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House | May 21, 2013 | Committee Room | Health

Full MP3 Audio File

Ladies and gentlemen, at this time home, we'll call this meeting of health and human services to order. I'd like to begin by welcoming our pages that are with us today, and I'd like to recognize you, if you would stand and the recognize when a caller name. Madison Gilliani, from Mecklenburg County sponsored by representative, I suppose that's William Brawley. Ape Commodore, from Cumberland County, sponsored by Representative Lucas. Graham Lauder from Wake county, sponsored by speaker Tillis, and Elizabeth Mazinka from Wake county, sponsored by representative Stam. We're happy to have all of you with us, and we hope you're having a good week at the general assembly. Very educational, and a good time. We're glad to have our sergeant at arms with us today, Bill Bass, Joe Crook, Carl Morello, and Martha Gadison. Thank all of you for what you do for us every day. Members, we have three bills on our calendar today, and will begin with house bill 580. We'll ask Representative Martin to come forward and present your bill. [SPEAKER CHANGES] Good morning. Members of the committee, I know you don't get enough e-mail, but I hope you had it chance to see the e-mail that I sent out that a lot of background information on house bill 580, on tele-psychiatry. We've had a pilot program in place for the last year or so that's been really a partnership between ECU school of medicine and Avamore Hospital foundation, and it's been very successful, and I met at the joint legislative oversight committee of health and human services during the innerim and proposed that this be continued and expanded because of the success. And we've also seen as implemented on the state level in South Carolina. I do have some folks here who have run the pilot, who are prepared to give you some more background information, but I think this is really a good strong policy position for us. We know we've had a lot of issues with mental health in the state, and this has come from losing hospital beds and trying to push it more into the community, but not necessarily having the services available in the community, so what this will do is allow us to get the patients in the door sooner and have the skilled people to make an assessment fee a telemedicine so that in those rural communities, in places where we don't have access to care, that they would get in, they wouldn't be sitting in the waiting room and get into the system, they would have a diagnosis by skilled psychiatrist whose licensed in North Carolina who could reside somewhere else in the state. And we would create that hub across a state what this bill. So that we get patients in the door quicker, shorter wait times and appropriate diagnosis. And we've seen it this is saved a lot of money and has really improved access to care and improve patient outcomes. So it's a small investment, but it saves a lot of money in the backend and its something proactive we can do to improve mental health. So, I think it's a strong policy. It is in the senate proposed budget. The same amount of money, two million dollars, to move this forward. And we've seen this work, so I recommend we move will forward, blessing this proposal, and let the department work with the different groups that are out there. There's actually two groups. ECU is implementing this, as well as Carolina's medical center has a hub that is doing this. So what we want the department to do is bring it together, make it statewide. And that is the bill. [SPEAKER CHANGES] Comments or questions? [SPEAKER CHANGES] Comments or questions, members of the committee, Representative Brady? [SPEAKER CHANGES] Thank you, Mr. Chairman. I rise just in support of this bill, also because of the one of the bill so we passed recently was a telemedicine bill, and I think these are going to go hand in hand, and I do, when appropriate, would like to make a motion. [SPEAKER CHANGES] OK. If you'll hold that motion. Representative Farmer Butterfield, you're recognized. [SPEAKER CHANGES] I was just going to ditto what the gentleman just said. [SPEAKER CHANGES] Very good. And the other members to speak? If not, Representative Brady, you're recognized for a motion. [SPEAKER CHANGES] Thank you, Mr. Chairman. I'd like to make a motion for favorable to report on house bill 580. [SPEAKER CHANGES] Represented Brady moves for a favorable report for house bill 580. All members in support, signify by saying aye. All opposed, no. The ayes have it, and Representative Martin, it looks like you have house bill 973 as well, so if you'd like to precede with that. [SPEAKER CHANGES] Thank you. House bill 973 addresses a similar issue

