Working for North Carolina’s Mental Health Through Advocacy, Education, & Service August 7, 2006 Legislative Wrap-up Please distribute this information to others! The General Assembly adjourned at 1:00 AM on Friday, July 28th after finalizing details of lobbying and ethics reform, addressing university building projects and several other items. The nearly three month “short” session included many items that impact mental health. In this report: Budget Adjustments Finalized:
Passed Legislation:
Not Passed:
Legislative Oversight Committee Meetings for 2006-2007 Budget Adjustments Finalized: The budget adjustments bill, S1741, was passed by the Legislature and signed by the Governor on July 10th. Mental health, developmental disabilities, and substance abuse services got about $67m in recurring and $34m in non-recurring for a total of $101m. Not included in this total are funds in the capital budget for new hospitals; it authorizes $20 mil in debt to complete Butner Hospital, $145 mil in debt for new 304-bed hospital in Goldsboro, and $162.8 mil for new 382-bed hospital in Morganton. Also in the budget is an additional $500,000 allocated to AHECs, Area Health Education Centers, to develop model programs for placement and retention of psychiatrists in rural areas. Complete budget documents can be found on the first page of www.ncleg.net.
Funding Numbers: Here is a quick summary of the MH/DD/SAS items:
TOTAL RECURRING 67,133,357 TOTAL NON-RECURRING 33,332,500 TOTAL 100,465,857
The $100+ million appropriated in this year’s budget is a great victory for persons with mental illness, developmental disabilities, and chemical dependency disorders. Even with this increase, the public mental health system still falls short of fulfilling the need for community services and supports. People still lack services; service numbers have increased 25% in the past 6 years, and our state’s population continues to grow. The Legislative Oversight Committee on MH/DD/SAS recommended $156 million in increases, and a report released by the NC Psychiatric Association stated that North Carolina needed to an increase of $285 million in mental health services alone in order to bring us up to 88.8% of the national median. The $100 million is a wonderful first step and we will continue to advocate for funds to meet the needs that still exist. ACTION: Please thank your Legislators for this $100 million dollar increase. Your state elected officials need to hear your support for this positive first step forward. You can also let them know that we know the work is not done. Contact information for your representatives can be found at www.ncleg.net or use the CPDMI CyberAdvocacy site at http://capwiz.com/cdpmi/state/main/?state=NC to find out who represents you. You can also contact your local elections board; a list of local elections boards can be found at the State Board of Elections website or by calling SBOE: http://www.sboe.state.nc.us/ or (919) 733-7173. Special Provisions: The special provisions attached to the budget bill were remarkably shorter this session due to House Legislators’ self imposed limits and concerns over controversial provisions included in last year’s budget. Included this session were: Ticket to Work effective date change: This provision moves the effective (start) date for the Medicaid buy-in program for disabled adults from January 1, 2007 to July 1, 2007. The budget bill also removes the $150,000 allocated for administering the program this year. This delay in implementation is the result of information systems delays and the recent “firing” of ACS, the company contracted to develop a new Medicaid Management Information System (MMIS). The NC Department of Health and Human Services and the State Medicaid Office have stated that they are unable to implement the new program without a new information management system (which has been in development for some time). With ACS out, a new company will need to finish the work they started on the new MMIS. Advocates have been told that North Carolina is still committed to ticket to work/Medicaid buy-in and that the program will start following a new MMIS. Medicaid buy-in allows persons with disabilities to purchase Medicaid coverage, allowing them to return to work (thus ending or limiting disability payments) without fear of losing their health benefits. Crisis Regions: This provision directs the development of LME crisis regions and the use of the 5.25 million in crisis funds in the budget. The funds are to be used to assist in the development of plans for a continuum of regional crisis services and for the development of regional crisis facilities where needed. It directs regions to work to secure crisis services through community hospitals/facilities before developing facility based crisis centers. First Commitment Pilot Program Extension: The provision that authorizes several pilot programs for eligible mental health or substance abuse professionals to perform an initial first-level exam of persons being committed has been extended to October 1, 2007. Under current statutes these exams are performed by physicians or eligible psychologists. These pilots are being studied to determine if they improve delivery of services while still protecting the health, safety, and welfare of those involved. LME functions: This provision directs the DHHS to reallocate LME funds so that each LME will be able to implement 24-hour, seven day a week screening, triage and referral, and monitor all person centered plans. It also directs the Secretary of DHHS to revise the LME cost model that determines funds allocated for administrative costs and consult with the Legislative Oversight Committee on MH/DD/SAS before implementing the new model. The provision changes the requirements for an LME catchment area