Wrapping Up the 2015 Legislative Session

NC House ChamberThis article was contributed by Jennifer Mahan, Director of Advocacy and Public Policy at ASNC.

The NC General Assembly recently concluded an eight-month legislative session, the longest on record for the past 14 years. During the long session, ASNC continued to advocate for our legislative priorities, including access to high quality services and supports, better education opportunities, and a system that promotes good outcomes. The NC General Assembly passed a number of bills that affect people with autism and their families. A summary is below.

Budget HB 97: ASNC has posted a separate blog post about items in the state budget that affect people with autism, other intellectual and developmental disabilities, and health conditions. The budget includes a number of policy issues as well as additions and cuts to the state’s two year budget. The full budget bill HB 97 and committee reports can be found on the General Assembly website in the left column on the front page.

Autism Insurance SB 676: Senate Bill 676, “Autism Health Insurance Coverage,” passed in the final day of the legislative session. The new law requires large group health plans to provide health-care benefits for the treatment of autism for children and youth through age 18. The new law applies to companies that operate only in North Carolina with more than 50 employees and who do not “self-insure.” Insurance laws can be complicated, and ASNC recommends reading more details in this blog post and checking our autism insurance information page.

ABLE Act for North Carolina: Legislation passed this year will allow people with disabilities and their families to open 529 “ABLE” accounts and set aside money for disability related expenses without losing eligibility for other benefit programs such as Medicaid, Medicare, and Social Security. The law passed this year, and the NC Treasurer’s Office estimates that accounts will be available by summer of 2016. Read more in this blog post. A longer article can be found in our Summer 2015 Spectrum magazine on pages 10 and 11.

Medicaid Reform: NC will create a new Medicaid managed-care system and change the state agency that operates North Carolina’s Medicaid programs. Medicaid services will be contracted out to private managed-care companies and regional provider (hospital) led health systems. The focus of this new system will be on integrating care, especially physical and mental health care, improving health outcomes and controlling costs. All Medicaid services, excluding dental but including those for intellectual and developmental disabilities, are expected to be part of the managed-care model. Changes could take 5-10 years, depending on how long it takes to set up the new system and for the federal government to approve North Carolina’s Medicaid managed-care waiver(s). ASNC staff are reviewing the final Medicaid reform bill and will post more information in the future.

HB 921/Budget Education Provisions: Significant sections of House Bill 921, Educational Opportunities for People with Disabilities, were included in the budget in two sections on elementary and post secondary education. Section 8.30.(a) requires North Carolina to study and develop policy changes for improving outcomes for K-12 students with disabilities, including ways to:

  • Raise graduation rates
  • Provide more outcomes-based goals
  • Ensure access to career-ready diplomas
  • Integrate accessible digital learning options
  • Provide earlier and improved transition planning

State agencies are expected to reform the IEP process to focus on outcomes-based gals, bring together stakeholders to improve transition services plans, create ways for students with IEPs to access Future Ready Core Courses of Study (technical and vocational education) as a viable alternative to Occupational Course of Study diplomas, and look at model programs for increasing school performance and graduation rates. The NC Department of Public Instruction is required to report to the General Assembly’s Joint legislative Oversight Committee on Education on the above activities by November 15 and annually thereafter.

Section 11.19.(a) requites state agencies to collaborate to support educational opportunities for students and young adults with intellectual and developmental disabilities, particularly in transitioning to adulthood, post-secondary education, and employment. It requires the NC Department of Health and Human Services; the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services; the University of North Carolina system; and the community college system in consultation with the NC Postsecondary Education Alliance and other stakeholders to:

  • Assess system gaps and needs for supporting students/people with disabilities transitioning into adulthood
  • Develop policies and programs to expand post-secondary educational options and employment
  • Implement more public awareness of post-secondary education and employment of people with disabilities
  • Develop joint policies and common data indicators for tracking outcomes of people with disabilities leaving high school
  • Consider options for technology to link agency databases

ASNC advocated for funding to support technical assistance centers to support the above activities, but these were not funded in the budget. We will be going back to the legislature during the short session to continue to work on additional funding.