As I mentioned, we have a transition from the statewide beds to the community beds, and the community beds are three-way contract beds, and the recommendation also came into the legislative oversight committee that we needed to consider having two-tiered payment system for higher acuity mental crisis patients that are in the community, that the funding that we have for a bed in the community , which is 750 dollars per bed day, is not sufficient for higher acuity patients, and the hospitals were losing money and not necessarily bringing the patients in, and then there’s the lack of availability of the state beds, which are for the most severe acuity, so the whole point of this is to get the patient… first we dealt with evaluation, but to get them into the appropriate beds, so we want to provide funding to support our community hospitals, and they need a little more money for these higher, more severe cases. So this came also out of the oversight recommendation, and we want it to be less funding than what is in the psychiatric hospital because if they need that level of care then we want them to get a bed in the psychiatric hospital, but one thing of note is in 2001 we had a total of 3,483 beds, combining what we had in the state hospitals and in the community and as both have moved, in 2012 we had 2,665 beds, so we haven’t done very… we haven’t been as successful as we would have liked in replacing those beds from the state hospitals to the community, and some of that will be improved in the budget, but also going to two tier payment will help the folks, and I think there’s an amendment. I don’t know who’s offering that amendment. Is he here? [SPEAKER CHANGES] The amendment sponsor’s not here. Is it an amendment that you wanted offered, or…? [SPEAKER CHANGES] I think it’s the technical amendment on the dates in section 1b. Do you want me to put it under my name? [SPEAKER CHANGES] If you want to sign it, we’ll go ahead and send it forth. Members will be at ease while the amendment is being passed out. I would also bring your attention that in the previous motion for House Bill 580, we did not mention that it is referred to Appropriations. Without objection, we’d like to do that. We’ll so note. Is this regarding the amendment? [SPEAKER CHANGES] Regarding the bill before we get to the amendment. [SPEAKER CHANGES] Representative Fulghum. [SPEAKER CHANGES] Thank you, Mr. Chairman. Representative Martin, the beds that we’re contemplating here are existing hospital beds in general hospitals that will be contracted for to be used an psychiatric beds for a temporary period of time? [SPEAKER CHANGES] Yes, they are existing and new three-way contract beds, and under the budget we have tried I think to get 45 more beds funded last year, but because of the Medicaid shortfall they did not get in there, but they should be in there this year, so for all of our three-way contract beds to make this second tier available, up to two million dollars, which would not be all of them all the time. It would be a percentage of them. [SPEAKER CHANGES] Follow-up, Mr. Chairman. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] How many total beds then would that be annually, that this two million would make available? [SPEAKER CHANGES] Let’s see. I have the two… I think it… I believe that the three-way contract beds would be 186, but I would need to double-check, which is in the Senate budget where they are outlining the three-way contract beds from 141 to 186 by allocating the funds that were in last year’s budget. [SPEAKER CHANGES] Follow-up again. [SPEAKER CHANGES] Thank you, Mr. Chairman. And does that still leave a shortfall in regards to what’s required? [SPEAKER CHANGES] Yes it does. [SPEAKER CHANGES] Follow-up, Mr. Chairman. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] And what would that be? [SPEAKER CHANGES] I do not have that number here, but I’m happy to show you this presentation with you where we can go over it afterwards, but I believe

[Speaker changes.] That is part of the reason why you might see additional hospital...state hospital beds proposed on top of the three-way beds. [Speaker changes.] Thank you. [Speaker changes.] Representative Fulghum, I think we have a representative from physical research here that could answer that question. If you would please state your name. [Speaker changes.] Yes, Denise Thomas, physical research division. Representative Fulghum, who asked the question about how many beds we have right now or...we have...you have funded enough right now for 186 beds so two million would be...we'd have to calculate that since it's tied, I think to an elevated...I mean to an increased rate so that would...we'd have to get that information from the department after they decide what this higher rate would be. [Speaker changes.] Members, do you have a copy of an amendment before you? Representative Martin, you're recognized to explain your amendment. [Speaker changes.] Thank you. I'd like to defer to staff to explain the provision. [Speaker changes.] The amendment..when the amendment was drafted, it just restates Section 1B entirely so that the members could see the amendment in context but what has changed...if you refer to the bill on line 26...it adds a reporting requirement currently in Section 1B of the bill. It requires the department to report by March 1st, 2014, regarding the efficacy in the success rate of the actual three-way contract and the assessment of the two tiered system of payment. What this amendment would do would also ask them to report by June 30th, 2013, what the description is of the performance measures. The amendment essentially would require a description of the performance measures that are being used to give the report to the General Assembly on March 1st, 2014, so that if the General Assembly were to have any problems or issues with performance measures being used, that adjustments could be made before the March 1st, 2014 report was due. [Speaker changes.] Representative Insko, is this on the amendment? Do you have a question on the amendment? [Speaker changes.] I think it's on the bill. [Speaker changes.] Ok...Members, any comments or questions on the amendment? Seeing none, Representative Martin moves for passage of Amendment...I believe it's ATJ38, B1. All in favor signify by saying "aye". (Ayes.) All opposed,no. The ayes have it and the amendment does pass so now we're back on the bill. Representative Insko, you're recognized to speak on the bill. [Speaker changes.] Thank you, Mister Chairman. I apologize for not being here when the discussion was started. I sent some questions of last..er...yesterday I think about this bill...maybe to somebody in fiscal...but I'd like to have some comparison about the cost that we pay for our state hospital beds as compared to the cost that we pay for our local inpatient beds. I don't know whether anybody from fiscal has that information. [Speaker changes.] I don't know if you..I don't know that they have a fiscal note or viewed it online. I did include that in the email...a link to that so if you don't have it, you can pull up the details. And they have...from fiscal research that the state hospital beds are ?????????? 