Coalition Rally 2012

Mark your calendars now and join The Autism Society of North Carolina (ASNC) at the for the 2011 Coalition Popcorn Rally and Advocacy Day at the NC General Assembly on May 22nd from 8:30 am to 3:00 pm.  The Autism Society of North Carolina is a long time member of The Coalition, a group of 40 statewide organizations advocating on behalf of individuals with developmental disabilities, mental health issues, and the disease of addiction.  Telling legislators our stories is our most powerful advocacy tool.  Join us in making the concerns and presence of the autism community known to each NC State Senator and Representative.

Registration will begin at 8:30 Am and continue throughout the day on the back portico of the Legislative Building, located at 16 W. Jones Street.  During the morning hours Coalition volunteers, including ASNC’s Director of Government Relations Jennifer Mahan will be providing brief training on making the most of your Legislative visits and current issues impacting people with disabilities. There will be opportunities to listen in on Legislative Committee meetings and Legislative session throughout the day and The Coalition will be handing out popcorn starting at 11AM, with the Rally starting at Noon. If you plan to addend, we encourage you to make an appointment with your Legislators for May 22 as soon as possible. You can reach your NC state Legislator by calling the General Assembly switchboard at 919-733-7928 and you can find out who represents you via the General Assembly website.

ASNC would love to know that you are attending to we can assist you with talking points related to autism spectrum disorder and any questions you might have. Though registration is not required, please contact Jennifer Mahan at ASNC at jmahan@autismsociety-nc.org or call 919-865-5068 to sign up for our special ASNC Coalition Rally emailing list or for additional information.

[For those attending, a map of the Legislative Buildings and local parking can be found here.  Please note that there is a new parking lot located at Edenton and  McDowell Streets, near the old Education building and attached to the "green" building with the giant globe. Parking in downtown lots is NOT free. The Legislative buildings have several snack bars and a cafeteria and nearby Fayetteville street has a number of restaurants. ]

CAP I/DD Waiver Changes Part 2

The Community Alternatives Program for people with intellectual and developmental disabilities (CAP I/DD, formerly known as CAP MR/DD) is expected to change beginning November 1st, 2011. Changes to the program still need to be approved by the Federal Government, however approval is expected and the Division of Medical Assistance which operates the CAP I/DD in North Carolina is moving ahead as if the plan will be implemented November 1st, 2011. These changes are being made so that the CAP I/DD Waiver stays within its budget and so that the waiver has similar services to the new Innovations Waiver that will be part of the new managed care system in North Carolina. Reductions in habilitation hours are the result of CAP I/DD being over budget and no new funds being appropriated.

If you do not make plan revisions before November 1, your CAP I/DD plan will not “roll over” to the new CAP waiver. Let me say that again: this is a new waiver, your current plan will not automatically change to the new waiver with fewer hours. You must submit a revised person centered plan in order for CAP services to continue after November 1st.

The Biggest Changes:

There will be a 129 hour per month limitation on habilitation hours for adults and children.

“Habilitation” includes Day Supports, Supported Employment, Long Term Vocational Supports and Home and Community Supports.

The 129 hour limit is inclusive of all these habilitation services; the total number of hours of these services cannot exceed 129 hours.

It does not include habilitation hours provided in Residential Supports and/or Home Supports.

Habilitation hours for children in school will be reduced to 20 hours per week. This includes any week school is in session, even for one day, even if the child is not in school that particular week.

The 129 hour limit is a monthly limit; it is not a yearly average of habilitation hours.

Home supports will no longer be a service under the 2011 CAP I/DD waiver. Personal care and Home and Community Supports may be used instead of Home Supports. Hours restrictions that apply to rest of waiver apply to those transitioning out of Home Supports.

Family members can continue to provide Home and Community Supports and Personal Care as they did under Home Supports. Other services under the CAP I/DD Waiver, such as Day Supports and Respite, cannot be provided by family members.