to contain a minimum population of 200,000 or six counties; DHHS is directed to reduce administrative allocations by 10% for programs that do not comply with the new catchment area requirements. Psych Hospital Debt Service: Clarifies that the cost savings from state hospital downsizing that are in excess of the operating costs for hospitals are to be placed in the MH/DD/SAS Trust Fund, not used for debt service on the new hospital. Also of interest: DHHS will study strategies to assist pharmacists providing services to Medicaid recipients enrolled in Part D and the impact of the Deficit Reduction Act on payments for generic drugs. Legislators provided one-time funds to help counties with their share of Medicaid costs. North Carolina is one of two states that require counties to contribute a significant percentage to the cost of Medicaid. The State of New York enacted a law capping the annual increases in Medicaid spending by counties and New York City at 3.5 percent and lawmakers have said they intend to phase out local contributions, but have yet to allocate funds to do so. DHHS will “study and develop a proposal for an equitable standard for providing inflationary increases” to Medicaid service providers. With the shift from institutional care to community based care, and the increasing role of Medicaid in providing funding for mental health services, advocates have long asked for inflationary increases for all community-based services. Bills that Passed: MH Reform Changes H 2077: Near the end of the budget process, several of the Legislative Oversight recommendations that had been put into individual bills on the House side and special provisions on the Senate side were wrapped up into a singe bill, H2077, and passed in quick order. Included in H2077 are changes to area authority (LME) boards to give more membership flexibility, the establishment of Consumer Family Advisory Committees (CFACs) in statute, a definition of the functions of LMEs, and a section that allows for two or more counties in an interlocal agreement to become public providers of services if qualified and competing fairly with other providers. The bill also directs DHHS to establish state performance measures for the MH/DD/SAS system and establish standard forms, measures, contracts, processes, and procedures for the system. Also included is the development of state job classifications for LME/area program directors. Of greatest concern to consumers, families, and advocates are two items. First, the statutes that outline the make-up of the LME/Area Boards have been changed to allow for more “flexibility.”. During the Oversight Committee meetings, several members were concerned that LME/Area Boards should have more financial expertise and that some of the categories of membership were “difficult to fill.” The new language attempts to give more flexibility and financial expertise by allowing for larger boards in areas with more than 8 counties, requiring a person with financial expertise, allowing a qualified person to fill two categories of membership, and stating that “not more than 50%” of the members shall represent physicians, clinical professionals, family members, and consumers. By changing the language from “at least 50%” to “no more than 50%,” the new requirements for Boards allow for a minimum of one family member and one consumer. We would hope that LME/Area Boards would continue to represent the diversity of their communities and include many consumer and family members in their ranks. While the codification of the CFACs ensures the existence of consumer and family advisory boards, they are still advisory committees. The LME/Area Board is where the decisions are made and where the oversight of the LME takes place. This is one of the many places in the public mental health system where consumers and families need to be involved to ensure quality and responsiveness to those in need. Second, item 5 under “Functions of LMEs” allows LMEs to participate in modifying person centered plans for high risk and high cost consumers “in order to achieve better client outcomes or equivalent outcomes in a more cost-effective manner.” The language then goes on to give the Commission on MH/DD/SAS the authority to adopt rules that define “high-risk” and “high-cost” consumers. This language was changed from its original drafting to better reflect advocates concerns that the focus of modifying plans should be for good consumer outcomes, not simply lowering costs. However, including language regarding lowering costs and finding efficiencies in service delivery creates concerns that the system’s focus will shift to one solely driven by cost-effectiveness and not individual needs and good outcomes for consumers. Strengthen Oversight Committee, H 2120: The Joint Legislative Oversight Committee in MH/DD/SAS will now have similar powers as other committees to obtain information from state agencies and the Study Commission on MH/DD/SAs is repealed. The LOC may study mechanisms for LMEs to purchase state hospital bed days, the impact of the Piedmont 1915 Medicaid waiver and its possible use statewide, the use of disability categories for service appropriations, and drug treatment courts. Special Education Re-write H 1908: House Bill 1908, “An act to rewrite the laws governing the education of children with special needs,” was a result of the efforts of the House Select Committee on the Education of Students with Disabilities, which met on several occasions before and during the legislative session to hear from experts in the field and plan for the changes carried out in this bill. Disability advocates are pleased that it gives the State Board of Education the authority and ability to set standards for the education of children with disabilities that are higher