Public Policy Update - September 2021
STATE UPDATE
Legislative/Budget
Following the approval of their separate budgets, a conference committee was appointed to work out differences between the House and Senate. The work has been slow and it may be the end of September or later before a state budget is passed. Once passed, the budget will go to the Governor for signature. Legislative leaders are working closely with the Governor’s office in order to avoid a possible veto of the budget.
The NC House version spends significantly more on some health and human services priority items, like increasing the wages of direct support staff, and also requires a plan for increasing Innovations slots and community-based services beyond the next two years. Below is a comparison of some of the items that relate to the Council’s priorities.
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Adds $40 million to a fund for public schools to use if enrollment of students with special needs exceeds anticipated enrollment. Note that the 12.75% cap on special education funding for school districts remains in place in the Senate’s budget bill and this additional enrollment funding still cannot exceed this cap. |
Adds $40 million to a fund for public schools to use if enrollment of students with special needs exceeds anticipated enrollment. Note that the 12.75% cap on special education funding for school districts remains in place in the Senate’s budget bill and this additional enrollment funding still cannot exceed this cap. |
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The House budget includes 7.7 million to increase the cap on the current funding formula for children with disabilities from 12.75% to 13%. |
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Requires a report to look at current ways of allocating money per student with disabilities and make recommendations about better ways to do this. Report due March 2022. |
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Change to the state’s process for special education due process appeals by ending the practice of appealing cases to a special education Review Officer and allowing for parents to file civil cases in state or federal court following the decision of an administrative law judge. Almost no appeals were won by families using the Review Officer process, and this change allows for a more impartial appeal process. |
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Provides funding to allow an additional 1,000 Innovations waiver slots - 800 new slots effective January 2022 and 200 slots effective by October 2022. |
Provides funding for 1,000 Innovations waiver slots - 420 in October 2021 and 580 in July 2022. |
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Provides funding to increase Medicaid reimbursement rates for the purpose of increasing direct care worker wages among HCBS providers. (This is a response to HB 914 Support Our Direct Care Workforce). |
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Provides funding for a wage increase for direct care workers employed by intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs). |
Provides ongoing funding after receipts in the amount of $17,500,000 in the second year for a wage increase for direct support personnel employed by Medicaid providers, effective July 1, 2022. |
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Uses the $274 million in savings from increased federal share of Medicaid funding to create a home and community-based services reserve (HCBS Reserve) to be used to fund expanded access to home and community based services. |
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Requires NC DHHS to plan for additional Innovations Waiver slots that could be added in the future. Report is due March 2022. |
Tailored Plans
As reported last month, the Department of Health and Human Services (DHHS) announced that all seven of the current LME/MCOs received the awards to become Behavioral Health/Intellectual and other Developmental Disabilities (BH/IDD) Tailored Plans beginning on July 1, 2022. This will shift to six Tailored Plans assuming the merger between Cardinal Innovations and Vaya Health progresses as well as the other county disengagements that are underway.
Below are the counties included in each LME/MCO. The highlighted counties are those who left Cardinal and other LME/MCOs.
Alliance Health: Cumberland, Durham, Johnston, Orange, Mecklenburg and Wake.
Eastpointe: Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne and Wilson.
Partners Health Management: Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union and Yadkin.
Sandhills Center: Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond and Rockingham.
Trillium Health Resources: Bladen, Brunswick, Carteret, Columbus, Nash, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell and Washington.
Vaya Health: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Swain, Transylvania, Vance, Watauga, Wilkes and Yancey.
Pending: Chatham, Halifax, Stokes and Warren.
In this interim one-year period, Medicaid beneficiaries who are eligible for a Tailored Plan will receive physical health services through Medicaid Direct and BH/IDD services through the LME/MCOs.
As a part of the responses to the Request for Application (RFA), each LME/MCO provided the name of a Standard Plan (PHP) with which they intend to partner to provide integrated physical, BH, IDD, SUD care. The following were listed in the RFAs:
- Alliance – Wellcare
- Cardinal Innovations – HealthyBlue**(they have announced intent to merge with Vaya)
- Eastpointe – Wellcare
- Partners – Carolina Complete Health
- Sandhills – AmeriHealth Caritas
- Trillium – Carolina Complete Health
- Vaya – Wellcare
There is still work to be done before these LME/MCOs will officially become Tailored Plans on July 1, 2022. NC DHHS has a Readiness Review process that requires the LME/MCOs to meet certain requirements before they can begin work on July 1, 2022.
Advanced Medical Home Plus (AMH+) practices and Care Management Agencies (CMAs)
A critical part of Medicaid transformation are Advanced Medical Home Plus (AMH+) practices/Care Management Agencies(CMAs) which will provide coordination and support for people enrolled in the Tailored Plans. The Department has conducted desk reviews of round one Advanced Medical Home Plus (AMH+) practices/Care Management Agencies (CMAs) provider applications and advanced 54 providers to the site review stage.
The certification candidates advancing on to the site review phase are:
- A Small Miracle
- Alexander Youth Network
- Appalachian Community Services
- Autism Society of NC
- B&D Integrated Health Services
- Carolina Outreach
- Catawba Valley Behavioral
- Children’s Hope Alliance
- Coastal Horizons Center
- Coastal Southeastern United Care
- Community Alternatives, Inc (Community Choices)
- Community Partnerships
- ComServ
- Crossnore School and Children's Home
- Cumberland County CommuniCare
- Daymark Recovery Services
- Developmental Disabilities Resources
- Dixon Social Interactive Services
- Dream Provider Care Services
- EasterSeals UCP
- ECU Physicians
- Elite Home Health Care
- Families First
- Freedom House Recovery Center
- Genesis Project
- Genesis Project 1
- Greater Vision Counseling and Consulting
- Groundwater Solutions
- HomeCare Management Corp
- InReachNC
- Integrated Family Services
- Johnston County Industries
- LeChris
- Life, Inc
- Lindley Habilitation Services
- Monarch
- Phoenix Counseling Center
- Pinnacle Family Services
- PORT Human Services
- PQA Healthcare
- Primary Health Choice
- RHA
- Skill Creations, Inc.
- Southlight
- SPARC Services & Programs
- Stephens Outreach Center
- Sunrise Clinical Associates
- Support, Inc
- The ARC of NC
- The Cherokee Indian Hospital Authority
- Triangle Comprehensive Health Services
- UNC Center for Excellence
- VOCA Corp of NC Community Alternatives NC
- VOICE Therapeutic Solutions
The 7500
DHHS continues to share information for the 7500 Medicaid beneficiaries who are eligible for the Tailored Plan, but chose the Standard Plan. As of June 30th, 7,500 Tailored Plan eligible individuals had chosen a Standard Plan. This would prohibit them from receiving services that are only available through the LME/MCOs and Tailored Plans. These individuals have received written materials and access to an Enrollment Broker so they can make an informed choice about their plan.