What You Need to Do:

This is a difficult time for families and people on the autism spectrum who get CAP I/DD (MR/DD). The system is already confusing and many changes are going on all at once. It is hard for the Autism Society in North Carolina (ASNC) to give good advice about the upcoming changes: on the one hand, the waiver has not yet been approved so if you make changes to your CAP plan, hours will be reduced now. On the other hand if you wait to make those changes because there may be some delay in getting a new plan approved which could mean services are interrupted.

Repeated: If you do not make plan revisions before November 1 and the Waiver is approved (and we expect it will be), your plan will not “roll over” to the new waiver. You must submit a new plan in order for services to continue after November 1st.

Legal Rights and Recommendations:

Legal Services of Southern Piedmont, in consultation with Disability Rights North Carolina and the National Health Law Program, has issued the following advice.

1. Personal care: If the recipient is under age 21, EPSDT [Federal laws about early periodic screening diagnosis and treatment] applies. This means the family can request in their plan more hours of personal care than the clinical policy criteria allow and/or can ask in the plan to keep enhanced personal care because it is medically necessary.

2. If the recipient is age 21 or older, the family can ask in the plan for enhanced personal care or for additional hours as a reasonable modification under the Americans with Disabilities Act (ADA) if the recipient at serious risk of institutionalization without the service.

3. Either a child or adult can request more hours of personal care if a revised SNAP is submitted showing higher level of need than previous SNAP.

4. Habilitative services and respite: EPSDT probably does not apply. But either a child or adult can ask in the plan for more than 129 hours per month as a reasonable modification under the ADA if at serious risk of institutionalization without the service.

5. Private Duty Nursing (PDN): if the recipient is under age 21 the family can ask to keep the service under EPSDT if medically necessary.

6. PDN: if the recipient is age 21 or older, the family can request to keep the service for longer than 30 days so long as criteria for PDN are met or as a reasonable modification under ADA if at serious risk of institutionalization without the service.

7. Other new restrictions on services: the family can request a waiver of the rule as a reasonable modification under ADA if at serious risk of institutionalization due to restriction.

8. The family absolutely has the right to submit a plan asking for services in excess of policy limits in the above circumstances.

9. If the recipient is under age 21 and the plan is denied, the family will receive a written notice with appeal rights. The family must appeal to the Office of Administrative Hearings (OAH) within 30 days. The recipient will be able to continue to receive services at the prior level pending the outcome of the appeal. The appeal process starts with a telephone mediation. If the mediation is not successful, the case goes to an Administrative Law Judge (ALJ) for hearing.

10. If the recipient is age 21 or older and the plan is denied as in excess of policy limits, the provider will get notice but not the family. The notice will not include appeal rights. However, the family nonetheless can file an appeal in OAH if there is a valid factual issue for appeal rather than just a challenge to the legality of the policy. The family can argue to the ALJ that whether a reasonable modification under the ADA is needed in that case is a factual issue. If the ALJ agrees, the family can ask that services be reinstated pending the outcome of the appeal.

11. Even if the family decides not to request services in excess of policy limits at this time or not to appeal if that request is denied, the family and case manager should monitor the recipient’s conditions and health. If that deteriorates, the family can ask for the plan of care to be amended to increase the level of service and appeal if that request is denied. However there is no right to continued services pending appeal in that instance.

12. The family also has the right to challenge the plan denial in federal court instead of OAH.

13. Legal representation is likely to be needed to succeed in an appeal in these cases. Families who submit a plan that is denied and who want to appeal can contact:

Disability Rights NC (statewide) 1-877-235-4210

Legal Aid of NC (statewide) 1-866-369-6923

Legal Services of Southern Piedmont (if recipient lives in Mecklenburg county) 704 376 1600

Council for Children’s Rights (if recipient is a child and lives in Mecklenburg) 704 372 7961

Pisgah Legal Services (if recipient lives in Buncombe, Henderson, Madison, Polk, Rutherford or Transylvania counties) 1-800-489-6144

However, be aware that these nonprofit agencies have limited resources and cannot represent many of the families that contact them. Families with the means to do so may wish to contact a private attorney.

