NCACDSS – NC Association of County Departments of Social ...



Adult Services Committee

July 10, 2019

Committee Members: Angela Ellis, John Carrol, Clint Lewis, Felissa Ferrell

In attendance: Melanie Corpew-Carteret, Karen Harrington-Catawba, Toni Welch-Randolph, Becky Wise-Harnett, Edwin Bass-Harnett, Lindsey Shewmaker-Orange, Trish Baker-Alexander, April Snead-Scotland, Velvet Nixon-Robeson, Christine Dowdell-Chowan, Tammy Chaney-Hoke, Renae Alston-Warren, Terri Weddle-Surry, Kristy Preston-Surry, Lisa Jackson-DMH/DD/SAS, Kim Bailey-Onslow, Jenise Horton-Guilford, Preston Craddock-Greene, Ashley Dawson-Wayne, Dora Ann Carter-Halifax, Lara Gurganus-NC DAAS, Denyse Leake-NC DAAS, Sarah M. Smith-NC DAAS, Trina Ebron-Edgecombe, Susan Thigpen-Duplin, Chuck Lycett-Dare, Brenda Daniels-Edgecombe, Adrian Daye-Alamance, Rich Ohmer-Brunswick, Angie Phllips-NC DAAS, Karey Perez-NC DAAS, Yvette Smith-Iredell, Sharon McLeod-Cumberland, Crystal Black-Cumberland, Angela Ellis-Greene, John Carrol-Rutherford, Angela Karchmer-Gaston, Kim Harrell-Yadkin, Laurie Potter-Hyde, Felissa Ferrell-Rockingham.

On the phone: Tony Carpenter – Lincoln, Lori Hall – Rutherford, Cim Brailer – Chatham, Annie Murrell – Duplin, Beverly Heine – Brunswick, Cheryl Millimore – Guilford, Carolyn Perry – Pasquotank, Daina Frederick – Rowan, Joni Perry – Cumberland, Makkitra McKoy – Cumberland, Kathi Graham – APR, Linda Brumsey-Moore – APR, Diane Franklin – Haywood, Susie Branch – Surry, Rebecca Neil – Bertie, Dean Bethea – Lincoln, Tom Ensley – Cleveland, Brenda Yeatman – APR, Renee Dutcher – Mecklenburg, Marlana Riley – Yadkin, Michael Coone – Gaston, Crista Ramroop – Davie, Cathy Murray – Rockinigham, Carye Dickerson – Rockingham, Joann Windley – APR, Angie Brinkley – Johnston, Chiquita Gooding-Register – New Hanover, Diane Hayden – Guilford, April Black – Moore, Cynthia Ross – Pitt, Priscilla Delano – Pitt, Sarah Hill-Nash.

1. Welcome

2. Approval June 12, 2019 Minutes Wes Stuart, Edwin Bass- Harnett County

3. Disability Rights Determination Presentation- Ms. Shiwanda Leonard, Professional Relations Officer.

a. DDS: The State Agency that Determines Disability

← Definition of Disability:

← The inability to engage in any substantial gainful activity as a result of any medically determinable physical or mental impairment(s);

← Which has lasted or can be expected to last for a continuous period of not less than 12 months

← Or result in death

b. Difference between Adult versus Child determination was discussed

c. Substantial Gainful Activity

d. Applying for Disability

i. In person at one of the 37 SSA offices in NC

ii. Internet

iii. Schedule a phone interview

e. Basic information then any medical records information, medication, etc. Try to have the information up front

f. Fast Track

i. Quick Disability Determinations-required to make a determination within 20 days; medical evidence is readily available

ii. CAL-Compassionate Allowances: a way of quickly identifying diseases and other medical conditions that invariably qualify under the Listing of Impairments based on minimal objective medical information. Diseases or issues such as ALS, Inflammatory Breast Cancer, etc.

g. SSA-Determines if the basic administrative allowances have been met.

i. Title II-insured status SSDI. Based on work history, have worked at least 40 quarters.

ii. Title XVI-income and resources (SSI)

iii. From a medical standpoint, these programs are treated identically.