920, Central Regional 1107 and Cherry???? 1417. Right now, the community three-way bed is 750 and in the bill, it proposes it to be not more than the lowest hospital one so I think kinda' when we did the math, if we were to say...half of the patients, half of the time...would be a higher acuity and what kind of a number would it be, we used $900 but we're asking staff to come up with that...we're asking the department, not staff...we're directing the department to determine what is an appropriate higher acuity level in the community setting. [Speaker changes.] Then I have a follow up question. [Speaker changes.] Follow up. [Speaker changes.] We used to have LME's that had agreements with their local hospitals for inpatient beds at no cost to the state and I'm wondering if there are any of those LME's that currently are providing inpatient beds at no cost to the state. That was a problem because when we started paying for beds, the people who were doing it voluntarily were then wanting to also be paid for their beds...so I'm just curious....

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What this is all about, and what we hope to achieve with it, and why I think it is one of the best directions we can take for the children in our foster care system today. [SPEAKER CHANGES] Representative Avila, you have a speaker you wanted to present? If you would sir, please come and state your name and who you're with for the committee, for the record, and you are recognize for a period not to exceed 3 minutes. [SPEAKER CHANGES] My name is Brian Manis, I'm with the Children's Home Society of North Carolina, I'm always cautious when someone says I will be eloquent, I'm doomed for failure for that. The Children’s Home Society was established in 1902. We are one of North Carolinian’s leading organizations in the areas of adoption, family preservation, and family support services. Our mission has been consistent throughout our history, that's to promote the right of every child to a permanent, safe, and loving family. We have completed about 15,000 adoptions in our history. This year we'll work with about 1,000 children and families who are involved in our child welfare system and our foster care system. We complete about 25% of all adoption work for children in foster care. We do a little bit more than half of all the work that's done by private organizations. This bill is very important for a number of reasons. We believe children do best when they are part of and raised by a family. We believe government makes a poor parent, and the outcomes for children who spend long periods of time in foster care or who age out of foster care really prove that to be true. And what this bill does is addresses the children who languish in foster care. Children's Home Society works in partnership with our Department of Health and Human Services, and our County Departments of Social Services. We work with about 75 county DSSes in any given year. The adoption promotion fund which is featured bill 971 is critical to supporting adoption work in North Carolina for these children in foster care. The trend has been that funding for the adoption promotions fund has been decreasing, and this is due largely by cuts in federal funding which have supported that fund, but the reverse is true for children who are aging out of foster care in our state. So last fiscal year 574 children were placed for adoption via the special children's adoption promotion fund or the adoption fund as it's also know as. Meanwhile, 603 children aged out of foster care in that same year. And that trend is increasing. More kids who are aging out without the benefit of a family that's there to support them into adulthood. That trend is bad for children and is bad for our state. So that outcomes are really bad, and I have a colleague that will speak for just a second around some of those outcomes. And the outcome for our state is bad, because we incur a huge cost to maintain these children in foster care, and then we all pay for the poor outcomes that they experience as adults. What Children's Home Society brings to our public partners is our expertise in permanency work, as well as relationships with private funders across the state. And we've been fortunate to enjoy many relationships with private funders who have funded some real innovative work with us for the last 10 years. The services that are featured in house bill 971 are really a product of that private investment and innovation. Specifically the services that are outlined around family engagement and called family finding, and child-specific adoption recruitment. So several foundations, the Duke Endowment, the Thomas Foundation, the Edna McConnell Clark Foundation, have invested more