More than a decade ago, North Carolina’s system for providing services to individuals with mental health needs, developmental disabilities and addictive disease was deeply troubled. Allegations of fraud, mismanagement and conflicted governance signaled poor accountability mechanisms.
In response, the General Assembly directed the state Auditor to investigate the situation. In April 2000, the Auditor issued a report identifying two overarching problems: over-reliance on state institutions and lack of accountability among the local area programs responsible for providing community-based services. The findings also documented North Carolina’s failure to comply with the Americans with Disabilities Act’s “integration mandate.”
The report triggered massive changes to state law designed to reform the service system. The changes included a planned reduction of the number of state hospital beds – closing Dorothea Dix Hospital in Raleigh and replacing the derelict facilities in Goldsboro, Morganton and Butner with new buildings. The semi-autonomous governmental “area programs” created to provide direct services were replaced with county-operated systems or “Local Management Entities” (LMEs), acting under long-term contracts with the State to manage services.
Now fast-forward to 2011 to experience a profound sense of déjà vu. The State still relies on institutional-based care, but now in so-called “adult care homes.” Meanwhile, it has failed to develop adequate community-based services. The system responsible for providing services is again in trouble. Allegations of fraud, mismanagement, and conflicted governance again signal poor accountability mechanisms. To make matters even worse, the latest round of systemic failures are compounded by the State’s severe revenue deficiencies.
Again, the General Assembly has intervened. This time, the legislature has passed a law that mandates the conversion of all “Local Management Entities” into “Managed Care Organizations.” Essentially, the state is demanding radical statewide transformation based on an unproven model used by one very small LME called Piedmont Behavioral Healthcare. The state Department of Health and Human Services is being required to standardize and replicate Piedmont’s practices and processes for providing services across the entire state. This is a bit like the tail wagging the dog.
Unfortunately, this change raises several red flags for other reasons as well. Most notably, Piedmont’s practices include a pattern of violations of individuals’ constitutional due process rights and a disregard of judicial and administrative authority. Indeed, the organization I lead, Disability Rights NC, has filed two federal lawsuits challenging the Piedmont model – one of which (KC v. Cansler) challenges the lack of due process as guaranteed by the 14th Amendment and other federal requirements.
There are other problems with this managed care model.
Under the new law, the same organization (the MCO) is responsible for making requests for services and for approving and/or denying those services. This creates an inherent conflict of interest because it pits the need to save money against the needs and bests interests of the consumer – a problem that Piedmont has already been guilty of in multiple instances.
Yet another controversy surrounds a requirement that the new MCOs contract with Piedmont to obtain its business practices and processes. Remarkably, the contract actually contains a “non-disclosure” clause that would, in effect, keep the processes and practices hidden from the public eye. This is a huge problem because MCOs are not private entities but quasi-public entities serving the public interest with public money. Moreover, they’re linked to county governments subject to the state public records laws.
While the state and Piedmont claim the secrecy provisions are necessary to protect “intellectual property,” as a practical matter, such provisions will allow Piedmont and other newly-created MCOs to operate without real public oversight. This is especially true in light of Piedmont’s expansive view that it can refuse almost every request for information – including those with respect to how resources allocations are made, the standards by which providers are evaluated, and many others. This, of course begs the question: If the Piedmont model works so well, then why the secrecy? Why the lack of due process? And without transparency, how can there be public accountability?
In short, it appears that, once again, state leaders have failed to learn from past mistakes and in so doing continue to fail vulnerable populations. Let’s hope that it doesn’t take another decade for them to correct this latest mistake.
Vicki Smith is the Executive Director of Disability Rights North Carolina.
Sunday, November 6, 2011
Thursday, October 20, 2011
Report Finds Hunger Cost North Carolina More Than $5.4 Billion in 2010
Report Finds Hunger Cost North Carolina More Than $5.4 Billion in 2010
Raleigh, N.C. -- Hunger cost North Carolina more than $5.4 billion in lost productivity and reduced outcomes last year, according to a recent report from the Center for American Progress. These findings come on the heels of alarming Census data which show unemployment in North Carolina stalled above 10 percent for the second consecutive year and poverty is increasing across the state.