h. DDS Role in making those determinations-SSA verifies the non-medical requirements-age, employment, social security coverage

i. There is one DDS for the entire State, located in Raleigh

j. DDS will contact MDs, Psychologists, etc. to gain access to information; then make a determination of the impairment impact

k. Agency Statistics

i. Has about 776 employees; includes about 50 MDs, psychologists and SLP. They are the 7th largest of 52 DDS nationwide. They had 131,930 cases closed in FY 2018 and they received 36,305 Medicaid cases received in FY 2018. They currently receive about 2700 federal cases a week.

l. What information is needed?

i. Impairment

ii. History of the condition

iii. How it limits functioning or activities

iv. Treatment and responses to treatment

v. Medical testing results, like labs, x-rays, testing, etc.

m. How to send Records

i. Fax: 1-866-885-3235

ii. Web

n. Remember, this is an administrative decision for disability

o. Consultative Examination-this is a contracted service; in FY 2018- scheduled 1600 per week.

p. They use a 5 step process for determination

i. Is the person engaging in SGA

ii. Is the person’s impairment severe

iii. Does the person impairments meet or equal a listing

iv. Does the person impairment preclude the ability to perform their past work

v. Does the person impairment prevent them from performing another type of work?

vi. RFC-Residual Functional condition

q. Website of the listing of Impairments:

r. Case Exercises: similar situations; with different impacts from the impairments can result in different determinations-one will qualify for Disability, one will qualify for some type of substantial gainful activity.

s. EOD-established onset date-the date DDS determines an impairment meets the definition of disability and the claimant is no longer working. Title XVI starts from the EOD.

t. Type II- EOD-5 month waiting period; if claimant passes away during this period, they are not eligible for any cash benefits

u. Medicaid versus Medicare

i. Medicaid at DSS

ii. Medicare-SSA-2 years after claim is found

u. Four levels of appeals:

• Reconsideration-must appeal within 60 days.

• ALJ-review by ODAR

• Appeals Council

• Federal Court Review

v. Average Monthly Payment

w. Questions:

i. Can someone still work who has been declared disabled- yes, cannot have earnings over a certain amount

ii. How does DDS relate to SSA; DDS uses the SSA rules to make determination

iii. How long does it take to get a determination without fast track? Depends on the information we have to review, doctor visits, etc. Medicaid-we try to get them completed by 70 days.

4. DHSR-Tameka Riggsbee-County of Liaison-DHSR

a. Initial Licensure Process, Survey Types and Licensure Action

b. Process- 6 month initial license-131D-2.5 License & registration fees. Full license issued upon survey recommendation-131D-2.4 Licensure of adult care homes for aged and disabled. Change of ownership occurs when they want to leave the business-they will review the history. If there is an outstanding issues, they will not approve the change.

c. Certificate of need- a new Adult Care Home facility and new construction-you have to ask for those beds for your county-and it can be denied if there are plenty of homes. 131D-4.6 Licensure of Special Care Units-there is a moratorium-it has to be approved through Certificate Of Need and the request is approved by the Secretary; must show need.

d. Observations, Interviews, and Record Reviews: 131D-2.11 Inspections, monitoring, and review by State Agency and county departments of social services

e. Survey Types

i. Annual/Biennial Survey-Look at care of the residents, quality assurance and qualifications for the staff. Must be surveyed at least every two years.

ii. Follow-Up survey-have those areas of non-compliance been ratified or corrected?

iii. Complaint Investigations- Adult home Specialist (AHS) and the state will be surveying under the rule area of that specific complaint. Sometimes it is a dual role with APS. The public can request state involvement; but most are completed by AHS. What we need from the county: if we have a number of complaints coming in-please contact the team supervisor at ACLS-so we assist in the process; they will come up and assist you. We have a team: nurses, dieticians, social workers, etc.

iv. Initial Survey-

v. Licensure Actions-Counties will be notified of issues

1. Summary Suspensions-This is the most severe. Facilities do not know until DHSR is onsite that a summary suspension has happened. They hand deliver this to the facility. A HUB alert is usually issued a day before they arrive. County DSS responsible for relocation of residents. In almost every case, the Department will begin revocation of the facility’s license. The Department may summarily suspend a license pursuant to GS 150B-3© whenever it finds substantial evidence of abuse, neglect, exploitation or any condition which presents an imminent danger to the health and safety of any resident of the home.

