Persons with Disabilities "It is recommended that the Governor's Advocacy Council for Persons with Disabilities be shifted to a nongovernmental organization. Funds will cover the severance pay for the 26 employees that will be moved out of state government. Of the 26 employees, 6.28 positions are supported through appropriation, and the remainder are supported through federal funds, Appropriation - Non-recurring - $846,114." (Governor's proposed budget Page 91) Coalition 2001
Advocacy Rally Day _______________________________________________________________________________________________ February 6, 2006 Update on Developmental Therapy in Schools The decision on whether to allow the use of the State funded service, Developmental Therapy in schools has not yet been made. The Division is working internally to develop guidelines on the use of the new State funded service.
We will keep you informed of any new developments.
February 3, 2006 Update to Strategies for CBS Transition In our earlier E-Alert today, we stated that the State funded service call Developmental Therapy will be available to be used for some children who are currently using CBS in schools. The Arc of North Carolina has heard that the Division of MH/DD/SAS stated on a conference call this morning that Developmental Therapy could not be used in schools. The Arc of North Carolina is waiting on a return telephone call from the Division to determine if in fact, this is what the Division intends. The Arc of North Carolina will advocate strongly that the State funded service, Developmental Therapy be made available for use in school on a limited basis. This would be for the children who do not transition to the CAP Waiver or the MH service of Community Supports.
February 3, 2006 E-Alert Advocacy Strategies for Transitioning from CBS to New Services During the next six weeks, the Mental Health/Developmental Disabilities/Substance Abuse System will be greatly challenged in its attempt to “crosswalk” individuals with developmental disabilities from Community Based Services (CBS) to the new service for which they are eligible. These changes will happen at the same time as the massive implementation of the new Mental Health and Substance Abuse definitions. Needless to say, there is great potential for chaos during this transition. Though we do not have as much specific information as we would like, we do feel it appropriate to offer the following as guidance in your advocacy efforts for individuals. The Division memo detailing the transition plan is available below this alert or on the MH/DD/SAS Division’s Announcement page at www.dhhs.state.nc.us/mhddsas/announce/. The memo is titled Enhanced Services Implementation Update 2. Our first recommendation is that all individuals who currently are receiving CBS services immediately contact their case manager to begin the process of this crosswalk. If they are unable to reach their case manager, contact the LME and ask for a timeline for this transition. Since the timeline is so short, it is important that families and consumers not wait. CAP Waiver services will be available for those who are eligible. To be eligible, a person must need the level of care provided by an Intermediate Care Facility (ICF-MR). We encourage families who are reasonably sure their family members are eligible; to immediately contact their case manager to begin the process to determine eligibility. For those individuals who may be eligible, but families are not sure, we suggest aggressive efforts to push case managers to gather information and if reasonable, submit to the State for determination. Though the assessment and eligibility requirements are standard, there is, of course, a degree of subjectivity to this determination. It is worth the effort to try if there is any question. If the individual is not eligible for CAP, it is important that families and consumers understand their options. The three possible services available are very different and will result in services that are different in scope and intensity. The three services are:
With all of these options, it is important that individuals understand how CBS worked in conjunction with other funding streams to allow for continued placement in a residential or employment setting. There will be cases where, due to restriction of a service definition or funding level, placement could be lost if accommodations are not made. This is why it is critical for not only the case manager and family to participate in the discussions but also the provider. For children receiving CBS in school, the options are more limited and solutions more complicated. CAP cannot be used in schools! Community Supports and Developmental Therapy can be, but they cannot be used in conjunction with CAP. Medicaid PCS is not available in schools. For those students currently using CBS in schools but who are moving to CAP, we’re advocating with DHHS and The Department of Public Instruction (DPI) to find appropriate solutions for when CBS is no longer available for those students (see memo below this alert from Mary Watson, DPI) We are also advocating for students using CBS who will transition to other services which may not have the same scope and intensity as the CBS service currently being used. We will keep you informed of all updates on the DPI issue. We hope these recommendations are helpful. Of course, there will be difficult situations that take place. We encourage you to work with families, consumers, providers and LMEs to work through these issues. We ask that you keep us informed of these issues as they occur. Our staff is available to assist you in thinking about solutions to specific issues. We will continue to advocate with State agencies and the General Assembly to assure the best possible outcome. Click here to read a memo from Mary Watson DPI about CBS in schools Click here to read Enhanced Service Implementation Update 2 As always feel free to call our office with any questions at 1-800-662-8706