Additional Recommendation from ASNC:

16. Due to the expected number of person centered plan revisions that will be submitted to Medicaid and Local Management Entities, the Division of Medical Assistance is recommending that services are transitioned at least 15 business days prior to October 31st. Plan revisions should be submitted as soon as possible to allow time to complete authorization of services. Some areas of the state may be able to process plan changes more quickly and Local Management Entities may be saying its ok to wait until October 15th or later. You should use your best judgment in determining how long to wait before changing CAP plans; delays could mean interruption of services because existing plans will not roll over to the new waiver.

Other Resources:

NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services Implementation Updates Page (current information on services, policies)

The following information is from Western Highlands LME based on information about the CAP I/DD waiver from the NC Division of Mental Health Developmental Disabilities and Substance Abuse Services and the NC Division of Medical Assistance. It may be helpful in determining if you need to make changes to your plan.

Current CAP MR/DD Waiver	New CAP I/DD Waiver  (Nov 1 2011)	What should participant do?
Adult Day Health Care Services	Adult Day Health Care Services	No action required.
Behavioral Consultant	Behavioral Consultant	No action required.
Crisis Respite	Crisis Respite	No action required.
Crisis Services	Crisis Services	No action required.
Day Supports	Day Supports	Action required if total hours of habilitation services exceeds 129 hours per month in combination. See Guidance for Habilitation Services Transition.
Enhanced Personal Care	Personal Care OREnhanced Personal Care	Action required if participant receives the service to address intense behavioral issues. See Guidance for Enhanced Services Transition.
Enhanced Respite Care	Respite Care  OREnhanced Personal Care	Action required if participant receives the service to address intense behavioral issues. See Guidance for Enhanced Services Transition.
Home and Community Supports	Home and Community Supports	Action required if total hours of habilitation services exceeds 129 hours per month in combination. See Guidance for Habilitation Services Transition.
Home Modifications	Home Modifications	No action required.
Home Supports	Home and Community Supports AND / OR Personal Care	Action required that terminates existing authorization. Service should be replaced with level of periodic services determined to meet the needs of the participant. Services requested should be within the Utilization Review Criteria. See Guidance for Home Supports Transition.
Individual Caregiver Training and Education	Individual Caregiver Training and Education	No action required.
Long Term Vocational Supports	Long Term Vocational Supports	Action required if total hours of habilitation services exceeds 129 hours per month in combination. See Guidance for Habilitation Services Transition.
PERS	PERS	No action required.
Personal Care Services	Personal Care Services	No action required.
Residential Supports	Residential Supports	Action required if combination of habilitation hours required for the daily level (see Utilization Review Guidelines) and any daily periodic habilitation services exceed 12 hours on any given day. Teams must consider direct contact hours. Targeted Case Management should update the Person Centered Plan to ensure that habilitation does not exceed 12 hours on any given day if necessary.
Respite Care	Respite Care	No action required.
Specialized Consultative Services	Specialized Consultative Services	No action required.
Specialized Equipment and Supplies	Specialized Equipment and Supplies	No action required.
Supported Employment	Supported Employment	Action required if total hours of habilitation services exceeds 129 hours per month in combination. See Guidance for Habilitation Services.
Transportation	Transportation	No action required.
Vehicle Adaptation	Vehicle Adaptations	No action required.

[Note that the timelines listed below may vary from LME to LME. See your case manager plan submission deadlines. ]

Guidance for Habilitation Services:

Periodic services are reimbursed in 15 minute units. Support services do not require a habilitation component. Currently, the waivers provide enhanced and standard periodic support services (Personal Care & Respite Care) for individuals with intense medical and/or behavioral needs. Enhanced periodic support services will not be available for intense behavioral needs on October 31st.

Enhanced periodic support services will be available for individuals that have intense medical needs that require a higher level of service to prevent hospitalization or placement in a skilled facility. To meet medical necessity criteria, the participant must require the following:

• Expertise and supervision of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) because of complexity or critical nature of activities provided

• Person Centered Plan must clearly document the need for the enhanced periodic service

• Enhanced periodic support services staff will receive training and/or supervision from an RN or LPN at minimum monthly

Enhanced periodic support services for intense behavioral needs should be replaced with standard periodic support services. Standard periodic support services will typically be limited by the Utilization Review Criteria outlined in Clinical Coverage Policy #8M.