Changes to Students with Disabilities Scholarships: The Students with Disabilities Scholarship for students with IEPs who opt for non-public education was increased from $3,000 to $4,000 per semester ($8,000 per year), and policy changes allow funds to be dispersed to families and schools prior to the school year. Due to increased demand, there is a waiting list for the scholarships. ASNC will continue to advocate for additional funds to serve those waiting.

In addition, House Bill 334, passed at the end of session, will change the re-assessment process for students in receiving the scholarship: students must either be “assessed for continued eligibility” by a) the local Education Authority to determine if the child is still a child with a disability under IDEA, OR b) by a licensed psychologist with a school psychology focus who shall assess whether the non-public school has improved the student’s educational performance and the student would benefit from continuing to attend the non-public school.

School Staff Assault Bill SB 343: ASNC continues to monitor SB 343 legislation which would make assault on school personnel a felony. Advocates, including ASNC, pushed for changes to the bill that exempted students with IEPs and required assessments to determine if the student has a disability. ASNC remains concerned about the bill given that “assault” is not well defined and many students with a diagnosis of autism or other developmental challenges may not have IEPs. The bill is eligible for consideration in next year’s short session and is currently being held in the House Committee on Children, Youth, and Families.

If you have questions about the North Carolina state budget or other policy issues, please contact Jennifer Mahan, ASNC Director of Advocacy and Public Policy at jmahan@autismsociety-nc.org or 919-865-5068.

A Closer Look at North Carolina’s 2015-17 Budget

GA Front

This article was contributed by Jennifer Mahan, Director of Advocacy and Public Policy at ASNC.

The new state budget for budget years 2015-17, which began on July 1, 2015, sits at $21.7 billion. It includes several important policy initiatives for people with disabilities, but it also makes changes that could keep people with autism, intellectual and developmental disabilities, and other conditions from gaining access to health care and supportive services.

Note that where two numbers are listed for funding amounts, the first number is for fiscal year 2015-16 and the second is for fiscal year 2016-17. Recurring funds mean that the program will be funded in an ongoing way (at least for the next two years), and nonrecurring indicates that funds are one-time and only for a particular year.

Medicaid

This year’s budget funded increases in the Medicaid rebase, which is the funding it will take to continue serving the eligible population with current services. No cuts were made to Medicaid eligibility or to optional Medicaid services. This is a big win; previous budgets have included one if not both of these cuts.

In addition, Medicaid reform legislation was taken out of the original budget bill and passed as separate legislation. The changes to North Carolina’s Medicaid health care and disability services program will create a new Medicaid managed care system and change the state agency that operates the Medicaid programs. Medicaid services will be contracted out to private managed care companies and regional provider (hospital) led health systems. ASNC staff are reviewing the final Medicaid bill and will post more information in the future.

The Medicaid rebase was funded at $299,358,485 recurring and $496,326,936 recurring.

Medicaid reform was funded at $5,000,000 recurring and $5,000,000 recurring.

Vocational Rehabilitation

No cuts were made to Vocational Rehabilitation funding. Again, previous budgets have included cuts.

Early Intervention

No cuts were made to early intervention services, and Children’s Developmental Service Agencies (CDSAs) were not consolidated further.

State-Funded Services

Cross Area Service Program (CASP) funding did see an increase of $800,000 recurring in the first year of the budget and $1.6 million recurring in the second year. CASP funds services such as employment and vocational supports for people with IDD.

“Single-stream funding,” which provides some state funds for people without health care (non-Medicaid populations) was removed from the budget, and the General Assembly required LME/MCOs to use their fund balances to make up the difference. Single-stream funding pays for services such as developmental therapies, respite, employment support, residential supports, and other services. This swap removes state funds and replaces them with LME/MCO cash fund balance money for two years at the following amounts: $110,808,752 and $152,850,133. This is a nonrecurring adjustment, and the special provision language sets up the expectation that no service will be reduced or cut. Special provision language also states that the LME/MCO system must use fund reserves to fill the state dollar reductions.