February 2, 2006 The Division of MH/DD/SAS has posted a memo that outlines the transition to other services for people with developmental disabilities currently receiving CBS Services. Click here to read Enhanced Service Implementation Update 2 January 27, 2006 LOC Meeting Update
The Legislative Oversight Committee (LOC) on MH/DD/SA met yesterday. It was a productive and informative session. The morning agenda focused on an overview of community services for people with developmental disabilities. Specifically, CBS and services necessary to replace CBS were discussed. The committee room was packed with consumers, family members, advocates, and providers. In fact, there were so many citizens attending, that an overflow room was opened and the proceedings piped in! Thanks to all of you who took the time to come to Raleigh. You made quite an impression! As you know, The Arc of North Carolina has been actively advocating for seamless replacement of supports for all people using CBS. We were encouraged by the Division of MH/DD/SA's plan designed to keep people who currently receive CBS from losing supports. We think these replacement supports can be put in place and available through the end of the fiscal year (June 30, 2006). At the meeting, Leza Wainwright, Deputy Director of the Division, presented a comprehensive overview of community services (Medicaid and non-Medicaid) available for people with developmental disabilities. She reviewed, for the LOC members: eligibility for ICF/MR, federal guidelines for the CAP MR/DD waiver, and described the CBS/Developmental Therapy dilemma that could leave thousands of people without services. The plan is basically the one outlined in our January 25 Action Alert:
The Division believes that these four categories will capture almost everyone with DD currently receiving CBS. The exception is an estimated 410 children with DD who are receiving CBS in school. Diann Irwin, Section Chief at the NC Department of Instruction addressed the LOC. She distributed, to the LOC, a letter from Mary Watson, Director of the Exceptional Children's Division to all EC directors across the state. The letter informs them of the upcoming loss of CBS for many students and advises them to call together IEP teams and make plans to be sure that supports and services are in place when a CBS worker is no longer available on March 20. The Division of MH/DD/SA and DPI will be meeting to discuss this issue. Consumer, provider, family, and advocate experiences with community services were presented. This group of people did a fabulous job sharing, from their own perspectives, how reform of the MH/DD/SA affects people with DD, and what the state and LMEs can do to improve the system. Things are moving forward. We will have much more to report in the coming weeks.
As always feel free to call our office with any questions at
1-800-662-8706
January 25, 2006 E-Alert Update on Plan for Providing Services to People Currently Receiving Community Based Services (CBS) Below is the latest information we have concerning the Developmental Therapy/CBS issue. We are pleased with the progress from the State to ensure people do not lose services but know that we must continue to advocate for proper implementation and for supporting the children who currently use CBS in schools. The Arc will take an active advocacy role on this issue. Additionally we will continue to inform and advocate with the General Assembly about the need for services for those people who are waiting for service. We will send an additional alert following tomorrow’s Legislative Oversight Committee (LOC) meeting informing you of any new developments and any additional advocacy needed. If you are planning to attend the Legislative Oversight Committee (LOC) meeting on Thursday, January 26 (we still believe it important) the meeting has been moved to room 643 of the Legislative Office building, it will begin at 9:30 am. Since we expect a large crowd it would be good to arrive early! Please feel free to call The Arc of NC's office if you have any questions. 1-800-662-8706 CBS/Developmental Therapy Plan to be Unveiled The Department of Health and Human Services plans to present their detailed plan on how to deal with the lack of a federally funded Developmental Therapy definition to the Legislative Oversight Committee on MH/DD/SA tomorrow. The Department’s plan will be consistent with the information they have been sharing for the past few weeks.
