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Updated 01/12/06 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 €¯ (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"
Developmental Therapy Medicaid Service Denied December 20, 2005 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. he 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.
Medicare Part D Prescription Drug Plan Information In 2003, an act was passed that added a prescription drug benefit to Medicare. Individuals who are eligible for Medicare can sign up for a private drug plan and get help with prescription drug coverage. While some of these plans will cost a premium and co-pays, many individuals can apply and receive help with these drug costs. Individuals who are eligible for both Medicare and Medicaid benefits will automatically qualify for this assistance with costs. What is the Medicare Prescription Drug Plan? The new drug benefit will be provided by private prescription drug plans (PDPs) that offer drug-only coverage, or through Medicare Advantage Plans that offer both prescription drug and health care coverage (MA-PD plans). Plans must offer a standard drug benefit, including many, but not all, of the same drugs that are approved under the Medicaid program. Plans will have utilization tools, prior authorizations and limits, may have preferred tiers and will have network pharmacies. Beneficiaries will pay monthly premiums, deductibles, coinsurance and co-pays. The prescription drug benefit begins on January 1, 2006. For more information What do People Receiving Medicare Need to Do? There are two steps for consumers to prepare for the transition to Medicare Part D Prescription Drug Coverage: 1. Apply for help with Medicare Prescription Drug Plan Costs. If the consumer is eligible for both Medicaid and Medicare he/she is automatically qualified and does not need to apply. 2. Enroll in a Medicare Prescription Drug Plan (PDP) Where Can People Get More Information? The Disability Policy Collaboration has developed a web site A Guide for Medicare coverage for people with developmental disabilities. to help individuals who receive Medicaid and Medicare benefits, known as dual eligibles, their families and caregivers, and advocates for people with disabilities nationwide understand the new Medicare prescription drug coverage, called Part D. Dual eligibles must make decisions about which Medicare prescription drug plan will provide access to the medications they need. The NC Division of MH/DD/SAS has developed a Medicare Part D Web Page to assist North Carolinians in this transition. System Reform The State of North Carolina is in the process of reforming the entire Mental Health/Developmental Disabilities/Substance Abuse (MH/DD/SAS) service system. The reform is being guided by The State Plan. For further information about the reform process, please visit the Department of Health and Human Services website at http://www.dhhs.state.nc.us/mhddsas/. There is also information concerning the entire service delivery system in North Carolina. At times, the State requests feedback from people who use supports and services, family members and other stakeholders. Please provide input when asked so that your thoughts and ideas are taken into consideration. If a wide response is necessary The Arc of North Carolina may send out an Action Alert. Please subscribe to the network if you would like to be notified when action is needed. You can sign up on The Arc of North Carolina's homepage.
For further information on policy issues contact: Dave Richard, Executive Director:
Archives Information posted 9/23/04: The Arc of North Carolina's Response to the Draft CAP-MR/DD Waiver 9/23/04 The Arc of North Carolina has read the proposed draft waiver and offers the Division the following thoughts, questions and issues for consideration. The waiver is the foundation by which supports and services are delivered to CAP eligible recipients. As the foundation, it is very important for the Division to consider how policy based on broad generalizations can negatively affect individual people. The Arc recognizes that many of the problems people currently encounter with the waiver are due more to interpretation of the waiver, than the actual waiver itself. Therefore, some of the feedback below may not necessarily apply to actual needed changes in the proposed waiver but may assist the Division as the policy manual is being written. Historically, the variety of interpretations of the waiver and service definitions has created unequal access to services and supports across the state. It is for this reason that The Arc of North Carolina strongly urges the Division to write a clear, concise manual that does not leave itself so open to individual interpretations. The Arc has concerns about the proposed limitations on Personal Care as stated on page 19: Personal care service limitations include: Individuals who live in licensed residential facilities, alternative family living homes, licensed foster care homes or unlicensed alternative family living homes serving one adult may not receive this service. Broad generalizations about people and policy based on them can lead to inadvertent harm. The Arc recognizes that many individuals living in these settings will not need additional Personal Care Services however, some