NC General
Assembly

This goal seeks to enhance accountability in Federal Block Grants and increase consumer and family involvement in how funds are spent. In September 2000 Congress passed H.R. 4365 which requires SAMHSA to develop separate mental health and substance abuse "performance partnership plans" with states and other interested groups around a common set of performance measures for accountability. Mental health plans must be targeted to children with serious emotional disturbance, adults with serious mental illness, and individuals with co-occurring mental health and substance abuse disorders.

There have been ongoing concerns regarding the actual input families and consumers have in determining how block grant funds are spent. The state also has difficulty accounting for exactly how the funds are spent at the area program level. The federal legislation is so new we cannot assess North Carolina measures up. It will take some time for SAMHSA to develop expectations and requirements for the states.

NC Grade -- D
Past performance is marginal. Too early to tell how state will respond to new federal legislation.

The goal is to provide equitable coverage for mental illnesses equal and commensurate with that provided for other physical illnesses.

The North Carolina State Employees Health Plan has required a mental health parity benefit since 1991. Substance abuse parity was added in 1997. The plan experienced cost decreases subsequent to implementation of parity. Legislation to require mental health parity for group policies in North Carolina was first introduced in 1993 and every subsequent session of the General Assembly. The NC Senate approved a Mental Health Parity bill in 1997. The NC House has never allowed a committee vote on a parity bill.

NC Grade -- C
 Good job for state employees now how about the rest of us?

This goal looks at the issue of private and public sector health plans that place restrictions on access to medications. Many restrictions are designed to discourage use of more expensive medications. Limitations may include a restricted formulary, and "fail first" policies. NAMI is working toward mandatory access to medications. If the health plan uses a formulary, exceptions must be allowed when a non-formulary alternative is indicated. Health plans must establish procedures for appeal that provide an independent clinical review.

In the 1999 Legislative session SB347 was passed to require health plans that have a formulary to establish and maintain an "expeditious process" that allows an enrollee to obtain, without penalty or additional cost-sharing, coverage for a non-formulary drug determined to be medically necessary by the physician. The medication can be obtained without prior approval from the insurer after the physician notifies the insurer that the formulary medication has been ineffective or harmful, or can be reasonably expected to cause harm or an adverse reaction, and that the drug is prescribed in accordance with clinical protocol. Legislation to establish independent review panels for appeals was unsuccessful in the 1999 General Assembly.

NC Grade -- B-
Off to a good start but not there yet.

This goal looks at the availability and state support of development of PACT teams and fidelity to the PACT model. The PACT model provides the most effective, integrated, community based treatment for persons with severe and persistent mental illness.

PACT (or ACTT as it is called in North Carolina) is a reimbursable Medicaid service in North Carolina. The Medicaid service definition does not require adherence to PACT model standards. The Division has provided numerous training opportunities but to date, only four area programs have developed PACT teams that meet established model standards. The barrier seems to be the state’s failure to require this service and a lack of staffing and incentives to develop it.

NC Grade -- D
A start has been taken but we have a long way to go to meet this goal.

Federal legislation allows states to offer Medicaid coverage to SSI beneficiaries who go to work and earn up to 250% of the poverty level. The legislation also allows states to offer a Medicaid buy-in for people with disabilities who earn more than 250% of the poverty level up to 450% if the state charges a sliding-scale premium. Taking advantage of these options allows people with a disability due to mental illness to earn more money without jeopardizing their health benefits through Medicaid. This has been a major disincentive to return to work as many part-time and re-entry work positions do not provide health coverage.

North Carolina has not taken advantage of either of the federal options, despite the fact that offering Medicaid benefits to disabled individuals earning up to 250% of the poverty level would require a relatively small state expenditure.

NC Grade -- F
Failure to take advantage of the federal options means that people who want to work can’t or they risk losing health coverage…shameful.

In 2000 the General Assembly passed legislation to limit the use of seclusion and restraint, and require training in alternatives to seclusion and restraint, mandatory death reporting, and regular reports on the use of seclusion and restraint. The bill also establishes penalties for infractions.

NC Grade -- B+
Leading the nation, good job NC. Additional legislation to eliminate the "therapeutic" use of restraints would give us an A grade.

Over the past two years North Carolina has used some of its federal block grant funds to support the establishment of jail diversion programs. 10 programs have been funded to date. The court system is beginning to support the establishment of "therapeutic courts" and combination of mental health and drug courts. Two are operating for adults and one for juveniles. Too early to tell if North Carolina will take advantage of the new federal grants.

NC Grade -- D
A positive start, but a long way to go.

This goal concerns the availability of supportive housing for persons with mental illness.

North Carolina is one of only six states to limit Special Assistance payments to adult care home type facilities. As a result, 9,000 individuals with mental illness or developmental disabilities reside in adult care homes in North Carolina, a setting inappropriate for the needs of most, instead of being able to use Special Assistance funds to rent an apartment. North Carolina also provides no state funds to assist developers to leverage other federal or state development programs nor does it offer state funds to provide rental assistance to extremely low income disabled people while they wait to receive federal Section 8 assistance.

NC Grade -- F
Not only does the state not help with housing, it creates barriers by limiting access to Special Assistance payments…shameful.