• Each year on the NC Innovations Waiver participants will receive a letter explaining the specific amount of their Base Budget. Each NC Innovations individual also receives the NC Innovations Support Needs Matrix Guide.
• MCO selected provider options-Providers must be accepted into the MCOs network in order to provide services in that area. Provider Choice will be limited to the MCO selected network.
Bumps Along theWay
In July of 2010, the state released Implementation Update (IU) #76 and #80 with instructions to case managers to begin revisions, to ensure waiver participants meet the 129 hours of Habilitative service per month maximum policy by February 1, 2011. If individuals contested the 129 limit at the time, specific to health and safety issues, the Case Manager was to submit an exception form by December 1, 2010. Many plans were changed to meet the new standard, some families challenged the policy and submitted exceptions. On September 7, 2011 IU #90 was released, rescinding the entire process implemented back in July 2010. The update indicates “DMA is RESCINDING the requirement to request an exception because the 129 hour limit does not go into effect until November 1, 2011.”
It’s important to note that the new CAP-I/DD waiver was tentatively scheduled to begin on November 1, 2011. Many families were instructed to make changes to their PCP in order to become compliant with the 129 rule as of November 1, 2011. Case managers were advised to revise plans and submit revisions by the October 15 deadline for the November 1, 2011 implementation date. On October 25, 2011, case management agencies participated in a conference call with DMH and DMA. They were, at that time advised that an extension of the waiver had been granted until December 31, 2011 and that families could continue with the current services until the end of 2011. The swift change intended by the state had once again been halted and some families saved again from reductions/removal of supports by hiccups and faulty planning. Some individuals, exhausted from the constant changes, succumbed to the new limit reductions.
Rate Changes
On October 7, 2011 The Department of Health and Human Services, Division of Medical Assistance (DMA) provided notice effective November 1, 2011 that rates paid to North Carolina Medicaid service providers would be reduced by 2.67%. Rate reductions ranging from $.31 to $1.00 for CAP services and many other Medicaid services were approved.
When are all these Changes occurring?
Expect LMEs to transition from 23 separate entities controlling smaller centralized areas to 10 conglomerates monitoring and managing the services of larger populations. Some of these mergers have occurred and others expect implementation as early as January 2012.
• PBH & Alamance/Caswell - October 2011 • Western Highlands Network - January 2012 • PBH & Five Counties - January 2012 • PBH & OPC - April 2012 • PBH & CenterPoint - April 2012
• East Carolina Behavioral Health (ECBH) - April 2012
• SMC - July 2012 • Sandhills Center & Guilford - July 2012 • Mecklenburg - Unknown
• Southeastern Regional, Eastpointe, The Beacon Center, and CenterPoint - Unknown
• Southeastern Center, Onslow-Carteret - Unknown
• Pathways, Crossroads, and Mental Health Partners - January 2013
• Durham, Wake, Johnston, and Cumberland - Unknown
In a document dated October 27, 2011 entitled, Presentation to Joint Legislative Committee on Governmental Operations DHHS responded to questions from Legislative Fiscal Research.
Legislative Question 8 a: Is the waiver expansion plan presented to the Joint House and Senate HHS Appropriations Subcommittee in April 2011 on schedule?
DHHS RESPONSE: The expansion of the 1915(b)/(c) waiver program is running approximately three (3) months behind schedule.
Most of the changes individuals are experiencing are detrimental to their care, safety, and supports needed. The bottom line is that the state faces a Medicaid budget shortfall in excess of 100 million dollars and the focus does not seem to be on the needs of the people being served.
With an admitted three month delay of implementation, and many LMEs set to begin operation as MCOs in 2012, North Carolina continues to push forward with its Managed Care System. It’s very evident that we can expect there will be many more bumps and loops on this ride along the way.
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