Monday, April 26, 2010

Monday Quick Hits: Hot Policy Topics for This Week

Only two weeks until the start of the short legislative session. Committees that have been meeting during the interim are starting to wind down this week and present their recommendations for session.  Quick reminder: only bills that passed one of the chambers in long session, or an appropriation bill, or a bill that comes out of an interim committee is viable for the short session.
Of specific interest this week will be the recommendations from the Education Oversight Committee. This committee took up the debate on banning corporal punishment for all children with disabilities. Their recommendations are due on Tuesday, April 27.


Tue, April 27, 2010
10:00 AM
Legislative Study Commission on Children and Youth Public Hearing - Charlotte

N/A1
11:00 AM

643 LOB
1:00 PM
Economic Recovery, Joint Select Committee on

1027/1128 LB
1:00 PM
Banking Commission

1228/1327 LB

Wed, April 28, 2010
10:00 AM
Civil Custody Guardians, House Select Committee on

1124/1224 LB
10:00 AM

421 LOB
10:00 AM
Interim Joint Finance Committee Meetings on Tax Reform

643 LOB
1:30 PM

544 LOB

Thu, April 29, 2010
9:00 AM

544 LOB
10:00 AM

421 LOB
10:00 AM

643 LOB
1:00 PM

544 LOB

Friday, April 23, 2010

Arc of NC: Details on Governor's Budget

The budget released by Governor Bev Perdue on Tuesday reflected an attempt to work within the reality of a deep recession while preserving needed services for people with developmental and intellectual disabilities.

The budget reflected no freezes or cuts to core Medicaid services for people with developmental disabilities.

The budget included the following restoration of funding:

$40 million in community mental health state funding. This restores the state service dollars funding cut to LMEs that occurred in the 2009 budget.

The budget did include the following expansion items:

$8.5 million appropriation to expand the State Children’s Health Insurance Program. This expansion will provide access to additional 8,100 children from working families.

 $12 million appropriation to purchase additional local private hospital beds for mental health patients. This is targeted for crisis care needs.

$1 million appropriation to expand Project C.A.R.E. program. This will expand the program to allow 500 additional families to receive respite care services for people who are assisting their elderly family members who have dementia.

 $9 million to allow for targeted reimbursement to adult care homes that provide acute personal care services.  

 

Many of our concerns after reviewing the governor’s proposed budget are with reductions to Medicaid Optional Services.  Here are four that stood out.

Proposed reductions:

$11.6 million reduction that would limit adult dental coverage to emergency care only.

This recommendation limits adult dental coverage to emergency care only. With this policy change, covered services will include emergency exams; diagnostic x-rays; urgent care extractions; biopsies; excision of tumors; repair of soft tissue wounds; treatment of fractures; and a portion of adjunctive services, such as general anesthesia and IV sedation, hospital calls, and therapeutic drug administration.

 $4.3 million reduction under Improving Utilization Management for Optional Services.  This cut would reduce the maximum number of visits for adult speech therapy, physical therapy, occupational therapy, and respiratory therapy to three visits per year.

Various optional service changes are recommended. They include maintaining adult podiatry services for individuals with diabetes or vascular disease only ($535,436); eliminating adult optical 'refraction only' services to be consistent with Medicare reimbursement ($121,677); reducing the maximum number of visits for adult ST, PT, OT, and respiratory therapy (RT) to three visits/year ($1,507,110); and no longer allowing reimbursement of ST, PT, OT, and RT services when provided at the same time as other home care Medicaid services ($112,500). In addition, the division shall develop a plan that includes limits and prior approval on outpatient optional services for improved utilization management ($2,065,647).  

$59.8 million reduction found by reforming In-Home Personal Care Services.

This recommendation reforms the in-home PCS program in order to provide care for individuals who are at risk of needing institutional care. Reform includes the elimination of in-home PCS services for adults and the creation of a new program for adults with the most intense needs. Some of these individuals are currently enrolled in the PCS Plus program (those requiring extensive assistance with three or more ADLs). A portion of the individuals in regular in-home PCS that have the highest need for in-home support will also be included. The expansion of the PCS Plus into a new program will ensure those individuals that do not qualify for nursing home care and have the greatest need will receive appropriate service in their homes.

 $1.2 million reduction by creating a new Community Alternative Program technology waiver for private duty nursing.

This recommendation transitions adult private duty nursing recipients to a new Community Alternatives Program (CAP) technology waiver. The program will continue to serve children; however, it is recommended that independent assessments be conducted for children that receive the service.