The Division is finalizing its instructions to Local Programs (LME's) on how this transition will take place. They intend to have those instructions out no later than the first of next week. We understand they are working on strategies to streamline the process. Even so, they know that it will require an extraordinary effort by the Division Staff, the LME staff, and provider agency staff to create this transition by March 20th. The Division has set in place internal mechanisms to monitor progress and make adjustments to their plans. We believe this plan is the best option available considering the circumstances. One area that is not yet finalized is the question of providing support services to children currently using CBS in schools. The CAP-MR/DD waiver does not allow for any CAP service to be provided in school although CBS is currently being used in that way for some children. The Department is in discussions with Department of Public Instruction (DPI) on how best to resolve this issue but it will most likely require advocacy from the DD community to assure that these children continue to receive the support they need. The proposed solution, once implemented, should meet The Arc's goal that no one currently using CBS lose services. (Obviously the school children issue needs to be addressed) The Department has committed to fund the additional expense out of their existing budget, without reducing services for other disability populations, for this fiscal year and they have plans to include increases for next year in their continuation and expansion budget plans. We applaud their commitment and the efforts to date to solve this problem. Of course we want to see the details on implementation and monitor these efforts closely to assure that we truly do meet the goals of no one losing service. We will continue to forward all information received and provide additional analysis as we move forward. We expect a large number of people at the LOC meeting on January 26 which we believe will help impress upon the Legislature and the administration the critical nature of assuring a smooth and complete transition. January 19, 2006 E-Alert Update on Community Based Services (CBS) According to the Division of MHDDSA the Department plans to unveil a plan early next week that will allow for all individuals with developmental disabilities currently receiving CBS to continue receiving service after the new service definitions are implemented on March 20th. Though we do not have details of the plan we understand it involves a combination of CAP/MR/DD, utilizing the new Community Supports definition for those who are eligible and the use of a newly created state funded service for individuals who are not eligible for the Medicaid funded services. The division plans to send instruction to LME’s next week with the anticipation that Case managers will begin immediately working with individuals to transition them into these new options. We believe that by mid-week, prior to the LOC meeting we will be able to share with everyone the details of this plan. The update is consistent with what we have been told was the direction the Department was trying to take. Of course until we see details we are unable to evaluate the plan. Advocates, consumers and family members should continue to be prepared for advocacy efforts once the pan is unveiled. We still encourage individuals to attend the Legislative Oversight committee meeting scheduled for 9:30am on January 26th. As you can see by the agenda below, developmental disabilities will be an important part of the discussion. Though there will not be a public comment period the opportunity to talk to legislators during the breaks and having a packed room will be very beneficial to our positions. If you have any questions please feel free to contact our office. 1-800-662-8706
JOINT LEGISLATIVE OVERSIGHT COMMITTEE ON MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES AGENDA January 26, 2006, 9:30 AM, Room 643 LOB Rep. Verla Insko, Co-Chair, Presiding Greetings/Introductions 9:30 a.m. – 9:45 a.m. · Senator Martin Nesbitt, Co-Chair · Representative Verla Insko, Co-Chair Approval of Minutes Developing Service Capacity (Enhanced Benefits) Community-Based Services for the Developmentally Disabled Population · Introduction 9:45 a.m. – 10:45 p.m. Leza Wainwright, Deputy Director, Division of MH/DD/SAS · CBS for DD Population 10:45 a.m. – 11:15 a.m. o Division Update on Replacement of Services Leza Wainwright, Deputy Director, Division of MH/DD/SAS o DD Consortium Comments Dave Richard, Executive Director, The ARC of North Carolina · Consumer, Provider, Family and Advocates' 11:15 a.m. – 12:15 p.m. Experiences with Community-Based Services Jill Hinton Keel, Executive Director, The Autism Society of NC Kathy Bryan, Executive Director, Orange Enterprises, Hillsborough Laura Gorycki, Advocate for individuals and families, The Enrichment Center, Winston-Salem Jim Woolsey, Family member, Charlotte Rose Reeves, Consumer, Raleigh
Lunch 12:15 p.m. – 1:15 p.m. Division of MH/DD/SAS Updates 1:15 p.m. – 2:15 p.m. Mike Moseley, Director, Division of MH/DD/SAS · CMS Approval of Service Definitions for MH and SA Services · Implementation of Secretary's Proposal for Increased LME Efficiency Developing Management Capacity 2:15 p.m. – 3:15 p.m. State and Federal Funds: Requirements on Use of Non-Medicaid funds Lisa Hollowell, Fiscal Research Division Division Action Plan to Assist Providers 3:15 p.m. – 3:30 p.m. Mike Moseley, Director, Division of MH/DD/SAS Other Business Adjourn
January 11, 2006 E-Alert Update on Community Based Services (CBS)
The Arc of North Carolina received a call today from a family who was sent a letter from their Case Manager and Local Program stating that their daughter's CBS services will end.