Advocates have several concerns:

  • LME/MCOs have varying fund balances, and at this time, it is not clear what formula will be used to determine where funds are reduced.
  • Fund balances are intended to be used to expand services, so this “swap” that removes recurring state funds and replaces them with onetime LME/MCO funds from savings eliminates the possibility that funds can be used to expand services. The funds instead will be used simply to maintain existing services.
  • House Bill 916, which created the current public managed-care system, promised that savings would be retained and used to expand services to the thousands waiting for help.
  • It’s not clear that there are enough funds to take the *second round of cuts* in 2016-17, leaving the real possibility that services for people with autism and IDD without Medicaid or other health care will continue to shrink. ASNC will be working with other advocacy groups to prevent further cuts and services reductions.

Crisis Services

New NC START funding for crisis prevention and intervention was included in the budget with $1,544,000 in recurring funding to support children and adolescents with intellectual or developmental disabilities for both years of the budget. While this is not enough funding to support the significant need for crisis services, it is a first step for children and youth who have very limited options.

ABLE Act Funds

The NC Office of the Treasurer will oversee the new ABLE Act 529 savings accounts. The budget includes $215,000 in recurring funds and $250,000 in nonrecurring funds for 2015-16, and $540,000 in recurring funds and $55,000 in nonrecurring funds to administer the new savings plans, provide information to financial experts, and promote the plans to people with disabilities and their families. The IRS is expected to publish their final rules on how the plans will operate by the end of 2015, and NC hopes to have the ABLE savings plans available by the summer of 2016.

Education

The budget fully funds teacher assistants, lowers class size for K-3 grades, and fully funds the current exceptional children’s head count. Reading camps have been expanded to include first- and second-grade students who are at risk for not reaching third-grade reading proficiency. The program also will continue to support at-risk students who reach reading proficiency to ensure they stay on track.

No new funds are included to increase per-pupil spending for exceptional children (special education) or to alter the 12.5% cap on special education funds. ASNC continues to discuss with Education Committee members the ways to improve special education and funding.

Significant sections of House Bill 921, Educational Opportunities for People with Disabilities, also were included in the budget in two separate sections on elementary and post-secondary education. Section 8.30.(a) states that North Carolina will study and develop policy changes for improving outcomes for K-12 students with disabilities including ways to:

  • Raise graduation rates
  • Provide more outcomes-based goals
  • Ensure access to career-ready diplomas
  • Integrate accessible digital learning options
  • Provide earlier and improved transition planning

State agencies are expected to reform the IEP process to focus on outcomes-based goals, bring together stakeholders to improve transition services plans, create ways for students with IEPs to access Future Ready Core Courses of Study (technical and vocational education) as a viable alternative to Occupational Course of Study diplomas, and look at model programs for increasing school performance and graduation rates. The NC Department of Public Instruction is required to report to the General Assembly’s Joint legislative Oversight Committee on Education on the above activities by November 15 and annually thereafter.

Section 11.19.(a) requites state agencies to collaborate to support educational opportunities for students and young adults with intellectual and developmental disabilities, particularly in transitioning to adulthood, post-secondary education, and employment. It requires the NC Department of Health and Human Services; the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services; the University of North Carolina system; and the community college system in consultation with the NC Postsecondary Education Alliance and other stakeholders to:

  • Assess system gaps and needs for supporting students/people with disabilities transitioning into adulthood
  • Develop policies and programs to expand post-secondary educational options and employment
  • Implement more public awareness of post-secondary education and employment of people with disabilities
  • Develop joint policies and common data indicators for tracking outcomes of people with disabilities leaving high school
  • Consider options for technology to link agency databases

ASNC advocated for funding to support technical assistance centers to support the above activities, but these were not funded in the budget. We will be going back to the legislature during the short session to continue to work on additional funding.

Students with Disabilities Scholarships

The Students with Disabilities Scholarship for students with IEPs who opt for non-public education was increased from $3,000 to $4,000 per semester ($8,000 per year), and policy changes allow funds to be dispersed to families and schools prior to the school year. Due to increased demand, there is a waiting list for the scholarships. ASNC will continue to advocate for additional funds to serve those waiting.