Although we did not see any elimination of Medicaid optional services there are serious concerns over the adult dental reduction and over the proposed changes in adult ST,OT, PT and RT.  We will continue to research the scope of these proposals and will publish updated information on this blog as it becomes available.

Overall Governor Perdue’s budget did what she and her staff had said they would attempt to do. They protected to the best of their ability core services for people with developmental disabilities and their families and her budget restored the $40 million dollar cut in state funding for community based services.  The budget process will now move to the members of the General Assembly. The Senate will begin the process by presenting their budget shortly after the start of session. 

Here is the proposed calendar for the House and Senate Budget Process:

Senate to have an adopted budget my May 20th.

House to have their adopted budget by June 10th.

Final Budget June 29th.

Gavel out on July 1.

 The North Carolina Legislative session begins on May 12th

NC News: NC Policy Watch Article on the Budget

Perdue’s mixed bag of a budget

Thursday, April 22nd, 2010

By Chris Fitzsimon

There were few surprises in the budget Governor Beverly Perdue released this week, no tax increases, a few important new jobs initiatives, more painful cuts to education and human services.

The budget is a reflection of the perceived political climate in which elected officials seem scared to even discuss new revenues, even if it means cutting dental services and eye care for people on Medicaid or asking schools to find more cuts on top on last year's reductions that resulted in teacher layoffs and larger classes.

Perdue also largely declined to take on sacred cows to avoid the cuts. She didn't mention ending the in-state tuition subsidy for out of state athletes or diverting some of the state's annual payment from the national tobacco settlement.

Despite that flawed and limiting framework, she deserves credit for creative thinking in how she allocated the money she wants to spend.

One notable example is her Back to Work Incentive Fund that would provide $1000 per job subsidy to small businesses that add jobs by hiring workers who have been unemployed for more than 60 days.

Perdue also makes some important investments in repairing the gaping holes in safety net like restoring $40 million that was cut from mental health services in the final hours of last session's budget negotiations.  That only gets the system back to less than zero, the underfunded state it was in before the cuts, but at least it's not going further backwards.

Perdue also allocates $14 million for the AIDS Drug Assistance Program that provides lifesaving medication for people infected with HIV who can't afford it.  The program stopped taking new applicants earlier this year and now has a waiting list of more than 300 people.

Read more at NC Policy Watch.

Wednesday, April 21, 2010

NCGA: Joint House/Senate Appropriation Meeting Today

The Joint House and Senate Appropriation Committee will meet today at 10:00 AM in room 643 of the Legislative Office Building.

Members of the House and Senate will review Governor Bev Perdue's budget adjustments. Yesterday, faced with a $1 billion dollar deficit, the governor released her budget. That budget will now be reviewed by legislators who will then start to create their own budget.

We will bring you updates as available.

Tuesday, April 20, 2010

NCGA: Governor Bev Perdue Presents Her Budget.

Today Governor Bev Perdue released her recommended adjustments for North Carolina’s 2010-2011 budget.

In her letter to the General Assembly she stated that her budget “closes the $1.2 billion budget gap which results from lower than anticipated revenues and growth in entitlement requirements.  This gap is closed by implementing over $950 million in spending reductions and utilizing $550 million of additional federal Medicaid funds.  It prudently earmarks $100 million to replenish the state’s Rainy Day Fund.”

The Governor’s budget does not include any new taxes. To offset the cuts the budget maximizes all federal funding programs such as ARRA and increased federal Medicaid funding.

So what does this mean to families and people with developmental disabilities in our state who are currently struggling with accessing and retaining needed services?

Lets take a look at the positives of this budget first.  Last year the General Assembly in a last minute decision cut $40 million dollars in state funded money that supports community based services. Governor Perdue’s budget restores that funding by appropriating $23 million dollars from the general fund and then adding to that $17 million in TANF ARRA monies to make up the full cut. 

Governor Perdue also appropriated $12 million to increase local in-patient bed capacity to continue the development of local crisis response and her budget appropriated $534,795 thousand dollars to support training of direct care staff and front line leaders in our residential facilities.

So where are our concerns? Although there are no cuts to core Medicaid services for people with developmental and intellectual disabilities there are reductions and changes in Medicaid policy that do affect our community. Some of the adjustments affect durable medical equipment specifically high-end orthotics and prosthetics. Other adjustments are to the authorization process for adult physical therapy, occupational therapy, speech therapy and respite therapy. In addition there is an adjustment to service for adult dental under Medicaid.  We are currently researching the scope of these changes and we will update this blog with more information once we have it.

