News from the NC General Assembly
News from the NC General Assembly
Legislative Update
News from the NCGA
March 7, 2016
by Tony Adams, Adams and Associates Government Relations

Grassroots Advocacy

Beginning in January this year, NCALA has been arranging meetings with key members of the NC General Assembly at assisted living communities within their districts. In addition to the several visits that have already taken place, more forty additional visits are in the planning stages for the next few months. NCALA is focusing on legislators who serve on health, aging, and human services committees in both the NC House and Senate, and who can have a beneficial impact on potential legislation of importance to NCALA and its members. These legislator visits have been very successful in allowing the legislators to meet staff and residents of the local communities and to become better informed on issues of importance and concern to assisted living communities.

Of particular interest to NCALA members, Sen Tucker discussed the difficulty of serving Medicaid residents due to low reimbursement rates.

One of the completed visits was by Sen Tommy Tucker (R-Waxhaw), who visited Brookdale Union Park on February 26, 2016. Of particular interest to NCALA members, Sen Tucker stated to the Joint Legislative Oversight Committee on Medicaid, during the member comment period, that the staff had discussed with him the difficulty of serving Medicaid residents because of low reimbursement rates. Tucker expressed his concern about the lack of rate increases for the past several years for assisted living communities. Rep Hugh Blackwell agreed with Tucker on the need to look into the lack of rate increases for these types of communities. Rep Nelson Dollar, one of the committee chairs, stated that lack of provider rate increases, based on Tucker’s comments and others from earlier discussions, addressed critical issues, and he anticipated that the legislature will begin to address those issues soon.
The North Carolina plan for reforming Medicaid does not currently include information regarding assisted living; however, assisted living is included in the final Medicaid reform and will be paid at a capitated, per-resident cost. It is imperative for NCALA members to attend one or more of the twelve listening sessions across the state. These listening sessions are intended for legislators to hear from the public their concerns about the proposed plan, and will be completed within the next forty-five days. Please attend and ask questions, such as: “As current providers of Personal Care Services (PCS), what does Medicaid reform mean to us and to the PCS beneficiaries we serve, now and in the next four to five years?”
Listening sessions will be held in Asheville, Boone, Charlotte (2 sessions), Elizabeth City, Greensboro, Greenville, Lumberton, Raleigh, Sylva, Wilmington, and Winston-Salem. Comments can also be submitted to the Medicaid reform Web site (www.ncdhhs.gov/nc-medicaid-reform). A draft plan will be submitted to the federal Centers for Medicare and Medicaid Services, which must approve the plan by June 1, 2016.
Senior Living Guide

Medicaid Reform Update

Not quite six months after the state General Assembly passed a sweeping overhaul of the state’s Medicaid program, state officials presented a detailed outline of what that reform will look like once it’s implemented about three or four years from now. “This is really the end of the beginning; this is the first hurdle,” said Dee Jones, who was hired to lead the new Division of Health Benefits, which will run the new Medicaid program. “There’s a lot of work to be done.”
The plan, in the form of two reports totaling more than 100 pages, met the legislative deadline of March 1. Currently, North Carolina Medicaid—which serves about 1.9 million low-income children, some of their parents, pregnant woman, and low-income elderly—is operated on a fee-for-service basis, where the system’s approximately 80,000 providers bill for each service delivered.
DHHS Secretary, Rick Brajer, delivered an outline for Medicaid reform to the Joint Legislative Committee on Medicaid and NC Health Choice on Tuesday, March 1, thus meeting a tight legislative deadline. Legislators have mandated that Medicaid move to a so-called capitated system, where hospitals, clinics, doctors, and other providers will be paid a set, per-person, per-month payment in exchange for delivering all the care needed to those Medicaid beneficiaries.
Because the federal government pays more than two-thirds of North Carolina’s Medicaid expenses, federal regulators will exercise the final say over whether the state’s plan is acceptable. What DHHS officials presented to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice on Tuesday was the outline of that application to federal authorities.
The final application will be presented to the legislature on June 1, another deadline specified in the Medicaid reform law last year. The application for change that North Carolina will present to federal regulators—called an 1115 waiver—requires that the state come up with innovative ways to reduce cost while maintaining quality. DHHS officials said they had two other primary goals in creating the plan: to improve the experience for patients, and to keep providers happy.
“If we focus only on cost, we’ll miss some things that are very, very important for North Carolina,” said Warren Newton, a physician who has been hired by DHHS as an advisor in creating the federal application. Newton is also the head of the state’s Area Health Education Centers program. For example, he said, an adult Medicaid patient admitted to a North Carolina hospital has “about a one-in-five chance of being readmitted in 30 days. We can do better than that.” Newton told lawmakers that the new Medicaid system would compel doctors, hospitals, and other providers to change the way they operate. “It is working with them at their elbows to improve care, to change care moving forward,” he said. “And it’s also about creating the workforce that they will need in order to take care of patients in these new ways.”
Newton also talked about embedding mental health providers into clinics and physicians’ offices. “We can’t begin to bend the cost curve until we deal with behavioral health, until we attach the head to the body,” he said.
Newton said North Carolina has had success in creating innovative programs, such as enhanced pharmacy services and tele-psychiatry, along with the state’s patient-centered medical home network, known as Community Care of North Carolina.
“Ultimately, a 1115 demonstration waiver grants broad flexibility to use funds to research and test new ideas in program design and administration,” said DHHS Sec Rick Brajer, who asserted that other states will end up adopting some of the ideas generated by the 1115 waiver. Brajer told legislators that he and his team have met with dozens of stakeholder groups as they’ve worked on their plan. He later added that he’d met with organizations that will potentially bid for contracts to manage Medicaid patients’ care, including representatives from the state’s largest hospitals. “Interest is strong, people are highly engaged; therefore, I expect there to be a high degree of involvement and interest.”
Brajer presented a plan for dividing the state into six regions, where different management companies will operate. Each region would contain at least two major medical centers (except for Region 1) and approximately equal numbers of Medicaid beneficiaries. The regions also reflect existing Medicaid data on where patients in those counties already receive their care. Brajer told lawmakers that he has met with representatives from most of the large hospitals, which could develop provider-led entities to manage care for patients within those regions. He also said he’s met with representatives from commercial managed-care companies eager to do business in North Carolina.
DHHS officials’ proposal for dividing the state into Medicaid service regions involves asking legislators for a change to the law to allow twelve local provider-led entities, two for each region. North Carolina is the largest state that has not moved from a fee-for-service system to a capitated payment system—most states have some level of managed care in their Medicaid systems. Brajer said his department is planning public comment listening sessions in 12 regions of the state during the next 45 days. “There may be modifications to the waiver based on what we’ve heard, as well,’ said Brajer.
DHHS spokeswoman Kendra Gerlach said the department is still finalizing preparations and will announce dates and locations next week. Lawmakers lavishly praised Brajer and his team for delivering their draft plan within the tight deadlines they set in the Medicaid reform bill. They also praised Brajer’s team for the news that, thus far, Medicaid is running about $185 million below budget. “I do not want to minimize the good news here,” said Sen Tommy Tucker (R-Waxhaw), who has been vocal in his criticism of the department in the past. “I don’t want us to minimize the effort of these folks and the previous secretary in the reform of the department,” he said. “It has allowed us to look at $200 or $300 million in surplus. I got a warm-and-fuzzy feeling this morning,” Tucker said.
All About Seniors