In addition, House Bill 334, passed at the end of session, will change the re-assessment process for students in receiving the scholarship: students must either be “assessed for continued eligibility” by a) the local Education Authority to determine if the child is still a child with a disability under IDEA, OR b) by a licensed psychologist with a school psychology focus who shall assess whether the non-public school has improved the student’s educational performance and the student would benefit from continuing to attend the non-public school.

Additional Provisions of Interest

Medical Tax Deduction: This budget fully restores the Medical Tax Deduction that existed prior to the Tax Simplification Laws of 2013. Individuals and families who lack insurance coverage or whose autism therapy and related medical costs are not entirely covered by insurance may benefit from this state tax deduction. (See your tax professional for more information about tax deductions.)

Single-Case Agreements: LME/MCOS can contract with out-of-network providers of developmental disability, mental health, or addiction services. This provision allows for a more simplified contracting process for providers outside the catchment area for up to two cases per provider. (Inpatient providers are allowed up to five cases). Advocates hope that the expansion of out-of-network agreements will allow people to move from one LME/MCO catchment areas to another without a break in needed services as well as ensure access to specialty providers in areas where they are limited.

Overnight Respite: A pilot program will expand statewide so that adult day-care and adult day health-care facilities can provide overnight respite under new licensure rules. The new rules should allow overnight respite to be incorporated into Innovations/CAP waiver amendments and will not require additional legislative approval before submission to the federal government for approval.

What’s missing from the budget?

The biggest gaps in the system for people with autism and other intellectual and developmental disabilities were not addressed. There are 12,000 people on waiting lists for services and supports, including Innovations waivers through our LME/MCO system. This budget does not address funding for the 3,000 slots for support waivers that were to be created for those waiting for help. While the Centers for Medicare & Medicaid Services now require states to provide behavioral services to children with autism under Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), no new funds were added to the Medicaid budget to address this need. With LME/MCOs capitation rates remaining the same, it’s not clear how they will pay for an increase in services such as adaptive behavior treatment to address core autism behavior challenges.

Earlier versions of the budget included a proposal for a case-management pilot program, which was not included in the final budget. Case management is critical for people dealing with complex medical, developmental, and disability issues.

As mentioned above, there are no increases in special education funding or plans for alternatives to the 12.5% cap on funding. Students with disabilities who want to access the non-public school scholarships will wait for more funds to be put into the scholarship program.

The legislature is requiring LME/MCOs to swap state funds for their fund balances for two years in a row. This removes savings intended to expand services and could cut services in the second year.

The 2016 short session, which begins at the end of April, is the next opportunity to make adjustments to the state budget. ASNC will continue working with legislators to address gaps in services.

If you have questions about the North Carolina state budget or other policy issues, please contact Jennifer Mahan, ASNC Director of Advocacy and Public Policy at jmahan@autismsociety-nc.org or 919-865-5068.

Have Your Say on Innovations Waiver

Medicaid Diversion

This article was contributed by Kerri Erb, ASNC’s Chief Program Officer.

UPDATE: The North Carolina Department of Health and Human Services has notified us that the changes to the Innovations waiver are now proposed to go into effect November 1 to allow for additional training and preparation, and to provide additional time for approval of the changes by the Centers for Medicare & Medicaid Services (CMS). The entire overview of the Innovations waiver and updates are found on the Innovations landing page: http://www2.ncdhhs.gov/DMA/lme/Innovations.html

For webinars or other training/supplemental information, scroll to the bottom of the page and click on your topic of interest.

ORIGINAL POST:

The North Carolina Department of Health and Human Services (DHHS) has published the draft application to renew its Home and Community Based Waiver (HCBS/Innovations, formerly known as CAP) for people with intellectual and developmental disabilities (IDD). This is known as the Innovations waiver. DHHS is seeking public comment and feedback on changes made and needed to the waiver. After processing public comments, the state will continue the steps necessary to submit the application to the federal Centers for Medicare & Medicaid Services (CMS) for approval. Once CMS approves the waiver renewal application, DHHS will begin implementing the changes.

The waiver program allows people who are eligible to receive Medicaid services through an intermediate care facility (ICF MR) to instead utilize those services in home and community settings. See ASNC’s toolkit or the DHHS website for further information on the waiver itself.