In 2010, 15.7 percent of North Carolina households -- nearly one in six -- went hungry or faced food insecurity at some point during the year. When considered in relation to the total population, the direct and indirect costs of hunger averaged $570 per North Carolina resident -- about $1,452 per household.
North Carolina was one of just 12 states in which the estimated cost of hunger has increased by more than $1 billion since the start of the recession.
"These estimates are a gripping reminder that the social and economic implications of family economic security are far-reaching," said Barb Bradley, President and CEO of Action for Children North Carolina, a statewide policy research and advocacy organization that tracks child well-being in North Carolina. "When families struggle to put food on the table, the effects ripple through the state economy, creating greater health costs, educational problems and reduced opportunities for our children."
Research shows that children are disproportionately impacted by the experience of food insecurity -- an effect which persists well into their adult years. Children who grow up in food insecure households are more likely to go without health care, have increased school absenteeism and face greater risk of early academic failure, including dropping out of school, than their food-secure peers. As those children age and transition into the workforce, they encounter diminished outcomes in the form of limited employability and lower lifetime earnings.
Nationally, hunger-induced losses in educational outcomes, earnings and health cost the country an estimated $167.5 billion last year, an increase of 33.5 percent since 2007.
The report notes that expansions to a key federal nutrition assistance program, the Supplemental Nutrition Assistance Program (SNAP-formerly food stamps), helped many families meet some of their household food needs. In North Carolina, one in five residents, more than 1.9 million people, received SNAP benefits in 2010. Forty percent of them were children under the age of 18. Bradley says in these tough economic times, SNAP plays a pivotal role in helping to preserve the fiscal health of our state economy.
"Every dollar of SNAP benefit generates $1.84 in economic activity," said Bradley. "This means federal efforts to support families in tough times are not just good for individuals, they are critical for the state, keeping hunger-associated costs down, children in school and our workforce ready to drive the new economy. "
Read Hunger in America: Suffering We All Pay For.
# # #
Action for Children North Carolina is a leading statewide, nonpartisan, nonprofit policy research and advocacy organization dedicated to ensuring that North Carolina children are healthy, safe, well-educated and have every opportunity for success.
Raleigh, N.C. -- Hunger cost North Carolina more than $5.4 billion in lost productivity and reduced outcomes last year, according to a recent report from the Center for American Progress. These findings come on the heels of alarming Census data which show unemployment in North Carolina stalled above 10 percent for the second consecutive year and poverty is increasing across the state.
In 2010, 15.7 percent of North Carolina households -- nearly one in six -- went hungry or faced food insecurity at some point during the year. When considered in relation to the total population, the direct and indirect costs of hunger averaged $570 per North Carolina resident -- about $1,452 per household.
North Carolina was one of just 12 states in which the estimated cost of hunger has increased by more than $1 billion since the start of the recession.
"These estimates are a gripping reminder that the social and economic implications of family economic security are far-reaching," said Barb Bradley, President and CEO of Action for Children North Carolina, a statewide policy research and advocacy organization that tracks child well-being in North Carolina. "When families struggle to put food on the table, the effects ripple through the state economy, creating greater health costs, educational problems and reduced opportunities for our children."
Research shows that children are disproportionately impacted by the experience of food insecurity -- an effect which persists well into their adult years. Children who grow up in food insecure households are more likely to go without health care, have increased school absenteeism and face greater risk of early academic failure, including dropping out of school, than their food-secure peers. As those children age and transition into the workforce, they encounter diminished outcomes in the form of limited employability and lower lifetime earnings.
Nationally, hunger-induced losses in educational outcomes, earnings and health cost the country an estimated $167.5 billion last year, an increase of 33.5 percent since 2007.
The report notes that expansions to a key federal nutrition assistance program, the Supplemental Nutrition Assistance Program (SNAP-formerly food stamps), helped many families meet some of their household food needs. In North Carolina, one in five residents, more than 1.9 million people, received SNAP benefits in 2010. Forty percent of them were children under the age of 18. Bradley says in these tough economic times, SNAP plays a pivotal role in helping to preserve the fiscal health of our state economy.