Congressional Redistricting

Republican legislators’ recent proposed changes to North Carolina’s congressional boundaries dramatically reshape two districts a panel of federal judges found unconstitutional. But the proposed map also changes each of the state’s 13 congressional districts, some of them strikingly. Two House members would no longer live in the districts they represent, although by law that isn’t necessary. The 13th District, now anchored in the Triangle, would move across the state. And the 12th District would become the most compact.
But one thing would not change. According to voting statistics released for the proposed districts, three would strongly favor a Democrat, while the other 10 lean Republican. GOP lawmakers say they want to keep the existing 10-3 partisan split. The legislative committee charged with drawing new maps voted 24-11 along party lines recently in favor of the proposal. Democrats were opposed but did not submit an alternative map, saying they had wanted to see the Republicans’ version first.
The proposal then was brought before the full House and Senate for a rare special session called by Gov. Pat McCrory. The legislature also passed a bill that would delay the date of the congressional primary. A three-judge federal panel ruled Feb. 5 that the 1st and 12th districts were racial gerrymanders. Redistricting leaders said the new map was redrawn without consideration to race.
Though the judges’ ruling was about only two districts, the proposed map has the potential to shake up the US House primaries and the state’s congressional delegation. The 12th Congressional District would be entirely within Mecklenburg County, and no longer curl from Charlotte, up Interstate 85, to Greensboro. It’s represented by Rep Alma Adams of Greensboro; no current members of Congress live in the proposed new 12th.
The 1st Congressional District would no longer take in all or part of 24 counties. It would be more compact and include most of Durham County. The 13th District, which is represented by Republican George Holding of Raleigh, would shift across the state from its Triangle base and cover an area from Greensboro to Statesville. Areas in the current 13th District would be split among the 2nd District (represented by Republican Renee Ellmers), the 1st District (Democrat G.K. Butterfield) and the 3rd District (Republican Walter Jones).
The 4th District, represented by Democrat David Price, would become more compact, consisting of Orange County, southern Durham County and a chunk of Wake County centered on Raleigh. The current district stretches from Alamance County to Raleigh and Fayetteville.
Another major shift would affect the 9th District, represented by Republican Robert Pittenger. His district is a narrow strip from Union County through Charlotte north to Iredell County. Under the proposal, it would move east and stretch from Fayetteville to Charlotte along the South Carolina border. Many of the counties represented by Pittenger would move to the 8th District, represented by Republican Richard Hudson.
Incumbents could still seek re-election in the new districts because members of Congress are only required to live in the state they represent – not necessarily within the districts they serve. The NC Republican Party issued a statement saying the plan would make some GOP-leaning districts more competitive.
In past years, a large stack of statistics on the proposed districts, including the race and party registration of their voters, were distributed along with the maps. This time, only the total population, and whom voters in the districts favored in statewide races from 2008 through 2014, were included. With approval of the proposed new district maps by the Legislature, the federal court will still have to sign off on the proposal.
For more information about the North Carolina General Assembly, or to identify your legislators, please visit www.ncleg.net. For more information on these and other legislative issues, please contact NCALA.

ADAMS AND ASSOCIATES GOVERNMENT RELATIONS

1706 Rangecrest Road, Raleigh, NC 27612
(919) 841-0964    (919) 801-1837 Cell
ta@adamsgov-relations.com
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