If a participant is authorized to receive enhanced periodic support services to address intense behavioral needs past October 31st, their Person Centered Plan should be updated to either change the enhanced periodic support services to standard periodic support services or to provide justification to continue the enhanced level of services. A complete update should be submitted to the appropriate Utilization Review vendor by October 15th.

If the participant’s annual Person Centered Plan begins on November 1st, the Targeted Case Manager should submit a complete request package to the appropriate Utilization Review vendor by October 1st. Enhanced or standard periodic support services should be requested as deemed necessary by the planning team with the annual plan of care within the medical necessity and Utilization Review Criteria outlined in Clinical Coverage Policy #8M.

Should the participant and/or legal guardian of the person refuse to request services with the Person Centered Plan or update that are within the medical necessity and Utilization Review Criteria, the Targeted Case Manager should submit a complete request that reflects the periodic support services that the participant and/or legal guardian of the person believe are medically necessary. Complete requests may exceed the limits established for all periodic support services.

Upon receipt of a complete request, the Utilization Review vendor will review requests for medical necessity and render a decision. The Utilization Review vendor will offer the participant and/or legal guardian of the person due process rights as applicable.

The Utilization Review vendor will ensure that requests for children (<21 years of age) in excess of the Utilization Review Criteria are reviewed with consideration of Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) Special Provisions as applicable.

For a request to be considered complete by the Utilization Review vendor, the Person Centered Plan update or annual plan of care must be signed by the participant and/or the legal guardian of the person.

NC General Assembly Legislative Session Wrap-up

This article was published in The Autism Society of North Carolina’s summer 2011 issue of The Spectrum. Current and past issues of The Spectrum can be found under Publications on our website.

Families, self-advocates and ASNC faced difficult challenges in advocating for better services and supports for people on the autism spectrum as we headed into the long North Carolina General Assembly legislative session in January: ongoing tough economic times with a 2.2 billion dollar state budget deficit, new legislators unfamiliar with our needs, pressure from interest groups opposed to policy changes, and a determination across state government to use managed care for services to those with developmental disabilities.  ASNC pushed policymakers to think about the effects their decisions would have today and in the future. While we did not achieve all we set out to do, we were able to have some significant impacts.

 

Budget: At the beginning of the year, policymakers were expecting to make large cuts to all programs, including those that serve developmental disabilities. By the end, suggested cuts had been significantly reduced.  Most cuts to Medicaid we hope will come from efficiencies, connecting people to primary care services and better management tools. Cuts to state service funds were reduced to a $20 million onetime cut from a recurring $30 million cut.  Cuts to non-profit programs went from $ 10 million down to $ 5 million. Still, there will be significant impact; service providers have taken rate cuts for the last three years, despite needing to meet increasing quality standards and rising costs. Any reductions in a system that already struggles with waiting lists will likely come at the cost of people losing access to needed services and supports.

 

Other programs impacting children took deep cuts: Schools were cut by 408 million; early childhood education and development were cut by more than $55 million. Additionally, evidence backed programs like Smart Start will no longer be able to promote health screenings that help with early identification of children at risk for development problems.   ASNC pushed for legislators to take a balanced approach and keep current revenue streams in place to support these needed programs. Despite public support, legislators allowed the penny sales tax to sunset on June 30th.

 

Managed Care Waivers:  ASNC has made it a priority to advocate for I/DD system management options other than 1915 b/c managed care waivers for people with Autism Spectrum Disorder. Of greatest concern under managed care is the elimination of independent case management which creates a conflict of interest in managing the use of services (i.e. the cost of care) and determining an individual’s needs and plan of care. As the session progressed, it became clear that policymakers were determined to push managed care across the entire system.  ASNC pushed for additional consumer protections and for the voice of families, self advocates and local communities to be heard in the process.  Please see page 16 for expanded information about the new managed care waivers in North Carolina.