"Every dollar of SNAP benefit generates $1.84 in economic activity," said Bradley. "This means federal efforts to support families in tough times are not just good for individuals, they are critical for the state, keeping hunger-associated costs down, children in school and our workforce ready to drive the new economy. "
Read Hunger in America: Suffering We All Pay For.
# # #
Action for Children North Carolina is a leading statewide, nonpartisan, nonprofit policy research and advocacy organization dedicated to ensuring that North Carolina children are healthy, safe, well-educated and have every opportunity for success.
Monday, October 17, 2011
Monday Numbers
** This post is reposted by NC Policy Watch...every Monday, they post a list of numbers. NASW-NC is sharing this on their behalf as it's important to note the number of people who are affected by cuts in NC.
Monday numbers
Posted on 10/17/2011 by Chris Fitzsimon
1.5 million—number of people in North Carolina who do not have health insurance coverage (Five Reasons Everyday North Carolinians Need Medicaid, Even If They Don’t Know It, N.C. Health Access Coalition, October 2011)
27—percentage of Medicaid enrollees who are from middle class households including nursing home residents, people with disabilities, and victims of catastrophic accidents (Ibid)
73,000—amount in dollars of average annual cost of nursing home care for seniors (Ibid)
43,754—amount in dollars of the median income for a North Carolina family of four (Ibid)
70—percentage of nursing home residents nationwide who eventually become Medicaid recipients to pay for nursing home care (Ibid)
237,000—number of seniors in North Carolina who received Medicaid in 2008 (Ibid)
282,000—number of people with disabilities in North Carolina who received Medicaid in 2008 (Ibid)
683,000—number of infants in children in North Carolina who received Medicaid in 2008 (Ibid)
60,000—number of women in North Carolina who received Medicaid care affecting their pregnancy in 2008 (Ibid)
65—percentage of maternity stays for women under age 25 provided by Medicaid nationwide (Ibid)
3—number of years since study found that total medical spending is much lower when coverage is provided by Medicaid or SCHIP than it is when coverage is provided by private insurance. (Public And Private Health Insurance: Stacking Up The Costs, Health Affairs, 27, no. 4, 2008)
763 million—amount in state dollars cut from Medicaid in 2011-2013 in budget approved by the General Assembly in June (BTC REPORTS: The 2011-2013 Final Budget – Neglecting a Balanced Approach, Budget Costs Jobs and Delays Economic Recovery, June 2011)
1.56 billion—amount in federal Medicaid matching dollars that will be lost in the next two years because of state Medicaid cuts in the 2011-2013 budget (Ibid)
2.289 billion—total amount of reduction of state and federal Medicaid spending in the next two years because of state Medicaid cuts in the 2011-2013 budget (Ibid)
13,355—number of jobs that will be lost in North Carolina because of loss of Medicaid spending in 2011-2013 due to state cuts and resulting loss of federal matching dollars (BTC BRIEF: Legislative Budget Would Cost North Carolina 30,000 Jobs, Billions in Economic Output,” NC Budget and Tax Center: June 2011)
This entry was posted in Fitzsimon File. Bookmark the permalink.