What is clear about Governor Bev Perdue’s budget is that she did protect the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services from any additional deep cuts.  Secretary of DHHS Lanier Cansler and the governor’s staff heard the messages from families and advocates across our state. They understood that any additional cuts to core services would devastate an already fragile support system and they acted prudently to avoid additional reductions.

 

Monday, April 19, 2010

Monday Hot Topics: Hot Policy Topics This Week

We are getting very close to the start of the short session. This weeks meetings are an indication that we are getting to the end of the interim and their reports are coming due. Here are the Hot meetings for the week:
Mon, April 19, 2010
10:00 AM
Child Fatality Task Force - Joint Domestic Violence Subcommittee

1425 LB
11:00 AM
Childhood Obesity, Legislative Task Force on

643 LOB

Tue, April 20, 2010
1:00 PM
Comparative Effectiveness Study Committee

643 LOB
3:30 PM
Urban Growth and Infrastructrure Issues

544 LOB

Wed, April 21, 2010
8:30 AM
Joint Appropriations Justice & Public Safety Subcommittee

415 LOB
9:30 AM

544 LOB
10:00 AM
Justus-Warren Hearth Disease & Stroke Prevention - Legislation and Resource Development

1027/1128 LB
10:00 AM
Justus-Warren Heart Disease & Stroke Prevention - Prevention

1124/1224 LB
10:00 AM
Justus-Warren Heart Disease and Stroke Prevention - Management

1228/1327 LB
10:00 AM
Jusuts-Warren Heart Disease & Stroke Prevention - Public Awareness

1425 LB
10:00 AM
House and Senate Appropriations

643 LOB
1:00 PM

1027/1128 LB
2:00 PM
Work and Family Balance, Joint Study Committee

1228/1327 LB

Thu, April 22, 2010
10:00 AM
Blue Ribbon Task Force on State Health Plan

1228/1327 LB
1:00 PM
NC Study Commission on Aging - Tyvola Senior Center - Charlotte

N/A1



Friday, April 9, 2010

NC News: Fitzsimon Discusses the Budget-NC Policy Watch

The troubling budget dance begins

Thursday, April 8th, 2010

By Chris Fitzsimon

The public debate about the state budget began this week with talk of ridiculous deadlines and more devastating cuts and most troubling of all both were met with what seemed like weary resignation by many lawmakers and much of the advocacy community.

House Appropriations Chair Mickey Michaux told budget writers that not only is there no money available to replace last year's cuts, but lawmakers will have to address a shortfall of as much $1.2 billion when putting next year's spending plan together. And even that may be optimistic and counts on several hundred million dollars in federal Medicaid money that's not here yet.

Senate Budget Chair Linda Garrou announced that Governor Beverly Perdue would present her budget recommendations to lawmakers April 20, which may not give her budget staff enough time to incorporate the analysis of the April 15 revenue figures into her proposal. That may be the point and allow her to avoid dealing with more bad news about revenue collections.

Even more absurd was Garrou's announcement that the Senate planned to pass its budget by May 20th, just eight days after the General Assembly session convenes. That leaves almost no time for public meetings when the legislature returns, though public input hasn't exactly been a priority in the Senate budget process in recent years.

Read more at NC Policy Watch.

Thursday, April 8, 2010

NCGA: State of the State Numbers From This Week

State of the State Numbers:

This week we again received three very important numbers that will be the driving force behind the budget process.

The first number relates to our state Medicaid program. We are currently looking at a $250 million dollar deficit in Medicaid. This gap is due to increased enrollment, delays in getting state plan amendments through CMS and pending or current lawsuits over the cuts made in last years budget.

The second number is the over all budget deficit for the upcoming fiscal year of 2011-2012. Our state is currently looking at between a $1 to 1.5 billion dollar deficit in the current budget.

And last but not least, all appropriation subcommittee chairs have been asked to cut 5% from their budgets.


NCGA: Update From This Weeks Appropriation Meetings

This weeks activities began at 10:00 on Tuesday morning with an appropriation subcommittee chair meeting. The subcommittee chairs were given very specific directions regarding how to proceed with this year’s legislative budget process. Here are the basics:

1. Review impact of agency cuts-these would be the cuts taken after the Governor asked for an additional 5% reduction.

2. Create a budget that includes a 5% reduction off of the fiscal 2011-2012 budget numbers that were passed by General Assembly.