 

Autism Insurance Coverage:  Autism insurance bill sponsors introduced very good bills this year, Senate Bill 115 and House Bill 826, Coverage for Treatment of Autism Disorders. This bill ensure that North Carolina health plans cover services for ASD, so it’s disappointing that autism insurance legislation has not moved forward in the NC General Assembly this session. We all know it’s the right thing to do, so that those with autism get the services they need to be healthy and successful. We also know that it will save money in the long run by promoting independence.

Unfortunately, to get it passed, we need to convince NC General Assembly lawmakers to raise insurance standards in both private and public health plans, which is estimated to increase costs less than 1%. At this time, many lawmakers are against taking actions which would result in higher costs to business or state health plans. This is not the only reason that autism insurance bills have not passed, but it is a huge factor. Other factors include a lack of understanding about Autism Spectrum Disorder and its treatments, as well as opposition from powerful interests like the insurance industry and business associations.

 

The bill is still alive and will carry over to the short Legislative session in May-June of 2012. Between now and then, families, self-advocates, autism professionals, and other advocacy organizations must meet with their NC state General Assembly Legislators, especially those on the House Health and Human Services Committee, the House Insurance Committee, and the Senate Insurance Committee, to urge those lawmakers to pass the bill. 

 

Tax Credits and Corporal Punishment: Autism advocates had two solid victories this past session: House Bill 344, Tax Credits for Children with Disabilities, and Senate Bill 498, Modify Law Re: Corporal Punishment.  House Bill 344 Tax Credits for Children with Disabilities gives a $6,000 tax credit to families whose child with a disability moves from a public school to attend a private school or home school. To qualify for the credit, children must have been in a public school the previous two semesters, have an IEP, and be receiving special education or related services on a daily basis. The legislation also establishes a special needs trust fund to be administered by the NC Department of Education to supplement funding for special education services in the public schools. Part of the savings generated by the use of the tax credit will go to the trust.

 

Senate Bill 498, Modify Law Re: Corporal Punishment, requires schools to send a form at the beginning of the school year allowing parents to opt-out of corporal punishment for their children.  Many families are surprised to learn that 39 counties in North Carolina still allow physical punishment and that 17 are actively using it (Numbers are correct as of this printing. Counties are moving to ban the practice and this number may drop as we get closer to the school year start.) ASNC continues to promote positive behavioral supports and an end of the use of physical punishment for all children in schools. Previously, corporal punishment had been banned for students with disabilities; however, we know from parents that students with as yet unidentified disabilities continue to be subject to corporal punishment.

 

Your Advocacy: One of the best outcomes of this legislative session is that we heard that Legislators heard from you.  On managed care, on the budget, on education, on insurance – they got your calls, letters and emails.  Having real life examples of how Autism Spectrum Disorder is impacting you and your family does make a difference in public policy. ASNC needs that advocacy to continue to build so that every Legislator hears from families, self-advocates, and others in their districts.

 

Victories on autism insurance, funding for services, ending waiting lists, and creating lifetime supports will be won with your action. Policymakers were moved by your stories about struggling to find the right education options to ensure your child’s success. That same action is needed in the coming year to pass better insurance standards. ASNC challenges you not only to get involved, but to ask others who know you to join in this effort. Sign up for our e-updates, write letters, and pass them along to your neighbors with the request that they do the same.  

 Please contact Jennifer Mahan, Director of Government Relations, with questions or concerns. She can be reached at 919-865-5068, 1-800-442-2762, ext. 1116 or jmahan@autismsociety-nc.org. You can also leave your questions or comments in the comment section below.

This Week at the NC General Assembly

Governor’s Budget Veto

On Sunday The Governor vetoed the state budget passed by the NC General Assembly. At this point, the NC Senate has enough majority votes to override a veto, and the NC House believes they also can override a veto if at least 4 of the 5 Democrats who voted for the budget also vote with the Republican majority to override.  The earliest that the House can take up the veto override is this Tuesday June 14.  As of Tuesday, the House has scheduled a vote for Wednesday June 15, but could take it up late Tuesday night.