Monday numbers
Posted on 10/17/2011 by Chris Fitzsimon
1.5 million—number of people in North Carolina who do not have health insurance coverage (Five Reasons Everyday North Carolinians Need Medicaid, Even If They Don’t Know It, N.C. Health Access Coalition, October 2011)
27—percentage of Medicaid enrollees who are from middle class households including nursing home residents, people with disabilities, and victims of catastrophic accidents (Ibid)
73,000—amount in dollars of average annual cost of nursing home care for seniors (Ibid)
43,754—amount in dollars of the median income for a North Carolina family of four (Ibid)
70—percentage of nursing home residents nationwide who eventually become Medicaid recipients to pay for nursing home care (Ibid)
237,000—number of seniors in North Carolina who received Medicaid in 2008 (Ibid)
282,000—number of people with disabilities in North Carolina who received Medicaid in 2008 (Ibid)
683,000—number of infants in children in North Carolina who received Medicaid in 2008 (Ibid)
60,000—number of women in North Carolina who received Medicaid care affecting their pregnancy in 2008 (Ibid)
65—percentage of maternity stays for women under age 25 provided by Medicaid nationwide (Ibid)
3—number of years since study found that total medical spending is much lower when coverage is provided by Medicaid or SCHIP than it is when coverage is provided by private insurance. (Public And Private Health Insurance: Stacking Up The Costs, Health Affairs, 27, no. 4, 2008)
763 million—amount in state dollars cut from Medicaid in 2011-2013 in budget approved by the General Assembly in June (BTC REPORTS: The 2011-2013 Final Budget – Neglecting a Balanced Approach, Budget Costs Jobs and Delays Economic Recovery, June 2011)
1.56 billion—amount in federal Medicaid matching dollars that will be lost in the next two years because of state Medicaid cuts in the 2011-2013 budget (Ibid)
2.289 billion—total amount of reduction of state and federal Medicaid spending in the next two years because of state Medicaid cuts in the 2011-2013 budget (Ibid)
13,355—number of jobs that will be lost in North Carolina because of loss of Medicaid spending in 2011-2013 due to state cuts and resulting loss of federal matching dollars (BTC BRIEF: Legislative Budget Would Cost North Carolina 30,000 Jobs, Billions in Economic Output,” NC Budget and Tax Center: June 2011)
This entry was posted in Fitzsimon File. Bookmark the permalink.
Friday, September 16, 2011
Defense of Marriage
This past week, legislators met for three long days as promised at the end of last mini session in July. This mini session was to address the Defense of Marriage bill. NASW-NC members participated in many activities organized by Equality, NC and was inspired to watch their advocacy efforts and hard fight! Sadly, with just enough votes in both the House and the Senate, the bill was passed and ratified. In May, voters will have the chance to decide on the amendment.
What was the bill about?
The bill would provide an amendment to our state Constitution that would define marriage between one man and one woman and this would be the only recognized legal union in the state of NC (which is already a law here). During the May primary, voters will have the chance to vote on this Constitutional Amendment. If voters decide to vote no, the amendment will not be made. If voters decide yes, this amendment will be made to our Constitution; further discriminating our citizens. From now until then, NASW-NC, with the help of the PACE and Legislative Committees will be working with other organization on a campaign to vote no on this amendment.
Why is NASW-NC getting involved with this issue?
Our Code of Ethics is very clear about discrimination. We wrote a position paper on this very issue. It can be found by clicking here. Social workers are bound to the Code of Ethics in our practice and advocate on issues based on what is stated in our Code.
What can you do to help?
- Join the PACE and/or Legislative Committees if you're a member. These groups will be working on campaign efforts and other documents social workers can use.
- Write an Op-Ed to your local newspaper. Share with them how specific our Code of Ethics are about this issue.
- Continue to communicate with your legislators about how this issue affects you, your family, your practice, etc. They need to know how their constituents feel. Click here to find out who represents you.
- Talk to other social workers at your school, your place of employment or other networks you're a part of to let them know about this issue and what our Code of Ethics states.
From NASW's Code of Ethics (2008):
Social workers should not practice, condone, facilitate, or
collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion or mental or physical disability.
Social workers should act to prevent and eliminate domination of, exploitation of, and discrimination against person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, or mental or physical disability.”
To view our Code of Ethics, click here.
To view National's information on Diversity and Equity, click here.
What was the bill about?
The bill would provide an amendment to our state Constitution that would define marriage between one man and one woman and this would be the only recognized legal union in the state of NC (which is already a law here). During the May primary, voters will have the chance to vote on this Constitutional Amendment. If voters decide to vote no, the amendment will not be made. If voters decide yes, this amendment will be made to our Constitution; further discriminating our citizens. From now until then, NASW-NC, with the help of the PACE and Legislative Committees will be working with other organization on a campaign to vote no on this amendment.
Why is NASW-NC getting involved with this issue?
