Services in NC Medicaid Plan
NC plans to offer additional services to people with intellectual and developmental disabilities, as well as others, under (i) services plan through the Medicaid program. When Tailored Plans begin operation December 1, 2022 as part of the state’s Medicaid Transformation some of the services that LME-MCOs offered under b(3) such as respite, supported employment and community living and support, will be offered under a new Medicaid benefit for adults and children. Most b(3) services will have a similar service offered under the (i) services or under the state’s 1115 waiver.
Unlike waiver services, these (i) services are an entitlement for people on Medicaid who are eligible, meaning there is no cap on enrollment and people can’t be turned away for lack of slots or lack of local funds. There would be no “waiting list” for (i) services like there are for Innovations. The (i) services are however targeted at meeting specific needs and may have limits on the number of hours or have other limiting criteria. They are not as comprehensive as a full Innovations waiver slot. The (i) services could be used by people who are eligible for Medicaid and are on the Registry of Unmet Needs waiting for a waiver slot as well as by people who do not meet the criteria for an Innovations waiver, but who still need supports and services, if they financially qualify for Medicaid as their insurer
Read more about (i) services: https://www.autismsociety-nc.org/public-policy-update-i-services-in-1115-waiver-may-help-those-waiting/
Read the white paper on (i) services including a chart comparing b(3) services to (i) services in this March 2022 document from the Division of Health Benefits.
ASNC will update this blog and release additional information when the (i) plan is released for comment.
Innovations Waiver Slots
The budget passed by the NC General Assembly allowed for 1,000 waiver slots to be released this year through North Carolina Department of Health and Human Services and the local LME/MCOs. NC DHHS has submitted and the Federal Centers for Medicare and Medicaid Services (CMS) approved updates to that waiver (1915c) that allow for the additional disbursement of Innovations waiver slots, beginning May 1, 2022. Each LME/MCO currently maintains a waitlist, known as the “Registry of Unmet Needs.” They will be removing people from the waitlist and allocating slots in the months to come. We advise people to contact their LME/MCO at least once a year to be sure be sure the LME/MCO has your accurate contact information for the Registry.
If you have not been assessed for eligibility for Innovations waiver services, ASNC has resources to help you get started. See our Accessing Services Toolkit at this link or download a copy here. You can also reach out to one of our Autism Resource Specialists for more information on accessing services in NC.
Research Based – Behavior Health Treatment for Adults
Adults over the age of 21 on Medicaid are now eligible for Research Based – Behavior Health Treatment (RB-BHT) services, as long as the intervention is supported by clinical evidence for that individual. Request RB-BHT through your LME/MCO or Medicaid Standard Health Plan provider.
Read the announcement from the Division of Health Benefits: https://medicaid.ncdhhs.gov/blog/2022/04/19/research-based-behavioral-health-treatment-autism-spectrum-disorder
Background: RB-BHT services are researched-based behavioral intervention services that prevent or minimize the disabilities and behavioral challenges associated with Autism Spectrum Disorder (ASD) and promote, to the extent practicable, the adaptive functioning of a beneficiary. In practical terms, these interventions or therapies can include things that can promote positive behaviors and reduce negative ones, promote learning, develop social, communication and adaptive skills, and build motivation using a variety of methods including but not limited to visual supports, reinforcement, modeling, naturalistic intervention, social skills training, discrete trial training, pictorial communication, social narratives, self management, structured play groups, video modeling, tablet based programs, and other evidence-based interventions. While sometimes these interventions are referred to as ABA or applied behavioral analysis, RB-BHT includes many evidence-based approaches including, but not limited to ABA, that can be adapted for each individual’s unique needs.
Read the Clinical Policy for RB-BHT which gives information about the service and how it is provided in North Carolina (please note that the age range may not have been updated in this policy document and may still be referencing those under 21, despite being available also for those over 21.) The updates to clinical policy should come soon and LME/MCOs are also working to update their benefit plans with this change to clinical policy.
Blue Cross Blue Shield of North Carolina Adds Evidence-Based Treatment for Autism to BCBS Healthcare Marketplace Plans
Blue Cross Blue Shield of NC (BCBSNC) announced earlier this year that they have added an evidence-based autism behavioral treatment benefit to their Healthcare Marketplace health insurance plans sold in North Carolina. This benefit is currently limited to children up to age 18.
Background: Healthcare Marketplace plans are health insurance plans sold to individuals and families as part of the benefits available through the Federal Affordable Care Act (ACA). The Federal ACA regulations do not require plans to cover evidence-based autism behavioral treatments, so most marketplace plans do not provide this benefit. BCBSNC is the first plan in North Carolina to announce that they will add autism behavior therapies as part of their benefit package. Open enrollment for ACA Healthcare Marketplace plans for most people begins November 1 for plans that start in 2023. Note that if you have had a life event, like a job loss, marriage, or the birth of a child, you may qualify for a special enrollment period. You can find out more about marketplace plans at www.healthcare.gov.
Competitive Integrated Employment Update
The state of North Carolina (NC DHHS) announced in February that they entered into a settlement agreement with Disability Rights North Carolina and the Center for Public Representation to ensure that around 1,000 individuals with disabilities currently working in segregated employment settings have the opportunity to seek out community-based integrated competitive employment. ASNC wrote about this policy change: https://www.autismsociety-nc.org/public-policy-update-competitive-integrated-employment/
The original settlement included ending referrals to Adult Developmental Vocational Programs (ADVPS), sometimes called “sheltered workshops,” by July 1, 2022. That date has since been removed from the agreement after it was discovered that many providers licensed as ADVPs are also providing community-based employment, competitive wage employment, community enrichment and meaningful day programs under those licenses. In order to ensure that people with disabilities can continue to participate in those programs that were not considered part of the settlement, the July 1 date will not go into effect and referrals to programs may continue. The state of NC will likely need to develop a new license category and/or transition existing providers to licenses that better fit their scope of programing, while also working with providers to move participants and new referrals to competitive integrated employment options.
The state of NC continues to post updates regarding Competitive Integrated Employment to its website. The Competitive Integrated Employment Frequently Asked Questions page has helpful information about what the settlement means for people with disabilities.
NC DHHS Strategic Housing Plan Draft available for comment until June 10, 2022
North Carolina Department of Health and Human Services has released a draft of its Strategic Housing Goals, Objectives and Strategies document that will inform the development of a Strategic Housing Plan to address the housing needs of individuals with disabilities. The plan was developed with the input of stakeholders across the state and is intended to be a strategic guide to focus the state’s policy efforts and resource decision making. The goal is to increase community-based housing options for specific populations over the next five years. ASNC encourages you to review the document and submit comments to email@example.com before the deadline of June 10, 2022.
You can read more about NCDHHS activities related to housing and community living here: https://www.ncdhhs.gov/about/department-initiatives/transitions-community-living
Have questions about public policy or advocating? Contact Jennifer Mahan, Director of Public Policy at ASNC, at firstname.lastname@example.org.
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