Transcript Document

Welcome Committee
Members
OCTOBER 18, 2013
Legislative
Update
REBECCA TROUTMAN
INTERGOVERNMENTAL RELATIONS DIRECTOR, NCACC
Topics to be covered….
• State budget with focus on HHS issues
impacting county HHS
• NCACC HHS Goal Status
• Legislation impacting HHS
• Interim Activities
• Federal Shutdown
3
NC State Budget
Impacts on Counties &
Communities
4
S402 State Budget
• Spending at $20.6 billion
– Revenue growth still below recovery
• Modest revenue growth of 3.6% v. 5% historic
• Retail sales at 3.8%--reduced to 2.7% April
– Largely reflects Senate priorities
• Tax reform largely reflects House
– No salary increases
• Fully funds health & retirement cost increases
• 5 additional vacation days
5
Key County Budget Issues
• Lottery Funding
– Statutory language guaranteeing 40% of lottery funds to counties
eliminated
– Approp. allocation maintained at $100 M
• Unfunded mandates
– Counties paying for volunteer fire & EMS workers’ comp. costs
proposal eliminated
• Article 44 Hold Harmless payments
– Extends for 1 yr at 50%
• $4 M Federal HAVA Funds
– State MOE in yr 2
6
NCACC HHS Goals
• HHS-1: Ensure adequate mental health funding
– State budget increases local psych bed funding & creates telepsychiatry program for
IVCs
– Funds initial DoJ transition housing & group home pcs
– Did not restore $20 million in state community services
• HHS-2: Retain county management of nonemergency Medicaid
transport
– Sec. Wos issued letter to General Assembly leadership noting intent to continue
county service provision
• HHS-3: Preserve federal block grants and state aid to counties for
county-administered programs and oppose unfunded workload
mandates.
– State budget largely preserved fed. block grants to counties.
7
NCACC HHS Goals
• HHS-4: Restore local autonomy to LME/MCO governance structure.
– S208 creates county commissioner advisory committee
– H638 introduced to provide at least 1 seat per county unsuccessful
• HHS-5: Oppose weakening of smoke-free restaurant and bars law.
– H74 (Regulatory Reform Act of 2013) mandates clarification of enclosed areas.
• HHS-6: Increase Nursing Home Community Advisory Committee
membership flexibility.
– No legislation was introduced; state agency agreed to increase notice and advertising
for volunteers.
8
NCACC HHS Goals
• HHS-7: Increase childcare subsidies to reduce waiting lists and support
funding for Smart Start and NC Pre-K
– State budget increases Pre-K slots by 2,500 but uses lottery funds to offset additional
costs and maintains childcare subsidies at 2013 levels.
• HHS-8: Increase Medicaid rates to cover costs.
– State budget restructured some provider fees schedule to manage a $484 million
Medicaid deficit.
• HHS-9: Support an increase in food and lodging inspection fees to cover
costs.
– State budget increases fees from $75 to $120, with counties receiving an additional $20
per inspection.
• HHS-10: Restore state funding of public health accreditation.
– No legislation was introduced.
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Human Services
• Rebases Medicaid funding by $484 M
– 2013 & 2014 cost overruns consume surplus
– Directs DHHS to develop Medicaid reform plan
• Maintains county daycare admin at 4%
– Allows 2% for fraud prevention
• Temporarily & partially restores child welfare
federal funding loss of $4.8M
• Creates adoption promotion & permanency
innovation programs
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Human Services
• Cuts funding for children’s developmental services
agencies—may result in 4 closings
• Increases autopsy fees to $1250
• Reduces ADATC funding
• Directs DHHS to create non-profit grant program for
activities regularly funded w/ fed. block grants
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HHS Budget Provisions
TIERED STATE-COUNTY SPECIAL ASSISTANCE
PILOT SECTION 12D.2.(a)
• DHHS Aging and Adult Services to establish pilot program to implement a
tiered rate structure within SA for individuals residing in group homes,
in-home living arrangements, and assisted living residences
• Purposes to (i) determine the best way to implement a block grant for
this program statewide and (ii) test the feasibility and effectiveness of
implementing a tiered rate structure to address intensity of need,
• Department to select 4-6 counties to participate, at least 2 rural counties
and at least 2 urban counties.
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HHS Budget Provisions
DETAILED MEDICAID REFORM PROPOSAL TO BE
PREPARED BY DHHS; MEDICAID REFORM ADVISORY
GROUP ESTABLISHED; SECTION 12H.1
DHHS in consultation with Medicaid Reform Advisory Group to create
detailed plan for, but not implement, significant reforms to State's Medicaid
Program to accomplish the following:
(1) Create a predictable and sustainable Medicaid program
(2) Increase administrative ease and efficiency for Medicaid providers
(3) Provide care for the whole person by uniting physical and behavioral
health care.