DHHS spent last year listening to feedback on needs in the IDD community through stakeholder groups and listening sessions. Those results were evaluated by DHHS and elements of those needs are showing in the renewal waiver that attempts additional flexibility, predictability, and sustainability.

ASNC and many other stakeholders, including families, participated in the advisory committees and made comments throughout the draft period. Not all have been reflected, though several have been.

UPDATE: While the official timeline for public comment has ended, DHHS staff continue to monitor the email for feedback regarding the waiver and other services: IDDListeningSessions@dhhs.nc.gov. Comments may also be submitted by leaving a voicemail message at 919-855-4968.

As soon as the Autism Society of North Carolina has more information about the implementation plan, we will share it with families, staff, and the public. Often implementation takes much longer than originally thought because of changes ordered by CMS or others. At present, DHHS aims to begin implementation of the new waiver in April 2016.

Below are some of the changes in the renewal waiver:

  • Expands the resource allocation model statewide (currently Cardinal Innovations MCO uses this), which is a combination of the Supports Intensity Scale (SIS) and other measures to correlate needs/acuity to resources (services) to develop individual budgets. This change may result in more services for some and less for others. For more information, see Appendix C-4 in the draft (starting on page 119).
  • Phases in the individual budgets based on resource allocation over two years
  • Increases the flexibility of services
  • Replaces the current Personal Care and In Home Skill Building services with a new waiver service: Community Supports and Living. Those separate services will be blended into one to allow for more flexibility. At this time, ASNC is concerned about the removal of the in-home intensive skill building component and a lack of intensive skill building within the waiver. However, we understand that DHHS is also working on another service for autism treatment outside of the waiver through Medicaid that may alleviate some of these concerns as long as there is no gap in those critical services. We will share further information as it comes available on that proposed service.
  • Adds Supported Living as a new service that allows two adults to live in a non-licensed program and receive supports. This service allows for more flexibility and integration into the community.
  • Alters respite definition to allow for respite in an adult family living (AFL) setting

Other minor changes include:

  • Updates military transfer slots from out of state
  • Day Supports: moves to hourly units and no longer has service start and end in the licensed day facility to allow for more flexibility
  • Residential Supports: updates the levels 1, 2, 3, and 4 to be determined by the individual budgeting methodology. Allows new four-bed programs in the Appendix.
  • Respite: adds language around nursing level; allows respite to occur in AFL settings
  • Supported Employment: removes the requirement for staff to have three years of full-time experience to help with capacity
  • Community Guide: changes to Community Navigator with more specific and increased duties within the definition to help access supports and services as well as empower
  • Crisis Services: specifies the use of Consultative Services allowed as part of this service as well
  • Other changes and updates to service definitions, policy, and quality measures based on feedback and data review

Please take the time to review the document and submit comments to DHHS with needed changes from your perspective. ASNC will provide updates as it learns more throughout the year. If you have questions, please do not hesitate to contact Kerri Erb, Chief Program Officer, kerb@autismsociety-nc.org.

A Closer Look at the NC House Budget

GA Front

This article was contributed by Jennifer Mahan, ASNC Director of Advocacy and Public Policy.

The NC House passed HB97, its version of the two-year budget, on May 22. The House budget would increase spending by $1.3 billion (6.3 percent) to address funding needs in Medicaid, education, and other services. The bill includes funds for increased teacher pay, student growth, some education initiatives, current Medicaid services, and new crisis services.

The Senate is expected to reveal its version of the budget this week, with fewer increases in funding to make changes to income and corporate tax rates. Then a House and Senate budget conference committee is usually appointed to work out differences between the budget bills.

Here are some details on the proposed House budget:

Education

  • 2 percent pay increase for teachers
  • Student growth is funded
  • Special education per-pupil spending is increased in special provision language
  • Funds for technical assistance to increase capacity for postsecondary education for people with intellectual and developmental disabilities

The education special provisions include bill language from HB921 to begin addressing graduation and future employment of students with disabilities as well as to improve postsecondary education opportunities that promote employment and independent living.