3. Develop a list of actions to be taken including suggestions on consolidation of agencies. This is where expansions could be discussed.

4. Look at all programs that were subject to the continuation review process.

All appropriation budget subcommittee chairs will be receiving their budget target numbers later this week.

At the same time that this is happening Governor Bev Perdue is finalizing her budget, which will be released on April 20th.

The House and Senate will be working on a very tight time line to get their individual budgets completed.

Here is the Proposed Budget Calendar:

Senate to have an adopted budget my May 20th. (eight days after session)

House to have their adopted budget by June 10th.

Final Budget June 29th.

Gavel out on July 1.

 

 

Tuesday, April 6, 2010

Tuesday Quick HIts: Hot Policy Topics for This Week

Due to some technical issues the Monday Quick Hits did not post yesterday. No problem the real fun starts today in North Carolina.
First a quick rumor alert: The governor's budget may come out sometime this week. That will fit with the quick gear up of joint appropriation committee meetings at the General Assembly.

Now to the facts: Today the General Assembly will begin its April rounds of joint appropriation meetings. There will probably be no revenue package this year, which means we are looking at appropriation committees that will be looking at cuts. For those of us who advocate for people with developmental and intellectual disabilities and their families, cuts are not a good way to handle the current situation in North Carolina. We will be monitoring all the events in these meetings.

Here is the current schedule:
10:00 AM
Meeting of Joint Appropriations Subcommittee Chairs

544 LOB
10:30 AM
Joint Appropriations Education Subcommittee

421 LOB
11:00 AM

643 LOB
11:00 AM
Joint Select Committee on Global Engagement - Asheville-Buncombe Technical Comm. College

N/A
1:00 PM

544 LOB

Wed, April 7, 2010
9:00 AM
Joint Appropriations Justice & Public Safety Subcommittee

415 LOB
10:00 AM

544 LOB
10:00 AM
Finance Committee

643 LOB
11:00 AM
Subcommittee to Preserve the Culture and Customs of Indian Children

415 LOB
1:00 PM
Comprehensvie Rail Service Plan for NC, House Select Committee on a

1228/1327 LB
1:30 PM
Ex-Offender Reintergration Into Society, Joint Select Committee on

421 LOB
2:00 PM
Work and Family Balance, Joint Study Committee

1124/1224 LB
2:00 PM
Joint Appropriations Health and Human Services Subcommittee

643 LOB

Thu, April 8, 2010
10:00 AM

415 LOB
10:00 AM
House Select Committee on Civil Custody Guardians

421 LOB
2:00 PM
Alcoholic Beverage Control, Joint Study on

643 LOB

Thursday, April 1, 2010

NCGA: Upcoming Appropriation Subcommittee Meetings

Legislators will be heading back to work on the budget early this year. A series of appropriation subcommittee meetings were announced yesterday. As of the end of last quarter the state was still facing a serious deficit in revenue. Here is a replay of the numbers and the schedule for the upcoming meetings.

State of the Budget for North Carolina as of February 2010:

Medicaid: The hole in Medicaid has grown to between $250 and $260 million dollars. Part of the growth is due to the double-digit unemployment numbers in our state.

Revenue collection: State revenue collections are $45 million bellow the $12.1 billion target through February.

Income tax withholding: Currently the state is seeing income tax withholding down 4.1% through February. $145 million bellow target

Sales tax collections: Sales tax collections are down 11.0% and net collections are up 12.2% however the current budget expected a 15.9% increase. We are currently $125 million below target.

Budget Deficit for 2010: Governor Bev Perdue stated that her economic team forecasts a $1 billion dollar deficit for the coming budget year and a possible $3 billion dollar deficit for the 2011-2013 budget.

Rainy Day Fund: $150 million dollars. At the end of the 2009 session Governor Bev Perdue took an addition cut of 5%. That hold aside is being used to cover any deficit in the current operating budget. It will not be added to the $150 million dollar rainy day fund.

Appropriation Subcommittee Meetings:

Tuesday, April 6

Education: 10:30am 421 LOB

Wednesday, April 7

General Government: 1:00pm 1425LB

HHS: 2:00pm-5:00pm 643 LOB

Thursday, April 8

General Government: 9:00 AM 1425 LB

Monday, April 12

Education: 2:00pm 544 LOB

Tuesday, April 13

HHS: 8:30am (Room to be announced later)

General Government: 9:00 AM 1425 LB

Wednesday, April 14

General Government: 9:00 AM 1425 LB

Thursday, April 15

General Government: 9:00 AM 1425 LB