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Legislation of Interest to County
HHS Agencies
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Court Fees, H343
• Original version to require advancing of court
fees
• Muddled with lapsing special provision & clerks
of court not billing for fees
• Bill sponsor to extend child support exemption in
perpetuity ($3 mil+ savings)
• Counties have 45 days to pay others
• Signed June 30
• Continues RoD fees as is, too
15
Warrant Check/Drug Test,H392
• DSS to verify applicant/re-applicant is fleeing felon or
probation/parole violator for Food Stamps or TANF or illegal
drug user for TANF
– DSS has current access to state criminal history
– DoJ to provide fed. criminal history to DSS
• Fingerprints & $38 fee—feds. won’t allow for use
– DSS to notify potential applicant
• DHHS to administer drug test to TANF if suspected drug user
– Client to pay & reimbursed if negative
– Suspicion spelled out
16
Financial Exploitation of Older Adults,
S140
• Amends offense for financial exploitation to expand scope of law
– Defines “older” adult at age 65 (was 60) but eliminates other qualifications
– Adds “unlawful for a person to knowingly, by deception or intimidation”
– Removes requirement that violator “knows or reasonably should know that
…victim…lacks the capacity to consent”
• Clarifies DSS ability to issue subpoena to financial inst. for records
access
• Adds DSS duties to receive & evaluate financial reports
• Creates new 108A section on financial exploitation
17
Foster Care Children's Bill of Rights,
H510
• Establishes statutorily requirements for foster
children’s rights
– Safe housing, first priority with siblings,
communicate with social worker, stay in same
school, participation in transition plan
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County Inmate Medical Cost
Containment,S321
• Provide parity with state prison medical cost
containment initiatives
– Payments to providers limited to 70% of prevailing
charges or twice Medicaid rate
– Enables counties to pay Medicaid rates for in-patient
medical care
• Counties to fund non-federal share of cost
– NCACC to organize county Medicaid claims/payments
During the Interim
• Studies!
– Medicaid reform
– Procedures for reporting child abuse
– Effectiveness improvements to ADACs
– Health insurance purchase for HHS clients
– Effectiveness of CCNC by State Auditor
• Interim committees
– LOC HHS grills DHHS in marathon meeting
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GA PED Studies
Local Child Support Enforcement Programs.
Project Scope: This project will review operational effectiveness and efficiency
efforts by county child support enforcement offices. Will examine metrics and
analyze trends over time with regards to paternity establishment, collection
rates, cases under order, payments to arrears, as well as cost effectiveness
performance measures, identifying initiatives that can overcome barriers.
Evaluate methods used by the State to financially and administratively
monitor local offices to improve effectiveness and efficiency of child support
services.
. Project Lead: Jim Horne
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Federal Shutdown
What we knew…
• Fed. funding streams significantly support county programs
What we learned…..
• No consistent communication channel
• Uncertainty with regards to fed. reimbursement policy
What we did…
• Engaged early on NC-DHHS, state budget office & NACo
• Researched grant by grant impacts & fed. reimbursement likelihood
• Created web presence to document findings & state & fed. communication
• Hosted conference call with managers, finance officers, state HHS partners
What we’ll do…
• Convene state/county meeting for lessons learned
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Questions / Comments
Thank You!
Status of Mental Health
in North Carolina
JIM JARRARD
DEPUTY DIRECTOR, DMH/SS/SAS
LEZA WAINWRIGHT
EXECUTIVE DIRECTOR, ECBH
NC FAST Update
ANTHONY VELLUCCI
DIRECTOR, NC FAST
WAYNE BLACK
DIRECTOR, NC DSS
Networking Lunch
ENJOY!
NCACC Presidential Initiative:
Economic Development
Opportunities
JASON KING
ASSOCIATE DIRECTOR OF EDUCATION, NCACC
NCACC President
Ray Jeffers
Person County
Named Economic Development
as a Presidential Initiative
Economic Development
Task Force Chair
Larry Phillips
Surry County
Economic Development Task Force Mission
Statement
The Economic Development Task Force aims to ensure the important
role of county governments in economic development is maintained and
enhanced as the State of North Carolina revises its economic
development strategy. The Task Force will partner with the NC
Department of Commerce and other stakeholders to identify
opportunities for economic growth, the tools needed to grow North
Carolina's local economies, and strategies to achieve sustainable
growth for all counties.
Proposed Membership
(9 designated + 7 commissioner volunteers)
• Commissioner Larry Phillips, Chairman
• Commissioner Johnnie Ray Farmer, Hertford (Chair, Health & Human Services Steering
Committee)
• Commissioner Member of State ED Advisory Board if one is appointed
• County Manager
• County Manager
• President, NC Economic Developers Association
• County Economic Developer
• County Economic Developer
Committee Resource Person: Dr. Pat Mitchell, NCDOC
Economic Development Task Force’s Action
Plan
• Meet with the NC Secretary of Commerce to discuss the
state’s current initiatives, strategies, and organizational
structure
• Meet with the NC Economic Developers Association and The
Center for International Understanding to explore options for
enhancing county involvement
• Conduct a “listening tour” across North Carolina
How Can the Health & Human
Services Steering Committee Help?
• What do you see are the biggest areas for
improvement in economic development in the
state?
• What opportunities are available in Health &
Human Services to help with this initiative?
Steering Committee Work
Plan & Meeting Schedule
COMMISSIONER JOHNNIE RAY FARMER, CHAIR
Adjourn
THANK YOU FOR ALL YOU DO!