than those required by the national standard, IDEA (Individuals with Disabilities Education Act). It also outlines that individualized education plans (IEPs) are not only developed and reviewed for children with disabilities, but are also implemented and revised according to IDEA and state law. The bill determines that the State Board of Education will monitor the local education agencies to ensure that IEPs are meeting the educational needs of students with disabilities, and incentives will be put into place for those local education agencies that achieve or exceed targets and indicators. Overall, this rewrite of existing law ensures that the standards for education of children with disabilities in North Carolina may be higher than the national standards. Studies Bill: The studies bill passed at the end of the session included several items (in addition to those listed above) that may be studied by the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services: mental health parity legislation (H.B. 893), issues related to mental health parity, and funding for area and county program administration. Should the committee study these items they may also report their findings, with any recommended legislation, to the 2007 General Assembly. Update on items not passed during this session: Parity: Despite bills introduced in the House and Senate this year, parity was not taken up in the short session. Technically, these bills were not eligible for consideration as they did not meet the “crossover” deadline in the previous long session. Advocates had hoped that parity might be included in the final Legislative Oversight report but are now more hopeful that the LOC and the Legislature as a whole will take up the issue since it has been included in the studies bill. State Prescription Drug Assistance: A taskforce of organizations from the aging, health, and disability communities was formed very quickly this year to begin advocating for a state prescription assistance program to help lower-income persons with drug costs and medication management. Despite the recent implementation of a Medicare drug assistance plan, many seniors and persons with disabilities still have trouble paying for needed medications and do not qualify for federally funded low-income assistance. Many still have trouble understanding the Medicare plan and their prescribed medications. Advocates worked hard to educate the Governor’s office and Legislators and push for a state funded program, but it was not included in this year’s budget. The taskforce plans to continue their work in the coming year. High Risk Pool Insurance Plan: The NC Senate did not act on the High Risk Health Insurance Pool bill. From Adam Searing in the July 19, 2006 NC Health Report: “Despite months of effort by all parties concerned (insurers, hospitals, doctors, legislators, advocates, bill sponsors Rep. Verla Insko and Rep. Hugh Holliman, etc.) in the Institute of Medicine Task Force, consideration by a joint legislative study committee and extensive debate and modification in the House, the NC Senate will not even hold a hearing on the bill.” The Senate believed that there was not enough time at the end of the session to consider such complicated legislation, despite time spent considering other matters. Advocates suspect that special interests from the insurance industry, which helped craft the report that recommended the high risk pool, also had a hand in stopping the bill this year. For the full report see http://www.ncjustice.org/media/library/775_nchrptjuly192006.pdf or look for the report on the Justice Center’s website at www.ncjustice.org. Looking ahead to the next session… Legislative Oversight Committee on MH/DD/SAS: The LOC was very active in the past year hearing community testimony, considering the research of fiscal staff, state agencies and community organizations, and developing recommendations for the public mental health system, including increased funding. Meetings have been announced for the continued work of the LOC for the remainder of this year and January. All dates, times and rooms are subject to change. Please check the Legislative calendar for updated information at www.ncleg.net. Meetings held in rooms 643 and 544 can be listened to via the audio link on the legislative website as well. At this point all meetings are scheduled to begin at 9:30 AM in room 643 of the Legislative Office Building: September 6, October 4, November 7, December 6, January 10 2007. Our thanks go out to everyone who participated in advocacy efforts this year: those who called, wrote, visited their Legislators, traveled to Raleigh for the Coalition 2001 Rally for MH/DD/SAS, testified before committees, hosted visits from Legislators, and got others involved. You really made a difference. We hope the funding increases gained this year will be the first step for North Carolina to have a mental health system that truly meets the needs of its citizens. Our sincere thanks also to the Governor and General Assembly; especially to those who championed MH/DD/SAS appropriations in this year’s budget. Thank you for taking this first step forward in ensuring better mental health care in North Carolina. As always, if you have questions about these or other mental health policy issues, please contact Jennifer Mahan, Director of Policy and Advocacy Initiatives at the Mental Health Association in North Carolina, 919-981-0740 x239 or jmahan@mha-nc.org. Thank you to Adrian Lovelace, MHA-NC, for her reporting on the students with disabilities statute changes and to Adam Searing of the NC Justice Center for following and reporting on the high-risk pool bill.
Kelly B. Capps
Public
Relations & Communication Specialist Contact our Information & Referral line at 1-800-897-7494 or at callctr@mha-nc.org |