Legislative Update for May 20 – NC House Passes Autism Insurance Bill!

The following post was filed by Jennifer Mahan, Autism Society of North Carolina Director of Advocacy and Public Policy.

Crossover Week
Last week, the legislature finished a very busy week known as “crossover.” During each long session the NC General Assembly sets a deadline for policy bills to be approved by one chamber or the other (NC House or NC Senate) so that they can be considered by the other chamber. For example, if a House bill does not get passed by the House, it “dies” (does not go to the Senate) and under most circumstances cannot be brought up for consideration again until the next long session in 2015.

Some bills are not subject to crossover; mostly those that have to do with the budget and appropriating funds. Each chamber sets its rules for which bills need to meet crossover, so sometimes there is a rush to get bills through even if they have money attached to them or impact the budget.

Autism Insurance and Crossover Week
Crossover week is incredibly hectic. Legislators work long days with added committee meetings and long sessions into the night debating bills. This is the atmosphere in which H498, Autism Insurance Coverage, passed the NC House on Wednesday May 15th around 9PM.

The previous day, Tuesday, May 14, the House Insurance Committee had an afternoon hearing on the revised bill, and gave it a favorable report 25 to 4. With that favorable report HB 498 moved on to a hearing in the House Appropriations Committee around 7PM that same night (Tuesday). Eight amendments were proposed during the Appropriations debate and seven were adopted making many changes to the bill (see below for a summary of the new bill). The bill was then added, along with other bills that passed committees that day, to the revised House calendar (the “supplemental calendar”) for the next day, Wednesday, May 15th.

Wednesday’s floor session debate began late in the afternoon and carried over into the evening. Floor debate regarding HB 498 began at 7:50 PM. Our bill sponsors successfully defended the bill against several new amendments that would have significantly weakened the bill including one that would have removed 95% of the insurance plans in the state. The sponsors and other Representatives argued eloquently for the bill: both about its reasonableness for businesses in the state as well as the importance of providing this coverage to children and young adults and how much it will help them and their families. Once the amendments were voted on all of us following the bill held our breath as the Speaker called for the vote. The House allows 15 seconds for members to vote electronically. After 15 seconds that seemed like 15 minutes the vote results were announced: 105 in favor and 7 against (a few of the 120 members were absent). The final vote tally was an incredible show of support! Over the last few days and even hours preceding the vote several members changed their minds and voted in favor.

Thank you to everyone for your advocacy. As I visited with Representatives and checked in with the other advocates working on the bill, I heard over and over about the calls and emails they were receiving in support of the bill. Grassroots advocacy works!

While we are very pleased to have moved HB 498 out of the House, ASNC will need your continued involvement as the bill moves to the Senate where it will need to go through a similar process including committee hearings and a Senate floor vote. Please keep an eye on your email, this blog, and our Facebook and Twitter feeds for future calls to action.

The bill currently includes the following provisions (as amended by the NC House):

• Covers diagnosis and treatment of autism spectrum and related disorders, including ABA therapy.
• Covers children and young adults up to age 23, who are diagnosed by age 8.
• Caps yearly behavioral benefits at $36,000.
• Allows businesses with 50 and under employees to request a waiver from the requirement to offer this coverage if they can show their health care costs have increased by more than 1% over 12 months as a result of offering coverage for autism.
• Covers group plans in North Carolina who are subject to NC law as well as the State Health plan.

Links to the full content of the bill and an overview of its history can be found here.

For more information you can contact Jennifer via email at jmahan@autismsociety-nc.org or 919-865-5068.

What happened at the Legislature this session? ASNC Budget Wrap Up Report

Photo credit to Mr. T in DC via Flickr.com

Editor’s Note – The following article was written by Jennifer Mahan, the Autism Society of North Carolina’s Director of Government Relations.

During the General Assembly “short” legislative session that lasted from May 16 to July 3rd, state legislators made small changes to the second year of the two-year state budget they put into place last year. So, what changed?

The legislature:

• Funded Medicaid cost over runs for the current year (2011-2012) and added more funds to Medicaid to cover possible cost increases for 2012-2013.

• Increased funding for education, including teachers’ raises of 1.5% and $27 million for new education reforms, mostly focused on improving early grade reading skills. A loss of Federal funds and larger cuts in state funds in the second year of the budget means more cuts for local schools.

• Continued the $20 million dollar cut to state funded services (IPRS) for developmental disabilities, mental health and addiction, but did not require local management entities to use fund balances to cover the cuts as they did last year. It is likely that this cut will reduce availability of supports like developmental therapies and respite.

• Cut Medicaid personal care services by $6 million and changed the eligibility criteria. Because the changes are new, and the legislative language confusing, no one is sure how many people will lose personal care services.

• Added $1.7 million to Medicaid due to delays in some local management entities (LMEs) converting to the new 1915 b/c managed care waivers, while cutting $8 million from LME administrative budgets. The $8 million reduction is in anticipation of  savings from the conversion from a network of LMEs to MCOs. Legislators did not make changes to the waiver bill they passed last year or to the final timeline for implementation which remains June 30, 2013.