people, particularly those with significant disabilities, will need to have PCS provided that goes beyond the basic personal care that is provided through residential placements. Failure to provide this additional personal care will result in high support need individuals not being accepted in many community settings. This will place people with significant support needs at increased risk of institutionalization and result in out of community placement. Another area of concern on the limitations on Personal Care on page 19: This service does not include medical transportation and may not be provided during medical transportation and medical appointments; The Arc supports a woman who has her own van but cannot physically drive it. She occasionally visits doctors in the Chapel Hill/Durham area (2-3 hours away from this community). She lives alone and utilizes staff to drive her everywhere. Could the waiver qualify that adults living alone who require services from Doctors/Specialists outside their community can use personal care services to get there? She has used an ambulance, which cost the state $1,000.00 one way! By utilizing her own vehicle and gas, the state would be saving money and she would be contributing to her service delivery. On page 22 from the definition of Residential Supports: Habilitation, training and instruction are coupled with elements of support, supervision and engaging participation to reflect the natural flow of training, practice of skills, and other activities as they occur during the course of the person’s day. This service is distinctive in that it includes active treatment, habilitation and training activities. Residential Supports by proposed definition includes training and instruction. That fact, coupled with the proposed limitations on Personal Care may well bring about the unintended consequence of forcing people to receive a higher level of support then what is actually needed. People living in AFLs, Group Homes etc, who need additional assistance, may instead be forced to receive Residential Supports, a more intensive service than Personal Care that will no longer be an option for them due to the Personal Care limitations being proposed. On page 26: Supported employment services, which consist of paid employment for persons for whom competitive employment at or above the minimum wage is unlikely, and who, because of their disabilities, need intensive ongoing support to perform in a work setting. This statement may be construed as limiting and is wide open to misinterpretation. As the manual is being written, the Division should write this section with extreme caution and clarity. You do not want Supported Employment providers in North Carolina asking businesses to pay below minimum wage so the provider can still get funding from CAP to provide necessary services (a misinterpretation that has occurred). An employee of The Arc writes, "I facilitate a PATH for a man who was hired by a local business at $6.00/hr. Once he is trained, the plan is for his CAP services to pay for the long-term support he may need to maintain this job." Competitive employment should mean minimum wage and the state should support an individual in getting the highest paying job they can get. On page 49, Note: Wavier services cannot be provided to recipients by legally responsible relatives, i.e., spouse or parents/step-parents, guardians of minor children when the services are those that these persons are already legally obligated to provide. ……Medicaid payment may be made to qualified parents of minor children to spouses for extraordinary services requiring specialized skills (e.g., skilled nursing, physical therapy) which such people are not legally obligated to provide." This "note" needs clarification. What services are parents, spouses, stepparents legally obligated to provide? Who is defining this term? Failure to clarify this "note" will result in a wide variety of interpretations and will continue to perpetuate the unequal service and support system we currently have in North Carolina. On page 44 and 45 (in both Personal Care and Respite) within the "Other Standards" column: Staff providing enhanced personal care (also respite) have additional training/instruction specific to the medical and/or behavioral needs of the consumer. The Arc is assuming that this is indicating that there will be two levels of Personal Care and Respite Services. What are the requirements needed to be met to receive enhanced services? Will this be addressed in the manual? There certainly needs to be clear guidelines for eligibility for enhanced services but also a mechanism needs to be developed to address people’s needs for enhanced services who do not meet the strict criteria. It has been discussed by Division staff that people who have an overall NC-SNAP score of 5 or a score of 4 in either behavioral or medical domains would be eligible for consideration of enhanced services (if necessary). This seems to be reasonable but there also needs to be another way to capture truly unique support needs other than the NC- SNAP and to offer enhanced supports to others who may need them. It is amazing how these rules can affect real people's lives. Thank You for giving us this opportunity to comment on the proposed waiver.
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