Our Code of Ethics is very clear about discrimination. We wrote a position paper on this very issue. It can be found by clicking here. Social workers are bound to the Code of Ethics in our practice and advocate on issues based on what is stated in our Code.
What can you do to help?
- Join the PACE and/or Legislative Committees if you're a member. These groups will be working on campaign efforts and other documents social workers can use.
- Write an Op-Ed to your local newspaper. Share with them how specific our Code of Ethics are about this issue.
- Continue to communicate with your legislators about how this issue affects you, your family, your practice, etc. They need to know how their constituents feel. Click here to find out who represents you.
- Talk to other social workers at your school, your place of employment or other networks you're a part of to let them know about this issue and what our Code of Ethics states.
From NASW's Code of Ethics (2008):
Social workers should not practice, condone, facilitate, or
collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion or mental or physical disability.
Social workers should act to prevent and eliminate domination of, exploitation of, and discrimination against person, group, or class on the basis of race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, or mental or physical disability.”
To view our Code of Ethics, click here.
To view National's information on Diversity and Equity, click here.
Friday, September 9, 2011
AP: NC Did Not Miss Deadline for Adult Care Home Changes
Here’s the alert that went out on the wire after the change was made:
MENTALLY ILL-NURSING HOMES
NC officials now say no deadline for mentally ill
RALEIGH, N.C. (AP) — A spokeswoman for the state Department of Health and Human Services says she was mistaken when she said the state had missed a deadline for dealing with thousands of people with mental illness who live in adult care homes.
Renee McCoy had said federal Medicaid regulators had given the state until Sept. 1 to develop a plan. Medicaid notified the state earlier this year it was in violation because of how it pays for the care of people with mental illness.
McCoy said Wednesday that there was no deadline. Agency Secretary Lanier Cansler tells The Associated Press the federal government at one point wanted a plan "by September," but that timeframe has been relaxed.
Meanwhile, state officials say the number of facilities whose patients may have to leave has increased.
Here’s the rewrite of the full story:
http://www.thesunnews.com/2011/09/07/2374675/apnewsbreak-nc-misses-mental-illness.html
http://www.rockymounttelegram.com/news/ncwire/state-ups-count-care-homes-risk-pay-conflict-675945
Michael Biesecker
Staff Writer
Raleigh, N.C.
919.510.8937 office
919.741.9163 cell
919.783.9184 fax
mbiesecker@ap.org
Twitter: mbieseck
The AP, founded in 1846, has a global network of 240 bureaus, providing news in text, audio, video, graphics and photos to more than 15,000 news outlets with a daily reach of 1 billion people worldwide.
MENTALLY ILL-NURSING HOMES
NC officials now say no deadline for mentally ill
RALEIGH, N.C. (AP) — A spokeswoman for the state Department of Health and Human Services says she was mistaken when she said the state had missed a deadline for dealing with thousands of people with mental illness who live in adult care homes.
Renee McCoy had said federal Medicaid regulators had given the state until Sept. 1 to develop a plan. Medicaid notified the state earlier this year it was in violation because of how it pays for the care of people with mental illness.
McCoy said Wednesday that there was no deadline. Agency Secretary Lanier Cansler tells The Associated Press the federal government at one point wanted a plan "by September," but that timeframe has been relaxed.
Meanwhile, state officials say the number of facilities whose patients may have to leave has increased.
Here’s the rewrite of the full story:
http://www.thesunnews.com/2011/09/07/2374675/apnewsbreak-nc-misses-mental-illness.html
http://www.rockymounttelegram.com/news/ncwire/state-ups-count-care-homes-risk-pay-conflict-675945
Michael Biesecker
Staff Writer
Raleigh, N.C.
919.510.8937 office
919.741.9163 cell
919.783.9184 fax
mbiesecker@ap.org
Twitter: mbieseck
The AP, founded in 1846, has a global network of 240 bureaus, providing news in text, audio, video, graphics and photos to more than 15,000 news outlets with a daily reach of 1 billion people worldwide.