Should the veto not be overridden, the Legislature would need to pass a continuing resolution to fund state government in the absence of a new budget for 2011-2013. It’s unclear if the Governor would have the authority to continue to operate state government without a resolution, and House and Senate Leaders expressed a reluctance to pass a resolution that would not include a significant cut to state government agencies, along the lines of the budget that they have already passed. No one wants to talk about government shutdown, but that is one of the possibilities should post-veto negotiations not go well and the Legislature adjourns without a budget or continuing resolution in place.  The Autism Society of North Carolina (ASNC)continues to follow this issue and will keep you updated on what happens.

House Bill 344 Moves to Senate

Tax Credits for Children with Disabilities, H 344, passed the House last week and will be heard in the Senate this week. As we have posted in previous updates, give a $6,000 tax credit to families whose child with a disability attends a private school. To qualify for the credit, children must have been in a public school the previous two semesters, have an IEP and be receiving special education services on a daily basis.  The Senate Education Committee will hear the bill sometime on Monday afternoon from 4:30 to 6:00 PM in Room 643. If the committee gives it a favorable report it will be re-referred to Senate Appropriations.  Because this may be one of the last weeks the legislature is in session, we expect that H344 will move quickly through the Senate.  ASNC supports this legislation and will be closely monitoring the bill as it moves through the Senate.

As of Tuesday night  June 13th Senate Appropriations has given a favorable report to H 344 and re-referred it to Senate Finance which expects to hear it on Wednesday June 15th at 1PM in room 643.

Corporal Punishment Bill Update

The bill that would allow parents to opt out of corporal punishment in schools has been incorporated into Senate Bill 648 “Amend Law re: School Discipline”  a bill that clarifies school discipline and which was negotiated with child advocates and school groups. Because the Senate version and House version of Amend Law re: School Discipline are now different, the Senate version will need to go to the House for consideration. Since the House has passed its version of the school discipline bills (H736) and is taking up its version of the corporal punishment bill, it’s not clear which bill will be passed by the House.  ASNC will continue to monitor this issue and update you as we get more information.

Over the last two days, the corporal punishment language has been removed from the Senate bill Amend School Law re: Discipline. The House is now working to pass S 498 Modify Law Re Corporal Punishment which allows parents to opt out and makes practices uniform across schools. House Education gave it a favorable report on Tuesday June 14 and the bill may move to the House floor for a vote soon.

Since the law was passed last year banning corporal punishment for students with disabilities, additional local school districts have banned the use of corporal punishment. It is now being used in 17 of 115 school districts in the state.  ASNC appreciates the work on local advocates and parents who have raised this issue with school boards. Their work has helped to promote more positive behavioral supports and build support for ending physical punishment.

 

State Budget and Managed Care Waiver Update

NC State Budget

Last week the NC General Assembly passed a budget for the 2011-2013 budget years that was compromise bill negotiated between the NC House and NC Senate, prior to the Senate passing their own budget. In the final version, the General Assembly used the House version of the budget numbers for Health and Human Services (HHS), reducing Senate proposed cuts down to the House levels.  We reported on the House budget in our blog post  and a chart outlining the final cuts in the compromise budget is below. All in all while these cuts in HHS are not good, they could have been much worse. There is a $45 million dollar cut to IPRS state funds for Local Management Entities (LMEs) for services across intellectual and developmental disabilities (I/DD), addiction and mental health services; however the budget directs LMEs to use $25 million of their fund balances, reducing the cut to $20 million. A number of LMEs do not have fund balances, so making up the rest of the $20 million in cuts with existing funds is unlikely. The cut to non-profit funding has been reduced to $5 million dollars. The Medicaid cuts are a combination of savings through increased use of public managed care across the Medicaid system, provider rate cuts, cuts to services like Personal Care, and through additional Federal funding. However, if the NC Department of Health and Human Services is not able to meet their budget, they are authorized to reduce or eliminate optional services including many that could impact people with autism spectrum disorder.  

