Legislative Updates from The Covenant with North Carolina's Children

Provided by Stacey Massengill, NCSPA Legislative and Public Policy Committee Member

Originally Submitted by Rob Thompson, Executive Director of the Covenant with North Carolina's Children



In this update:

-CASE MANAGEMENT UPDATE
-COMPREHENSIVE SERVICE PROVIDER DEFINITION
-TOGETHER NC AND TAX MODERNIZATION
-ANNOUNCEMENTS
-STEP UP AND ACT FOR CHILDREN - 2009
-2009 MAKE A DIFFERENCE DAY
-STATE GRANT-REPORTING SYSTEM CHANGES

I hope everyone is doing well. Don't forget about the food-filled Covenant fundraisers!

1. 10/20 - NOFO at the Pig. 10% of all purchases will go to the Covenant, so this would be a good time to bring friends that like to drink and eat a lot.
2. 10/24 and 11/14 - Home-cooked meals by Jennifer Mahan, Covenant Board Chair and professionally-trained chef. Email Jennifer at mailto:Jennifer.mahan@mha-nc.orgif you're interested in attending.

CASE MANAGEMENT

As I reported in the last update, Medicaid is considering consolidating its case management services to meet budget targets that were mandated by the legislature. Last week, DMA released a proposed plan that would reduce case management costs. The following is a link to a powerpoint presentation that outlines the DMA plan: http://www.ncdhhs.gov/dma/provider/budgetinitiative/CaseMgtMeetingPresent092409.pdf.

At this point, it's unclear what the repercussions of such a plan would be. Here's how HHS characterized the cost-savings in the plan:

-Limiting the number of units of case management that may be billed in any given month for a recipient.
-Allowing only one case management provider to bill for an individual recipient in any given month.
-Implementing further rate reductions (beyond the rate reductions specifically mandated by the General Assembly).
-Implementing administrative changes to reduce the burden on providers, including paperwork reduction and reducing or eliminating requirements around Prior Authorization (PA) (not an exhaustive list).

Our biggest concern is that any attempt to consolidate specialty case management services (MH/DD/SA, Maternal Health, etc) would result in a serious decline in the quality of health care for these populations. At the bottom of this email, I've pasted a letter the Covenant sent to HHS regarding this issue. DMA will be accepting feedback through 10/5, so if you've got something to say, please say it now. When the Covenant's cadre of experts digest the plan a bit more, I'll send out another update.

COMPREHENSIVE SERVICE PROVIDER DEFINITION

HHS is sending a proposal to CMS (federal Medicaid) that would require all service providers to meet new criteria to be eligible for Medicaid payments. This could drastically reduce the number of service providers in the state in all areas of health care and mental health, which would be extremely damaging to our very fragile provider-infrastructure. The new comprehensive service provider criteria would require all providers to have an accountant with five-years of experience, to provide three 'enhanced' services, and to have a full-time psychiatrist on staff.

It's unclear as to why DHHS is doing this now. A cynical person might say that it's being driven by the small number of large service providers that would benefit from such a provider definition. As soon as we know more, I'll send out an update.

TOGETHER NC AND REVENUE MODERNIZATION

Meg Gray (Budget and Tax Center) and I did the first of several revenue modernization workshops in Asheville last week. Our goal is to educate Together NC partners on why revenue reform is so important to public programs and what that reform should look like. In the next couple of months, we'll be holding workshops in Rocky Mount, Charlotte, Greensboro, Fayetteville, Raleigh, and a couple other place TBD.

If you would like a separate presentation for your group or organization, please let me know - mailto:rob@nccovenant.org.

Also, we still expect a joint Senate and House effort to take place this fall with the goal of putting together a revenue modernization plan.


ANNOUNCEMENTS

Step up and Act for Children 2009

Child advocates across the country are planning nonpartisan events on Capitol steps the first week in October to call on federal elected officials to make children's issues a higher priority. Action for Children and partners will be calling on our leaders to commit to increased investments in children's health and early education.

Where: Old Capitol building, southside (outside), downtown Raleigh (where Fayetteville St. dead ends into Morgan St.)
When: Monday, October 5, 11:15 a.m.-12:30 p.m.

Who: Children's performance groups (11:15-12) will include: * Hunter Elementary show choir * Hunter Elementary advanced orchestra Press event speakers (12-12:30) will include: * Marian F. Earls, M.D., President, North Carolina Pediatric Society * Stephanie Fanjul, President of the N.C. Partnership for Children, Inc (Smart Start) * Worth Hill, Durham County Sheriff * Felicia Willems, mother and advocate for children


2009 Make a Difference Day

SaySo (Strong Able Youth Speaking Out) are participating in the 2009 Make A Difference Day Campaign (MADD). MADD is Saturday, October 24, 2009. This year's theme is "Give a Child a Smile", which is the suitcase project that we have had great success with in previous years. The goal is to collect 2,500 suitcases/duffel bags for children in substitute care throughout North Carolina. If you would like to help with this year's campaign, please contact Lauren Zingraff, SaySo Program Coordinator at mailto:lauren.zingraff@ilrinc.comor 1-800-820-0001. We need your help to meet our goal of collecting 2,500 suitcases by October 24, 2009. Thank you as always for your continued support of SaySo. Your efforts are greatly appreciated!

State Grant-reporting Changes
Some of y'all have experienced problems with this change. Here's a notice from the Philanthropy Journal:
RALEIGH, N.C. - As of Aug. 31, responsibility for state grants reporting has been transferred to the North Carolina Office of State Budget and Management.

The function previously was handled by the Office of the State Auditor.

To simplify reporting for nonprofits receiving state funds, the Office of State Budget and Management plans to create a new web portal for online reporting and information.

In the meantime, the online Grants Information Center will be unavailable through the end of September.
Grantees that are scheduled to report before Sept. 30 will receive an extension through Oct. 30. For assistance or information, contact the Office of State Budget and Management at mailto:ncgrants@osbm.nc.govor call 919.807.4795.


Best, Rob



Letter to HHS re case management

9/9/09

To whom it may concern,

I am writing on behalf of the Covenant with North Carolina's Children to express our concern with the potential consolidation of certain case management services. The Covenant is a coalition of over 70 service providers, advocacy organizations, and civic groups working to implement public policy that benefits children.

We understand that the Division of Medical Assistance has been required by the legislature to find unprecedented savings within case management, but we believe that many case management services provided by state agencies are too complex to consolidate and too important to lose. Specifically, we are concerned that child and maternal health, substance abuse, developmental disabilities and mental health as well as other populations and illnesses demand specific areas of expertise and an understanding of systems of care beyond the medical infrastructure. As an organization that represents North Carolina's children and families, we feel strongly that the aforementioned case management services should not be consolidated.

While the Division might save money upfront by consolidating case management in these areas, it will doubtlessly incur even greater costs when serious conditions go undiagnosed and unmanaged, and when individuals lose financial benefits or become homeless. Most importantly, the loss of these crucial case management services will lead to greater human suffering, especially when combined with the drastic cuts to other child and family programs across DHHS. We urge you to find a solution that maintains these invaluable case management services.

Thank you for your consideration. Please do not hesitate to contact me with any questions - mailto:rob@nccovenant.orgor 919.866.3280.

Sincerely,

Rob Thompson
Executive Director
Covenant with North Carolina's Children