• Created a new “Transitions to Community Living” fund and oversight committee. The fund will help people with mental illness move out of adult care homes and into community housing, while also assisting adult care homes who may lose funding from Medicaid in the process. The new Transitions oversight committee will also look at the issue of housing and community living for people with developmental disabilities.

If you would like to see the entire budget, H 850 (the budget adjustments act), the Committee report for H 850 (i.e. the money report) and S 187 (the budget modifications/corrections bill) go to the General Assembly Website at www.ncleg.net. For a more detailed summary of legislative action that impacts people with on the autism spectrum and other intellectual and developmental disabilities, please read ASNC’s 2012 legislative summary.

Questions? Please use the comment feature or email Jennifer Mahan at jmahan@autismsociety-nc.org.

What is the NC General Assembly Up to This Session?

Editor’s Note: The following entry was written by Jennifer Mahan, Autism Society of North Carolina Director of Government Relations. Jennifer will be providing a monthly summary of legislative activities while during this year’s short session as well as other updates about autism-related legislative efforts.

May 14th was the start of the” short” legislative session this year. Although the General Assembly has been back in Raleigh for several brief sessions to address specific issues in the last few months, the traditional “short” session takes place in even-numbered years and lasts for about 6-7 weeks. During this time, The NC House and the NC Senate generally only make adjustments to the two-year budget they passed the previous year and work on legislation that was passed by one chamber the previous year, but not taken up yet by the other chamber. The only new legislation introduced is based on recommendations of study or oversight committees or sometimes legislation that addresses urgent, unforeseen problems. So, we should see fewer bills to keep an eye on – but you never know! Here are some issues we are advocating on or monitoring:

State Budget:
The budget includes many items that impact people on the autism spectrum including funds for early childhood intervention, education, Medicaid and state funded services and supports like housing, respite, developmental therapies, and vocational services, just to name a few . Policy changes may also be included in the budget special provisions. So far, the House has been holding budget committee meetings and only making small adjustments: the good news is it looks like no cuts to direct services and supports. The process has just begun, though it is moving quickly, so as always we will continue to keep a close eye on it. We know that the House and Senate are likely to have very different versions of an education budget given that the Senate President Pro Tem has a set of education initiatives he introduced last week. Polls have shown public support for raising revenue to support services and education, but it is unlikely that this General Assembly will make any changes to the existing revenue or tax structure. The process has just begun, though it is moving quickly, so as always we will continue to keep a close eye on it.

HB 916 and Managed Care:
Last year the General Assembly passed a bill, HB 916, which mandated that the state implement managed care waivers statewide for nearly all publicly funded developmental disability, mental health and addiction services (DD, MH and SA) by July 2013. This huge change has been criticized by many individuals, families and advocates for the quick speed at which it is expected to happen, the loss of services like independent case management, changes to CAP IDD waivers, changes to guardianship, and other problems with a change of this size and scope. Some legislators have expressed concerns about the new system, and we hope to see some positive changes recommended in legislation.

LME MCO Governance:
The local management entities that direct DD, MH and SA services are becoming managed care organizations and in the process must provide oversight to larger regions with additional counties and more complex operations. The LMEs and some Legislators want changes to the way in which LMEs oversee the services they manage and to how governmental agencies and Boards oversee them. The Joint Oversight Committee on Health and Human Services recommended a series of changes which have been incorporated into Senate Bill 875 and House Bill 1075 including smaller Boards, more Board training, allowing for exemptions from the state personnel act such as control over MCO Director’s salaries, the ability to borrow funds and own real property, the ability to keep some information out of the public eye, and the transfer of guardianship from the LME to local Departments of Social Services. While the Autism Society of North Carolina does not have a position on this bill at this time, advocates have been particularly concerned about the makeup of the governing Boards to ensure they are representative of those they serve including families and individuals with intellectual and developmental disabilities as well as people with other expertise in this area. In addition, advocates are concerned about the availability of quality guardianship and the continued transparency of government activities, so we will monitor the progress of any bills.

Autism Insurance Coverage:
The Autism Society of North Carolina and other groups continue to advocate for better insurance standards that cover services and treatment of autism spectrum disorder. We have a bill that was introduced last session, but it has yet to be heard in any committee in the House or Senate. While there is support for the bill behind the scenes in the House, we have not seen the same kind of encouragement about the legislation from the Senate. Without the support of both chambers, passing a bill in the short session is not possible. Following the elections in November, ASNC will once again seek bi-partisan support in both chambers for a new bill to be introduced in the long session that begins at the end of January 2013. This is disappointing for families who have been waiting for better insurance coverage, and tragic for children who could be helped by better treatment, but it’s also a loss for the state – in the long run, untreated conditions like autism result in higher costs of care and fewer people living and working to their full potential.

What can you do?
The best thing you can do is tell your story. More and more Legislators are familiar with autism, but the Legislator who represents you may not understand how autism, and these issues related to it, affect you and your family. Check out the Autism Society of North Carolina’s “Tips for Contacting Your Legislator” for ideas about what to say and who to say it to!

Have questions about these of other policy issues? Contact Jennifer Mahan, Director of Government Relations for the Autism Society of North Carolina at jmahan@autismsociety-nc.org, call 919-865-5068, or post a question in the comments below.