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House | March 18, 2015 | Chamber | Health Meeting

Full MP3 Audio File

Trying to get this committee meeting going, thank you. We thank you for being here, I want to make you aware that we do have our Sergeant at Arms who are here with us, we appreciate that young bay, Bill Morris and Jim Moran. I looked around I did not see any pages and I don't understand that because this is a very exciting committee meeting and they certainly can learn a lot so they must be busy in other areas but we don't have any pages with us and we see if they will join us in the future. We only have one bill in front of this committee, house bill 119 and I will call on the bill sponsors to come Marvine briefly present to us this bill thank you Mr. Chairman, good morning members ladies and gentlemen this bill is ressolve PED program evaluation oversights study that was done in 2013, 2014 the 2013 budget bill required PED to review impacient alcohol and drug abuse treatment programs across our state. This bill will was approved or the study was approved by joint legislator program evaluation oversight committee and they conducted it obviously at Ohio till we have a bill PD found that there were two primary problems. This bill addresses the two primary problems, first the state run alcohol and drug abuse a treatment centers commonly known as AIDAX operate autonomously from the community based system. The separation limits North Carolina's ability to address service gaps. To know where they are and to provide addresses providing a seamless continual mob care and manage the high cost of inpatient substance abuse treatment. Also North Carolina's Performance Management System for substance abuse treatment has long running already, lacks long term outcome data. PD therefore made two recommendations. First because of the autonomus corporation of AIDAX where at the coordination challenges exist, coordination challenges and they ensydavised over utilization of AIDAX in North Carolina. North Carolina should gradually integrate the AIDAX into a North Carolina community base substance abuse, treatment systems that require LME's, MCO to pay for and manage induculation and second the division of Mill Hill Development Disabilities and Substance Abuse Services should strengthen its performance management system by improving data collection and tracking long term out comes. We were just talking some few minutes ago I was just talking with Robertson all about the lack of good data and knowledge of how OLIS coming together and the need for that. This bill does not emphasis would not reduce dollars spent on treatment, but instead allows the LME and MCOs to allocate the substance abuse treatment dollar to where they are most needed, so for few more details on the bill and by the way as you may know we presently have three AuDAX across North Carolina. We have I believe it's nine LME-MCOs operating these services. By consolidating these we'll get a better handle on what the challenges are as well as the opportunities and add some efficiency is in the system so that we can better utilize every available dollar and every available bed and in those cases where we need more of this [xx] or the other, we can identify that clearly and it takes appropriate action to that, Mr. Chairman I would like to ask some of the staff to kind if give us an overview of the Bill. OK, thank you Representative Horn and we will ask staff to give us that overview Representative Dollar. Well I'd be happy to provide a favorable motion is Seniors are ready forward I mentioned to the bill sponsor and to another

member I had a question about a section but I got that question answered sir. OK why don't we go make that motion and we'll come and let's as if is in public comment. I'd made for favorable report for House Bill 119 with referral to the community on appropriations. Representative Martin. Thank you Mr. Chair just a quick question, has there been feedback from these organizations and from the LMCOs like what kind of response have you got, and can you just share that. In the in the report itself that's produced by PED, copy which I thought I had right here in my pocket but you'll see in the report as you may know a PED, they always send their reports and recommendations to the affected agencies and then include their response [xx] in the report, and as I read the response, this is the report which is available both online or hardcopy down as PED and you'll go right to the back page, there's a response from North Carolina department of health and human services, division of State-operated, healthcare facilities dated November 12, signed by its Delon Armstrong[sp?] the Division Director. As I read that and I read it three times, I discern no real pushback and that they appreciated the results of the report, so I've not been approached or heard of any pushback on the Bill or its recommendations. Thank you, Representative Hone[sp?] brief presentation by staff, he's going to present that Okay. I'll be happy to do that Mr. Chair. You'll notice I'm going to really quickly go through the Bill and if there are any questions for more information, I'm happy to provide that. You'll notice the Bill is organised into eight different parts, the first part first is definition section, and then for many of us to work in the interested area, we have a lot of radiation to keep up with, that's what part one of the bill is. Part two of the bill establishes that the intend is to integrate the into the LMCO system of a three year period beginning July 1st, 2016, with full integration June 30th 2019, part two contain, is a reporting requirement for a [XX] to the Joint Legislative Oversight Committee on Health and Human Services with regard to the three on transition business plan, you can see the reports due by April 1st 2015, and it contains symbolic points if you want to look at the summary projected demand, project availability, procedures for making operational adjustments, methodology for establishing and updating rates and a uniform process for the LMENCOs to get prior authorization, those are some the things that need to be in the three year transition business plans, that's reported April first. Part three provides background information and requirements regarding termination and reallocation of direct state appropriation. It requires the LME MCO an opportunity to plan for the efficient and effective management of reallocated funds and has several different reporting dates you'll see on the second page of the bill summary, just to make sure that the general assembly is aware of how things are moving along, and that the LME/MCOs know what their funding is going to look like and complain accrodingly. Part four provides for the LMENCO payment and utilization management for Aid Act services. Again you'll see reporting more requirements in their pulp valve adjustmet of the aider cooperations, it provides it in turn for the aider to be wholly receit supported by the end of the transition period, and either must annually evaluate and adjust to operations based on projected demand for services and availability from funding from the direct state of carryotions and estimated receipt. Part six provides oversight reporting that during organization plan, the division of middle health development disability to resurface must monitor, and it provides the list of things including expenditures EMCO make sure it meets maintenace of other requirements, efforts by the EMCO to increase capaicty for substance abuse treatments and develop a community community based services and utilization of element EMCO of substance abuse services provided by The