Education across the board sustained deep cuts.  Early education and development programs like More at 4 and Smart Start took cuts of $16 million and $37 million respectively and will also be required to limit the scope of what they do. Schools were cut by $408 million, with the largest cuts to local school districts of $198 million, non-instructional support $60 million, and instructional support $23 million. The budget adds $62 million in funds for class size reduction in grades 1-3. Universities and Community colleges took cuts in the range of 15%.

Managed Care Waivers

As we mentioned in previous updates, the budget includes proposed savings for implementation of 1915b/c managed care waivers across the intellectual and developmental disability, mental health, and addictive disease system. In addition, two bills have passed the Legislature that expand managed care from one region, Piedmont Behavioral Health (PBH), to every LME across the entire state by July of 2013. Senate Bill 316  allows PBH to expand their waiver to more counties, and has passed both chambers. House Bill 916, which allows for additional waiver expansion to other LMEs was heard in Senate Mental Health and Youth Committee, was passed on the Senate floor and is now headed to the Governor’s desk.

The final version of H 916 does not contain independent case management, but it does allow an LME waiver site to contract for “treatment plan development” and for the “community guide” service which we believe allows some independent development of person centered plans and offers assistance to consumers and families.  The bill contains several other provisions which are a positive step for people with I/DD: aggregate funding, an intent to use future savings to expand services, continuity of care language, and the study of the use of the “I” option for I/DD.

Because the managed care waiver will have a significant impact on everyone with autism who uses any public funding, including CAP MR/DD, Medicaid, IPRS, and any other services they access through the LMEs, we urge you to pay close attention to your local communities waiver plan development.  Every LME has a website and customer relations staff and should be soliciting input from the public as they make these changes. The Autism Society of North Carolina will continue provide you with information on the new waivers, will work at the state and local level to monitor implementation and will recommend solutions to any problems that arise.

The Autism Society of North Carolina has compiled a list of cuts below we feel are relevant to people on the autism spectrum. For a full list of proposed budget cuts, visit the General Assembly web site  and review the articles under the “News and Information” section (left-hand column). The “Money Report” links is a list of cuts, and the “Bill Text” link includes an overview of the funding as well as the “special provisions” stating how funding is to be used and related policy changes. Items in () indicate cuts.

Department	Fiscal Year 2011-2012	Fiscal Year 2012-2013
DHHS Admin
Non-Profit Funding	(5,000,000)	(5,000,000)
CARELINE (handles calls for help, including Medicaid problems)	(380,478)	(380,478)
Div Child Development
Smart Start	(37,600,000)	(37,600,000)
Discontinue transport	(1,001,718)	(1,001,748)
Div of Public Health
Early Intervention	(3,118,046)	(3,118,046)
Div of Medical Assistance
Modify Optional and Mandatory Services (total of several)	(16,508,903)	(22,072,343)
Eliminate inflationary increases	(62,853,778)	(130,874,505)
Adjust provider rates	(46,420,718)	(46,458,260)
Behavioral Health 1915 b/c waiver (includes DD, autism)	(10,537,931)	(52,551,082)
CCNC savings (implementing more medical homes)	(90,000,000)	(90,000,000)
Div of Mental Health, Developmental Disabilities, Substance Abuse
Eliminate 7 advocacy positions (in state facilities)	(158,045)	(158,045)
Eliminate Community Funding (IPRS) for Medicaid recipients, except residential support	(20,000,000)	0
Swap (LME) fund balance w/ state service funds	(25,000,000)	0
Reduce Division management flex funds (emergency fund)	(7,180,807)	(7,180,807)
Education
Public Schools Total Cuts (-$65 mil transferred)	(394,051,894)	(408,543,951)
LEA adjustment (schools return funds to state, make cuts locally)	(124,217,542)	(198,293,574)
Community Colleges Total enrollment growth funded, but tuition increased and all programs cut	(117,475,214)	(117,475,214)
University System Total enrollment funded, but 470 mil flex cut to be determined by UNC	(347,117,332)	(335,057,688)