Wednesday, September 7, 2011
A Message on CAP-I/DD Waivers
The Division, in partnership with DMA and with the support of DDTI will be hosting five CAP-I/DD Informational Sessions for the purpose of communicating the changes in the CAP-I/DD Comprehensive and Supports Waivers that will be effective 11/1/11. The sites for the sessions were selected to accommodate as many interested individuals as possible in each region. We would appreciate your assistance in forwarding the session information to the DD Consortium membership, and all you feel would be interested in attending. There will be no charge for these events, and registration is now open. The registration links for the events are listed as follows:
Tuesday, Sept. 20, Greenville http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-a3395d80da8e42658f70c2cf4e87a956
Wednesday, Sept. 21, Wilmington http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-3f3755a5929a44b58aa6810487e1cb71
Monday, Sept. 26, Asheville http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-b6e9889699c04fe1994862930018eb7d
Tuesday, Sept. 27, Newton http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-b156bba189a34764a55d1f65b7a31366
Wednesday, Sept. 28, Sanford http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-0600c8fb057545ffa5938727a522e2c4
We are encouraging all who are interested in attending to register as soon as possible so we can monitor the attendance numbers. Also, we are encouraging people to arrive one hour or so ahead of the event as we expect large numbers.
Tuesday, Sept. 20, Greenville http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-a3395d80da8e42658f70c2cf4e87a956
Wednesday, Sept. 21, Wilmington http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-3f3755a5929a44b58aa6810487e1cb71
Monday, Sept. 26, Asheville http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-b6e9889699c04fe1994862930018eb7d
Tuesday, Sept. 27, Newton http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-b156bba189a34764a55d1f65b7a31366
Wednesday, Sept. 28, Sanford http://reg.abcsignup.com/reg/event_page.aspx?ek=0060-0003-0600c8fb057545ffa5938727a522e2c4
We are encouraging all who are interested in attending to register as soon as possible so we can monitor the attendance numbers. Also, we are encouraging people to arrive one hour or so ahead of the event as we expect large numbers.
Tuesday, September 6, 2011
ValueOptions Update
On Thursday, September 1st, ValueOptions requested to attend the Professional Association Council (PAC). NASW-NC is apart of this Coalition, meeting monthly to represent licensed professionals across North Carolina. The request for ValueOptions to attend our meeting was to inform us about a spike in denials of authorization and ways they are working to address the issue.
There are several points they wanted our members to be aware of when submitting authorizations:
1) Most of the time, reductions for requests are due simply by not having clinical information provided on the request(this information is missing from the request). Information such as diagnosis and treatment changes need to be noted, clinical support for service definitions need clinical support, no provider number listed, etc.
2) Lack of knowledge about due process rules that changed in May of 2011. For more information on this, click here or here for due process and prior approval information.
3) New process for submitting requests: Electronic submission mentioned in the August 2011 Medicaid Bulletin- this is effective 0ct. 1st, 2011. Providers will need to sign up with the Provider Connect website to submit requests, see authorization letters, etc. Click here and see the Section 1 for more information on Provider Connect.
ValueOptions is committed to help the providers of NC work with Best Practice standards. For more information on Practice Guidelines, click here.
NASW-NC Members: If you have any questions about this information, please contact Kay Paksoy at the chapter office.
There are several points they wanted our members to be aware of when submitting authorizations:
1) Most of the time, reductions for requests are due simply by not having clinical information provided on the request(this information is missing from the request). Information such as diagnosis and treatment changes need to be noted, clinical support for service definitions need clinical support, no provider number listed, etc.
2) Lack of knowledge about due process rules that changed in May of 2011. For more information on this, click here or here for due process and prior approval information.
3) New process for submitting requests: Electronic submission mentioned in the August 2011 Medicaid Bulletin- this is effective 0ct. 1st, 2011. Providers will need to sign up with the Provider Connect website to submit requests, see authorization letters, etc. Click here and see the Section 1 for more information on Provider Connect.
ValueOptions is committed to help the providers of NC work with Best Practice standards. For more information on Practice Guidelines, click here.
NASW-NC Members: If you have any questions about this information, please contact Kay Paksoy at the chapter office.
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