2. Licensure Revocation-If we issues the notice of revocation-can’t happen until 20 days of the notice. The facility can appeal. The facility has substantially failed to comply with the licensure statutes and rules; and it is not reasonably probably that the licensee can remedy the licensure deficiencies within a reasonable length of time. The failure to comply endangered the health, safety, or welfare of the residents. DHSR will send our HUB Alert when a revocation in effect issues

3. Provisional Licensure-There is a reasonable probability that the licensee can remedy the deficiencies within a reasonable length of time and there is reasonable probability that the licensee will be able thereafter to remain in compliance with the licensure rules for the foreseeable future. Cannot have a provisional license given more than twice. If a facility fails to come back into compliance and no appeal is filed; the license expires. If a facility comes back into compliance, a full license is issues.

4. Suspension of Admissions-non-compliance has led to the detrimental to the health or safety of the residents. New residents are no to be admitted during the effective date of the suspension. 6 month wait before licensee or any stockholder with 5% interest of more obtain a new license.

f. What is the county role at the Social Services Institute-DHSR is sponsoring this training at SSI.

g. Unlicensed facility: complaint will come in to the County-AHS will need to initiate it. The ACLS supervisor needs to be contacted on these types of issues. We will provide technical assistance; the letters to cease and desist will come from DHSR/ACLS

h. Training question: 1068 trainings and refresher trainings: 1068-they are behind, we are looking at a more efficient way to provide that training. They are trying to do a recording of trainings, post it on their Share Point Site, and then staff can view from their office. What should counties to get their mandated hours-get CEUs for training in working with aged or disabled adults. Refresher trainings- Basic and Complaint trainings-it focusses on writing a corrective action reports. We aren’t getting the participation; we are planning to have one in Raleigh in the future. We are hoping to video it and make it available to live stream.

5. Partner Updates

a. ACLS-No updates at this time. Just waiting on the budget approval process.

b. DAAS-Carrie Perez-Adult Services Section Chief- staff/consultants are trying to get those trainings out to you. We are working on developing some new trainings. DDL will be coming out in the next week. We hired new position: Laura Garganus- Adult Services program coordinator. ACL standards-will be presented at the SSI later this month. Save the Date-For the Opioid Symposium. DCDL-Modification-DAAS 2016-trying to track what’s happening with the guardianship bonds. DCDL-updates to the DAAS 5026-collect more data. Initiation time frames, etc. We do not have a State budget approval yet; Personal needs allowance-that could affect your SA budgets, when it is approved. The temporary payments-those are currently only be paid through June 30 because it is Non-reoccurring payments; will update you when we have more information.

c. DMH/DD/SAS-Lisa Jackson:

• Updated contracts between the LME-MCOs and the State (both the NC Medicaid/DHB contract and the DMH/DD/SAS contract) have been signed and executed (July 1, 2019-June 30, 2020). There will be the need for further updates on the NC Medicaid side that reflect the changes to take place in November.

• Benefit packets for Regions 2 and 4 are in process of going out this week and the DMH call center and LME-MCOs are preparing for increased calls and questions and will be directing those to the enrollment broker.

• If a person has questions about eligibility for a health plan or the process for enrolling in a health plan, transfer them to the Enrollment Broker at 1-833-870-5500 (TTY: 1-833-870-5588).

• We are expecting to get the Secretary’s feedback any day re: Tailored Plan (TP) regions and understand that she is supportive of keeping the LME-MCO areas as they currently are. Work continues with the Manatt consultants on TP design.

• We are watching SB212: PART III. POTENTIAL DELAY OF MEDICAID AND NC HEALTH CHOICE 13 TRANSFORMATION 14 SECTION 7. If House Bill 966, 2019 Regular Session, does not become law by July15, 2019, then the Department of Health and Human Services shall delay, until at least March 1, 2020, the implementation of the Medicaid and NC Health Choice transformation required by S.L.2015-245, as amended, and by the 1115 demonstration waiver.

• Rutherford County has now realigned with Partners (from Vaya), effective July 1st.

• Lots of energy going into the Transition to Community Living Initiative (TCLI) as we enter the home stretch of that settlement (Correction: the TCLI Settlement was originally July 1, 2020 but it has been extended to 2021); the big focus this year is on enhancing service delivery-specifically targeting Individual Placement Support – Supported Employment (IPS-SE) and the implementation of the new Community Support Team (CST) definition that will include tenancy supports.

• LME-MCOs have submitted their annual Network Adequacy Assessments that DMH and NC Medicaid will review for compliance over the next month.

Next meeting: September 11, 2019

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