And We Have a Budget – Or, At Least, a Conference Report!

March 09, 2020

The report this year is quite a bit more supportive than some recent years, and we have some real reasons to be pleased!  Let’s begin with the I/DD side of the ledger:

  • DD waiver rates will increase for all services using the updated (Option 2) including wage assumptions to 100 percent of the rate model benchmark.  DMAS will use the study to develop the rates.

  • Skilled and Private duty nursing rates will increase to 80% of the benchmark rate.

  • More than $200M are allocated to provide for a Medicaid funded comprehensive dental plan for adults beginning in January 2021.

  • Personal Care, Respite & Companion rates (both Agency & CD) will have a 5% rate increase for FY21 and an additional 2% for FY22.

  • Medicaid is directed to amend the State Plan to allow for overtime up to 16 hours for a single personal care, respite or companion (CD) and to conduct a review of methods and strategies for providing some sick leave benefit.

  • The Conference adds an additional 250 FIS slots in FY22; the Governor’s budget already increased the slots as follows –

    • CL Waiver – 145 (FY21), 95 (FY22)

    • FIS Waiver 640 (FY21), 205 (FY22)

    • In addition to 25 (CL & FIS) each year for reserve/emergency



  • DBHDS is required to report within 30 days after the end of each quarter the number of slots allocated and the number being utilized.

  • Funds have been allocated to contract with an expert in health care rate setting to analyze all Medicaid rates likely to be impacted by the increase in the minimum wage.  While the impact on our providers should be minimal this year, we know that we will need significant rate adjustments in the out years of the plan.

  • Outdated language which directed the expansion of a Medicaid services to managed care will be removed and the remaining services should only be moved if explicitly authorized by the General Assembly.


On the BH side of the ledger:

  • The Behavioral Health loan repayment program was funded.

  • DMAS is directed to continue working on the development of an 1115 Waiver for SMI and SED; this will be the result of the work currently being done on BH Redesign.

  • DMAS will also review services currently provided in schools to determine which can be paid for by Medicaid outside of the IEP.

  • Rates for psychiatric residential treatment are to be revised as they have not increased since 2008.

  • DMAS is directed to revise the current contract with the MCOs to more clearly articulate their interactions with providers and to insist on compliance with NCQA response time standards.

  • A number of items were included regarding the census issues for both adults and youth:

    • Funding for additional beds at Catawba Hospital and the Commonwealth Center for Children and Adolescents was removed, but

    • Funding was added to develop pilot programs to reduce the pressure on state hospitals,and to

    • Collaborate with Children’s Hospital of the King’s Daughters to dedicate a portion of the future bed capacity to reduce the census at CCCA,  and to

    • Accept proposals from private providers to acquire housing for individuals ready for discharge in addition to funds to support 1,000 more individuals in permanent supportive housing.




There were also three language amendments of note:

  • At our request – DMAS shall convene a group to examine the regulations for respite or personal assistance when provided in a center based program, and

  • Also at our request – DMAS shall convene an advisory committee to monitor the BH “Redesign” with a specific focus on ensuring the the systemic plan incorporates the development and maintenance of sustainable business models, and

  • DMAS shall review and consider amending the regulations for Peer Recovery Specialists.


There is more – but that gives you the highlights.