Health and Human Services

  • Funds Medicaid rebase (growth in Medicaid eligible populations and current services)
  • Adds $2.3 million to the NC START crisis program that serves individuals with IDD so that it can serve children and youth.
  • Adds about $7.5 million (some recurring and some non-recurring) to develop more crisis services for MHDDSA populations including hospital beds, behavioral health crisis units, and a crisis bed registry.
  • Adds $2.1 million to fund a pilot project for Targeted Case Management for individuals on the waiting list for Innovations waiver services slots.

The special provision language in the Medicaid section would return more control to the NC Department of Health and Human Services (DHHS) to manage the Medicaid budget. Legislators stated that the language in this section will allow NC DHHS to shift funds as needed to support group homes that have been affected by changes to Medicaid policy on who qualifies for personal care and other services.

Other

  • Funds the administration and promotion of ABLE Act 529 savings plans for people with disabilities.

What’s missing?

The House budget bill does not specifically fund the expansion of Innovations waiver slots to address the lengthy waiting list for IDD services. Also not included are any new funds to address the need for autism treatment under Medicaid Early and Periodic Screening, Diagnostic, and Treatment services. The $2.3 million in NC START funding in the House budget is enough to address the gap in adult IDD crisis but is not enough to address the needs of children and youth with IDD. Another $4-5 million would be needed to build effective child and youth crisis services.

ASNC will continue to advocate with the Senate to ensure that education and human services budgets address the growing needs of people with autism and other developmental disabilities.

Learn more

Information about the budget and the latest versions of the bill can be found in the left column of the General Assembly’s website at http://www.ncleg.net. The “bill text” includes all of the bill language including the special provisions. The “committee report” is also called the money report and includes funding cuts, additions, and shifts in funding from one source to another as well as a brief description of each funding item.

Have questions about this legislation or other public policy issues? Contact Jennifer Mahan, ASNC Director of Advocacy and Public Policy, at jmahan@autismsociety-nc.org or 919-865-5068.

A look back at a remarkable year

looking-backA few highlights from 2013

2013 was a busy year in the autism community. We witnessed the changeover in statewide service delivery from Local Management Entities (LMEs) to Managed Care Organizations (MCOs). Issues that had stalled for years with the legislature moved forward, but not all the way into law. And more families learned that they have a member on the autism spectrum. All in all, it was a significant year, and we would like to highlight just a few items as the year draws to a close.

Medicaid Waiver Transition
Many families receive funding for services through Medicaid in our state. Many more are eligible and are waiting for services. The first quarter of the year saw a change in service delivery that consolidated 22 LMEs down to 10 MCOs. The transition had some rough spots, and the Autism Society of North Carolina (ASNC) continues to work with MCO staff and families to advocate for improvements to the system and expansion of services to more individuals with autism.

Autism Insurance (House Bill 498)
For over five years, ASNC has worked with parents, professionals, and a coalition of other autism organizations to educate lawmakers about the impact that insurance coverage for autism would have in our state. These efforts resulted in an incredible 48 hours of activity in May. During those 48 hours, HB 498 was discussed and approved by the House Insurance Committee and the Appropriations Committee, and then passed the full House by a 105-7 margin. This moved the bill to the NC Senate, where if approved it would proceed to the governor. As the legislative session drew to a close, HB 498 was not given a hearing by the Senate, but it remains alive, and we expect the Senate to take this up at the start of the 2014 short session.

Expanding Services
Along with the waiver transition, many providers of services either scaled back their caseload, or in some cases, ceased operations. The Autism Society of North Carolina has worked to continue high-quality services and expand the regions in which we are able to offer them. These efforts included hiring a Services Coordinator and opening a new office in Charlotte. Now families in that area of the state will be able to access additional services from the organization. View the Autism Society of North Carolina services offices here.

Connecting with and Helping Self-Advocates and Families
This is the core of what we do, and during 2013, the Autism Society of North Carolina assisted thousands of individuals on the autism spectrum and their families through our Autism Resource Specialists, chapters, and support groups. Autism Resource Specialists (formerly Parent Advocates) cover all 100 counties and assist with information and referral, school issues, parent training, and community education. If you have not tapped into their expertise, please make sure to connect in 2014.