Aid Act, October 1st 2016 and annually they are after DHHS who must report to the oversight committee on health and human services through October 1st and finally part seven is the second issue that representative Ford mentioned that has to do with the performance management and the strengthening of performance management, provides that by January 15, 2016, division of middle health consolations with LME-MCOs must develop, and submit to the oversight committee, a plan to strengthen and performance management for the state, public funded substance abuse services, and it outlines, five things that the plan must include. And the bill will become effective when it becomes law be happy to answer any further questions. Thank you Mrs. Matula[sp?]. I believe we do have, maybe one or two from the public who would like to speak, and if you would like to speak you will come forward to the microphone make sure you push the button, and you have three minutes, give you the opportunity make some comments. You can identify yourself as well. Thank Mr. Cahirman. My name is Mark ezer[sp?]. I represent the addiction professionals of North Carolina our organization represents the interests of over 6000 addiction professionals including those in treatment, those dealing with prevention issues research around alcohol and substitute  of use issues. Our organization is not opposed to this bill. We are especially pleased with the provisions around addition data collection, we believe that that is very important. However, we do believe and I think many of you all have brought up additional concern, about the pace of this and other questions that may need to be answered before the full process of changing has been done. In the report you'll note that there are a number of different questions around the community capacity to provide the continue warm of care that may be available in some LMEs but not as available in others. I think that's an area that clearly we need to address, this particular bill does not necessarily as Representative [XX] said does not necessarily pull the rag out from the aid acts but it does potentially create some problems for those who now have a specially dual diagnosis of substance abuse issues along with mental health issues. We simply need to make sure that are LMEs and MCOs have the capacity, to deal with those particular types of clients, and frankly I think that a lot those LMEs and MCOs they do have that capacity, but that might not be as well spread as we would like. In addition to that, we need to make sure that providers are aware of this particular change, and again we are not opposed to this bill, we will say, I think it is very important as the report noted that the folks who are served in the [xx], generally tend to be those with the most significant problems, those with no insurance, those with no other place to go and we simply need to make sure that there are provisions available. Closer is better and if so those community capacities are there, we should use them. If not, the [xx] is an important safety net Thank you. Thank you Mr [xx]. Other comments to the public. Yes, good morning, My name is Roblin May I represent along with my colleague Ashley Perkinson, trying all residential options for substance abuse of TROSA. Which is a licensed residential therapy to community in terms that serve the entire state. We also have no complains with the bill, we apply the effort to build community based capacity. We are part of the solution we provide that community based capacity for all North Carolina counties currently for with two year 24/7 long term residential and vocational training and we provided those services since the early 90s. 80% of the revenue that TROSA grades is generated by the vocational programs, the businesses that it operates with assistance of it's residents less than or about 3% of trousers $14 million annual budget is provided by the state, non of that funding which is about $350, 000 it comes through the LMEs it's a direct appropriation a direct pass through. We are at the limit basically of our capacity to provide

this community based services again through all of and North Carolina counties as well as the court systems and the present systems, so that, I guess the message I want to leave with you, we'd like to continue the conversation with representative Foren and representative Barbara and all of you about moving when you move the resources out of the facilities and into the community, we would like to be part of the conversation about that capacity but currently if you move those resources out of the facilities and into the LME's, we the licence therapeutic communities in the state do not receive any support from the LME's. So you would be cutting, we would continue to be isolated from that funding support, while we were providing exactly the kind of services that you are trying to build with this legislation. So we want to continue the conversation about how those licence therapeutic communities, can be included in the effort to build more capacity. Thank you very much. Thank You. Anyone else? Understand Mr Armstrong's here, if he would like to say anything. Thank you for being here. It it working? Thank you chairman, Lambeth division director, state operated health care facilities. Just a couple of points for clarification that I'd like to make. One is that we do and have a round record as not opposing this plan to move forward that's been presented by PED. We think it could make sense. We look forward to working with the general assembly and other stakeholders in moving along this path. We do have some significant concerns regarding the implementation plan that is associated with the PDE recommendation. We feel that the proposed implementation plan is not a plan that will enable us or the communities to have a smooth transition of these services over the forum your period, also I want to make a note that the 196 beds that the ADACTs represent are a significant, vital resource in our continuum of care as a General Assembly is aware back in the mid 2000s we reduce a significant number of inpatient beds in our state hospitals. During that period of time I was recognized that the ADEX could help absorb some of that capacity which in fact they have done and they continue to do. So we just feel that we need to be very cognizant of the fact of the roles that the ADEX plays, we move forward in the transition and not end up in a situation where our capacity has been limited by inadvertently negatively impacting the beds in the ADEX and result in a significant increase, in the number of out-patients that are backlogged in our community Eds, thank you Mr. Chairman. Thank you Mr. Amstrong and thank you for the work you do. Yes mum thank you Mr. Chairman, I'm Lisa Weng Wright, I'm the executive director of this Carolina behavior of health, and we all one of the nine LME-MCOs across the state. I would just like to say in response to representative Martin's query, the LME-MCOs are also in favor of this transition general assembly has entrusted us with public management with the behavior of health and intellectual development of disability services, and we think that having is that continue north care under that management structure, makes a lot of sense and will enable us to make ensure that people move from the higher level of service at the Alcohol and Drug Abuse Treatment Centers into an appropriate community after care service much more seamless and efficient manner and so we appreciate that opportunity thank you. Thank you, thank you for what you do as well OK we have heard a motion of favor report with the [xx] before the foral appropriations all those in favor say I? I  Any opposed. Meeting is adjourned thank you very much represent.