The letter below from the Division Director, Mike Moseley was sent to the Area Directors of Local Management Entities/Area programs yesterday. Mr. Moseley is asking that the Local Programs wait to notify people currently receiving CBS services that their services are ending until a plan is developed that outlines how people who need CBS will be served. As stated in our January 10, 2006 E-Alert, The Arc will be in regular contact with the Division of MH/DD/SA during the next 10 days monitoring their progress on an appropriate plan. As always, if you have questions please call The Arc of North Carolina at 1-800-662-8706
Below is the letter that Mike Moseley sent to local programs
Dear Area Directors: We know that the CMS decision to require the elimination of CBS for persons with developmental disabilities from the State Medicaid Plan and their refusal to approve Developmental Therapy as a replacement service has consumers, family members, providers and LME staff understandably concerned. We have heard that some case managers or LMEs may already be notifying consumers and families that their service will end. We are asking you to please ensure that this does not happen at this time. The Department is committed to identifying alternative services for these individuals. We have analyzed the data that you submitted and are actively involved in developing alternative strategies. We ask that you and your providers hold off on modifying consumer’s€™ treatment plans, notifying consumers that the service will end, modifying contracts with providers, etc. for the next two weeks. By that time it is our intent to have solutions and strategies in place to address these concerns. The Department also plans to provide you with standardized language to be used to notify consumers of this change so each LME and provider will not have to reinvent the wheel €ť (We also plan to provide you with standardized language to be used for the other notices that will be required with the implementation of the new service definitions.) We appreciate your cooperation as we work through the issues that this unfortunate federal decision has created for the consumers and families we serve. Mike Moseley
January 10, 2006 Action Alert Community Based Service/Developmental Therapy In December, the Department of Health and Human Services and the Division of Mental Health/Developmental Disability/Substance Abuse Services (MH/DD/SAS) announced that the Developmental Therapy Definition intended to replace the Community Based Service (CBS) Medicaid service has been turned down by the Federal Government. This means that for some individuals currently receiving CBS there will be no Medicaid State Plan alternative service once North Carolina’s new rehabilitation option Medicaid plan is implemented. Please find below, a set of principles adopted by the Developmental Disability Community concerning the CBS/Developmental Therapy issue. These principles have been conveyed to the Department of Health and Human Services and the Division of MH/DD/SAS. The intent of these principles is to provide policy makers a guide for their plans as well as a benchmark for us to measure the success of their plans. On Friday we received a call from an official with the Department of Health and Human Services. Additionally, the Coalition 2001 chairman has had contact with the Governor’s office in which a similar message was delivered. We were told that the Department has made solving this issue its top priority. They informed us that they believe they can find a solution for the problem and that most of the actions could be taken within the Department without legislative action. Initial planning includes a solution for the vast majority of people currently receiving services. They are committed to and working on a solution that will provide for the remainder. In the conversation the Department asked if we would delay an all out grass roots advocacy effort for a week to ten days in order for them to finalize their plans and present them to the Developmental Disability community. This request was not made to minimize our advocacy efforts, but rather to give the department staff time to finish their work prior to being inundated with calls. After meeting with other statewide organizations concerned with Developmental Disabilities, we have agreed to postpone an organized grassroots advocacy campaign. Postponing this effort does not mean that we will not need to have a grassroots advocacy effort, only that we may change the timing and scope. We still encourage members to attend the January 26th Legislative Oversight Committee meeting in Raleigh at 9:00 am in room 544. Of course we will be in regular contact with the Division of MH/DD/SA during the next 10 days monitoring their progress on an appropriate plan. We will keep you informed through Action Alerts on new developments and what action that will be needed. Though this development is by no means a guarantee of a solution that meets our expectations, we do feel it is a positive sign that the administration sees this as an important priority. As always if you have questions or need additional information please contact The Arc of NC at 1-800-662-8706 Principles on Replacement of Proposed Developmental Therapies for Persons Currently Receiving Medicaid Community Based Services (CBS) No individual currently served should have services eliminated, or reduced in duration, scope intensity or quality. NC must create a state funded service to replace CBS through the end of the fiscal year in order to assure a smooth transition to new services. Transition to new services to replace CBS should be seamless with no disruption to the individual’s life. The use of the CAP/MR/DD waiver to serve people currently on CBS should not further restrict the availability for those currently waiting for waiver services. Any plan must include methodologies to provide service to those individuals currently not in service but who would have been eligible for the proposed Developmental Therapies service. Children who receive CBS in school settings must not be abandoned. Any plan that shifts this service to DPI without corresponding funding is unacceptable. North Carolina must be willing to provide additional state funds in order to serve those who may not be eligible for federal funding. The state must have a state level tracking system in order to assure that all individuals are Successfully transitioned. Individuals losing the CBS service must be adequately informed of their appeal rights under Medicaid law.
