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Lawmakers Will Wrestle With Tough Medicaid, Mental Health Issues During Short Session

Part 2 of 2: As lawmakers prepare to reconvene for the ‘short’ session today, there has been plenty of activity on health care related issues, even this week. And there will be a raft of bills for them to consider in the coming months.

By Rose Hoban

This week, the General Assembly reconvenes for the ‘short’ session, the second legislative session of the biennium, held in order for lawmakers to make adjustments to the two-year budget created last year.

Leaders of the Republican majority have said repeatedly they want to truly make this year’s short session as short as possible. Many say they intend to recess by late June.

But state legislators usually do more than simply tweak the budget during the short session, and changes to laws governing aspects of the state’s health care system are on the docket.

Below is a list of health-related committees and sub-committees, and what initiatives they will be sending to the larger legislative body later this week.

Mental Health

As the state compels all of the mental health local management entities (LMEs) to convert to managed care organizations by next January, the governance of these organizations will need to change. At issue is how much control and input counties will have in the new agencies, what will be the role of representatives from the disability community on the new governing boards, and how much autonomy the new mental health agencies will have.

A subcommittee on LME governance, lead by Rep. Nelson Dollar (R-Cary), has been meeting for the past five months and will suggest a raft of changes, specifying the size and composition of boards of directors, whether LMEs can borrow money and own property, what to do if a county withdraws from an LME, and what to do if an LME fails.

Members of the Subcommittee on LME Governance take a break during a meeting in March

Members of the Subcommittee on LME Governance take a break during a meeting in March

One contentious issue has been that of how much right do LMEs have to create private information if they are funded by public dollars. During a meeting of the subcommittee Monday, the issue emerged again, and fueled the most heated debate of the meeting.

“I fail to understand, if this is a public entity,” said, Sen. Fletcher Hartsell (R-Concord) “The bottom line is that transparency is absolutely essential for the long term benefit both for providers and constituents, for  development of the delivery systems.”

However, during Tuesday’s DHHS oversight meeting, Dollar submitted the legislation unchanged, to be presented to the larger General Assembly. Hartsell pledged he would ‘revisit’ that part of the proposed bill.

Another committee has been been working changes to procedures and rules surrounding what happens when someone with a mental health problem or developmental disability who commits a crime. In the past, these people have often been caught in a revolving door between the mental health and criminal justice systems.

Often, folks charged with a crime cannot go to trial until they get their mental health issues stabilized enough for them understand, and participate in, the legal process. But once they leave a state psychiatric facility and are sent back to the prison system, they can slip through the cracks, be taken off medications, not be treated, and de-stabilize to an extent where they are unable to proceed to trial.

“There could be and should be an expedited process that eliminates the revolving door and provides justice for all,” said Rep. Shirley Randleman, (R- Wilkesboro), who lead the subcommittee.

The committee suggested changes to procedures and more resources for judges, forensic psychiatrists and others in the system who deal  that will allow for more coordination among all of the many parties involved in their care and incarceration.  Because all of the stakeholder committee members have signed onto the suggestions, legislators and other committee participants say they believe the bill will pass easily.

Medicaid funding

During last year’s session, the new Republican majority wrote $356 million of dollars worth of cuts to Medicaid into the  budget for this year. Overall, Medicaid will account for about $12.8 billion in spending during 2011-12, about $2.9 billion of that is paid for by North Carolina, the rest is covered by the federal government.

DHHS Secretary Al Delia (r) talks to Sen. Tommy Tucker after Tuesday's Oversight Committee Meeting (R-Waxhaw)

DHHS Secretary Al Delia (r) talks to Sen. Tommy Tucker after Tuesday's Oversight Committee Meeting (R-Waxhaw)

Cuts to Medicaid are never as simple as they seem. Since Medicaid is an entitlement program, the state must pay for services for certain categories of people, such as elderly, blind and disabled people, children from low income families and low-income pregnant women. Any cuts have to be approved by the federal Centers for Medicare and Medicaid Services, a process that takes time.

So a deficit quickly developed when the Department of Health and Human Services couldn’t get cuts into place quickly enough. That deficit was the subject of political football throughout the winter, where some Republicans alternatively reassured DHHS officials the deficit would be taken care of, while others stated publicly that would not be the case.

Over the past few months, the rhetoric has died down, but the deficit has slowly grown to total $150 million.

Some relief is in sight, as state tax revenues this year have exceeded projections by $232 million, and lawmakers had signaled they are willing to use some of that money to close the gap.

However, lawmakers were thrown a curveball during the DHHS oversight committee meeting Tuesday when officials from the Department made a presentation about an outstanding legal settlement being negotiated with the US Department of Justice (see related story).

According to DHHS general counsel Emery MIlliken, North Carolina stands to be on the hook to allocate millions, if not hundreds of millions, of dollars to create community services for people with mental health disabilities over the next few years, if the state chooses to settle with the US DOJ over their investigation of North Carolina’s mental health service system. If the state chooses not to settle, the DOJ has stated they will sue the state.

During Milliken’s presentation, Senate President Pro Tempore Phil Berger (R-Eden) asked her, “Given this General Assembly is not going to raise revenue, are plans being developed on where cuts will take place to fund the cost of this settlement?”

DHHS officials will be briefing lawmakers over details of the agreement on Wednesday afternoon during a closed door meeting.

WakeMed/ Rex Debate

In a much publicized move last year, Raleigh’s WakeMed Hospital made an unsolicited bid of more than $750 million to purchase the North Raleigh-based Rex Hospital from UNC Healthcare, which owns Rex.

Members of the House Select Committee on State Owned Assets took up the matter at the beginning of the year, holding hearings where the CEOs of each organization presented to the committee.

During the process, Rep. Tim Moffitt (R-Asheville), proposed legislation to change the governing board of UNC Healthcare, and revert the organization’s mission statement to one that existed before the General Assembly approved changes to UNC’s governance in 1998.

UNC Healthcare officials have gone on record as opposing the changes to their governance. Members of the senate have indicated the bill will not proceed in their chamber.

No other legislative action on UNC or Rex Hospitals has been recommended by the committee.

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  • Arcpointrockhill

    This is a good descriptive article that helps explain the issues being dealt with by lawmakers

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