Celebrating and Accepting
On April 2, more than 500 people traveled to Camp Royall to celebrate World Autism Awareness Day (WAAD). This was the first ASNC attempt to have a public event in recognition of this day, and we were blown away by the response. Families traveled from as far away as Charlotte, Asheville, and the coast to enjoy fellowship, food, and fun with the variety of activities the camp offers. Camp Royall not only hosted WAAD, but also provided summer camp for over 350 individuals and served 900 more during year-round programming. 2013 marked the 42nd consecutive year that ASNC has offered a summer camp, the longest running summer camp program for individuals with ASD in the nation. Our community also celebrated awareness and acceptance at our Run/Walk for Autism events throughout the state. From the mountains to the sea, thousands of families and community members came together to walk, run, volunteer, and raise money to support each other and ASNC. More than $500,000 was raised through these events – a new record. What an accomplishment.

Collaboration and Community
Everything we do is related to providing support to and increasing opportunities that enhance the lives of individuals on the autism spectrum and their families. These principles guided us when the founders started the organization almost 44 years ago, and they still guide us today. Parent and professional collaboration is the key to promoting understanding and acceptance, and for your support – whether you have donated to the organization, written an email to a legislator, shared our website address or phone number with a family in need, or volunteered your time – we say THANK YOU. All of the above would not have happened without your involvement.

Best wishes for the New Year!

Sincerely,
David Laxton
Director of Communications

Medicaid Waiver (CAP IDD) Changes Take Effect Soon – What you need to know

Editor’s Note – The following update was compiled and vetted by Autism Society of North Carolina Senior Director of Quality and Programs Kerri Erb and Director of Governmental Relations Jennifer Mahan. Both these ASNC staff have been following changes to Medicaid Waiver services for quite some time.

Last year, the State of North Carolina submitted applications to renew its Community Alternatives Program (CAP) for people with intellectual and developmental disabilities (IDD), known as the CAP IDD or CAP MRDD waiver to the Federal government. This waiver program allows people who are eligible to receive Medicaid services through an intermediate care facility (ICF MR) to instead utilize those services in home and community settings. This community-based waiver has to be re-approved every 3-5 years.

North Carolina is in the middle of transitioning Medicaid services for people with Intellectual and Developmental Disabilities to a managed care model under another waiver called a 1915 b/c waiver (which for people with IDD is called “Innovations”). Given this transition to managed care, North Carolina officials asked for the current CAP IDD community based waiver to be extended several times. The state was hoping that it could transition to managed care Innovations at the same time so that those on CAP would not have to change services from their current CAP program, to a new CAP waiver program and then to Innovations.

North Carolina’s final extension on its current CAP IDD waiver has ended and the new waiver has been approved to start today, October 1, 2012. The state will transition participants to the new CAP IDD waiver starting this month. People on CAP IDD waivers and their families should not worry; CAP IDD services will continue after October 1. The NC Department of Health and Human Services, who are in change of Medicaid and CAP IDD, are working on the implementation plan for CAP IDD that will give direction to Local Management Entities, case managers, families and providers on what needs to be done and when. This plan may not be finalized until later this week.

As soon as Autism Society of North Carolina has more information about the implementation plan we will share it with families, staff and the public. Below are some of the changes in the new CAP IDD waiver that we have reported previously.

The Biggest Changes in the CAP IDD Waiver:

  •  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.
  • The hour limit 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.
  • Enhanced Personal Care and Enhanced Respite will be restricted to authorizations only for medical reasons (not behavioral).
  • 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.

For more information go to The North Carolina Department of Health and Human Services web page for the CAP waiver and see “Overview of New CAP Waiver” near the bottom.

To contact Kerri Erb email kerb@autismsociety-nc.org or call 919 865 5053. To reach Jennifer Mahan email jmahan@autismsociety-nc.org or call 919 865 5068.

Tips for Parents Transitioning to the Innovations Waiver

Editor’s Note – The following article was written by Jean Alvarez, Parent Advocate/Trainer for the Autism Society of North Carolina and parent of a young man on the autism spectrum. Jean lives in western NC.