January 5, 2006
To: Chapters of The Arc of NC, Board Members We have developed an advocacy strategy for our efforts to assure that a viable solution is found for people with developmental disabilities. Our intention is to begin an e-mail and phone campaign with the Governors office and the General Assembly. Next Tuesday you will receive an alert that will give specific instructions for the message and who to contact. That alert will also go through The Arc e-alert system and we believe many other organizations. Our goal is to have legislators and the administration understand that this issue must be addressed now! With the announcement that the service definitions have been approved and that there is a goal of a March implementation date our advocacy must be strong and quick. We believe that the Legislative oversight Committee meeting scheduled for January 26th will be an important event in this advocacy. We encourage you to attend and bring families and consumers who are affected by this issue. With the alert on Tuesday we will have more information on how that meeting will flow. Thank you for your efforts. Please call me if you have any questions prior to next week. Dave
December 20, 2005
To: Chapters of The Arc of NC, Board Members Action Plan on Developmental Therapy Definition The division of Mental Health/Developmental Disabilities/Substance Abuse has announced that the Developmental Therapy Definition intended to replace the Community Based Service (CBS) Medicaid service has been turned down by the Federal Government. This means that for individuals currently receiving CBS there will be no Medicaid State Plan alternative service when NC’s new rehabilitation option Medicaid plan is approved. Members should be cautioned that this does not necessarily mean that those individuals receiving CBS will lose service. The State has indicated they are working on options that will allow for those individuals to continue receiving service through other funding streams. (The Arc has been involved in numerous discussions with state officials about potential options.) It is estimated that nearly 6,000 people with developmental disabilities receive this Medicaid service in NC. CBS is critical for these individuals and our position is that every person currently in service must continue to receive service at least comparable to what they receive now. Additionally the state must have a plan to serve those people who would have been able to receive the developmental therapies service if it had been approved. We intend to work with state agency personnel to develop a plan to serve these individuals. We have also been clear that we will begin to work on an advocacy strategy with the administration and the General Assembly. The Arc, along with other agencies, is preparing for a grassroots advocacy campaign designed to send a strong message to legislators and the administration of the critical nature of this issue. Beginning in early January, we will issue alerts to members through our E-Alert system with specific legislative and administration targets. These alerts will include a focused message for those individuals as well as personal stories about how CBS has served people with developmental disabilities. Our goal is to assure that the administration and the legislature commit to a seamless solution to this problem. Members of The Arc who are affected by this issue should sign up for the E-Alert network by clicking on our web page at www.arcnc.org and sign up for Action Alerts. Others who are not members or who are not personally affected should also sign up if they are willing to e-mail and call public officials. Additionally, members who can, should plan to attend the January 26th Legislative Oversight Committee on Mental Health/Developmental Disabilities/Substance Abuse at the Legislative Building at 9:00 a.m. This meeting will have a heavy concentration on developmental disabilities and the Developmental Therapy issue will be a major part of the agenda. A large turnout will send a strong message. The first alert on this issue will be e-mailed on January 5th, so please sign up as soon as possible. For questions, please feel free to contact The Arc of North Carolina office at 800-662-8706 or e-mail Dave Richard, drichard@arcnc.org or Ellen Russell, erussell@arcnc.org.
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