As Local Management Entities (LMEs) move from the old system of service delivery to a network of MCOs and a new waiver – called Innovations, the changes will inevitably cause uncertainty and concern among parents whose children need these services. The Western Highlands Network (including 8 counties in the Asheville area) made the transition in January and the dust has not settled yet. I live and work in the Western Highlands catchment area and based on what I have heard from families and professionals, Innovations is a different playing field and the principal players don’t have all the answers.

My son Jaime has services through the Smoky Mountain LME, soon to be Smoky Mountain Managed Care Organization (MCO) as of July 1. Jaime has a very savvy case manager who walked Jaime’s team through what he called a mock Individual Supports Plan (ISP) meeting on June 12 in preparation for Jaime’s transition to Innovations. Jaime has an August birthday which means his annual plan falls due in the middle of the transition, something which heightened my anxiety. I had been dreading these monumental changes for months and found it very helpful to go through a practice session prior to the transition. The following information is based on what I learned at this meeting and it is intended to help parents be proactive in preventing their child’s needs from becoming someone else’s dropped ball.

Changes in terms:

  • Local Management Entity (LME) is now Managed Care Organization (MCO)
  • PCP (person centered plan) changes to ISP (Individual Support Plan)
  • Person Centered Meeting is now ISP meeting

Other changes:

  • Case managers change as well: Under Innovations Care Coordinators work for the MCOs. – Care Coordinators will NOT be the same as case managers and families have to understand this. Care Coordinators are responsible for the plans and meetings. If your child lives outside of the home (Group Home, AFL) or if a person’s parent provides services they need to be seen monthly.
  • Coordinators (Qs) with the Providers, such as ASNC, will basically stay the same but will have additional responsibilities
  • Community Guide – a new service that can help families navigate the changes as well as help with other areas of need.
  • People receiving state funded services may/may not have a Care Coordinator. In some MCOs responsibilities for state funded services have been passed on to the provider coordinators (Qs).

Suggestions for Parents

Case Management is gone now and depending on the MCO, parents may have to advocate for Community Guide service for help navigating the new array of supports. One way to advocate for Community Guide is to emphasize that if any of your child’s services are lost in this process it threatens his/her health and safety. Here is an example:

If an adult was successfully living and working in their community with necessary supports and the new ISP included a reduction in services, this is how it could impact their health and safety. If they only received 3 days per week of supported employment instead of five and did not have a trained job coach with them, what would happen if they became overwhelmed and bolted from the job site? This person would be alone in a city without the judgment and skills to keep themselves safe. In addition to being at risk for exploitation she/he would lose their job. Without a consistent schedule outside of their group home five days a week he/she would also lose their residential placement which would put them at risk for institutionalization.

I realize that this example is only relevant to parents of adults and there are many parents with younger children transitioning to the waiver. Keep in mind that Community Guide is a service to help them navigate all these changes and could help them learn how to insure that their child’s needs are still met by Innovations.

The Care Coordinators are brand new people who have huge case loads. It is very likely that they will not have time to read the background information and will not know your child. Parents will have to plan to educate this person on their child and the need for the services they are asking for.

In some cases Care Coordinators have been telling parents what services they can have. Parents have to be sure to ask for the services their child NEEDS. This is not the Care Coordinator’s call, they submit the plan for approval or denial but the team determines what needs to be in the plan.

If a plan is denied there is an appeal process.

Some elements of the plan have stayed the same and some have changed so don’t panic if it looks different. However, the plan should still describe your child’s needs and why the support is necessary.

Don’t sign the signature page until you have read the finalized plan. Care coordinators should not ask parents to sign the signature page before the parent has the opportunity to read through the final plan. There have been cases where the final plan was different from what was discussed and agreed upon by the team. The care coordinator had the signature page signed and did not submit the plan that the team agreed on.

There may be differences from MCO to MCO. Stay informed, ask questions, and advocate for your child.

The Summer Spectrum (arriving in mailboxes and online in early August) will also include information about the transition to Managed Care and Medicaid Services. Meanwhile if you have questions or concerns, visit the ASNC Calendar of Events to see whether there is a workshop on this topic near you or contact your ASNC regional Parent Advocate/Trainer.

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