than 12 million dollars over the last 5 years to develop these services in North Carolina, all private investment. In addition, our family finding program was recognized by the federal social innovation fund, and was awarded a 3 million dollar, 3 year investment, due to it's innovative approach and promising outcomes. All of that funding, and those funding sources will participate in this demonstration project, and that will leverage the state dollars that would be invested in this. [SPEAKER CHANGES] I'll introduce Matt Anderson, prior to his role with Children's Home Society, he was the producer of film that Representative Avila mentions. [SPEAKER CHANGES] Mr. Anderson, you're recognized for a period not to exceed 3 minutes if you would please state your name and who you represent. [SPEAKER CHANGES] Thank you, good morning. My name is Matt Anderson, I'm with Children's Home Society of North Carolina, and I would like

Thank you all for taking the time today, and especially Representative Avila for your work on this. I also do not have a personal experience. I was not in foster care, nor have I adopted any children from foster care, but I really can't imagine a more important thing to work on than these particular issues, so thank you. I'd like to start by saying that House Bill 971 is about fulfilling our promise of a family for every child in foster care. Our federal policies, state priorities require that we involve the biological family, that we put in place a strong support system for these children, that we place children with a safe, permanent family, and we do everything we can to set them up for success in adulthood. An example of this is the 2008 Fostering Connections Act that required states to notify and engage all relatives of children that had been placed in foster care. Five years later, North Carolina, like most states, struggle to meet this requirement. Part of what we are trying to accomplish with this Bill and our Family Finding Program is to make sure that we cannot only meet this requirement to these children, but go well beyond that. Today, there are over 8,600 children living in foster care, all of whom are trusting all of us that we will do what we can to meet our obligations to them. The cost of maintaining these children in foster care can be as high as $54,000 a year per child, and that's just direct foster care maintenance payments. The additional administration, court, Medicaid costs can drive those costs even higher. Last year over 2,000 children were waiting to be placed with a family to call their own, and our Adoption Promotion Fund accomplished 574 adoptions. We see that gap between those numbers as the opportunity to provide the benefits of a family to more children in foster care as well as to reduce the costs associated with maintaining children in foster care. As Brian mentioned, 603 children aged out of foster care last year. These children, we know, will suffer outcomes such as homelessness, incarceration, unemployment, unplanned pregnancy, all of which will bring upon their own costs, well into adulthood. For example, among those youth who age out, 75% of women will use government benefits in adulthood, such as food stamps. Seventy-five percent of the women will also become pregnant. Seventy-seven percent of the men will be arrested, and 29% of whom will be incarcerated. There's a handout that was sent out to you all that will show some of the costs associated with these outcomes. [SPEAKER CHANGES] Mr. Anderson, if you would, try and wrap up your remarks. [SPEAKER CHANGES] Yes. I'll close by saying House Bill 971 has four broad goals; one, to reduce the number of children in foster care; two, to reduce the length of stay in foster care; three, to reduce the number of children aging out; and lastly, to increase the number of children that achieve legal permanency and the benefits of being connected to their biological family. I'll close. [SPEAKER CHANGES] Thank you, Mr. Anderson. Members, before I recognize Representative Avila for a motion, further comments or questions? Representative Brady? [SPEAKER CHANGES] Thank you, Mr. Chairman. Actually, for one of the speakers, if they wouldn't mind. On the left-hand side of your sheet, you had the number of statistics, and I was wondering if you could answer this? Let's say 20 years ago, and it's just a number I picked out of a hat--20 years ago, were these statistics the same, or are we seeing, overall, an improvement of this problem, or going the opposite direction? [SPEAKER CHANGES] If you would, again, please state your name for the record. [SPEAKER CHANGES] Sure, my name is Brian Manus with the Children's Home Society of North Carolina. [SPEAKER CHANGES] Can you hear me? [SPEAKER CHANGES] Yes. [SPEAKER CHANGES] I think we have seen some improvement as a state over the last 10 or 15 years. I've been with the Children's Home Society about a dozen years. When I came to work with Children's Home Society we had about 12,000 children in foster care in the state. You heard Matt mention that we have about 8,600 children in foster care today, so we have made some progress. That doesn't mean we don't have more potential to continue to improve. I will say one of the key things, in terms of achieving that progress that we have made, has been the Adoption Promotions Fund, which is specifically targeted adoption for children in foster care, and that's what's been cut in the most recent budget. [SPEAKER CHANGES] Representative ?? will be recognized. [SPEAKER CHANGES] A question for the sponsor. Are you satisfied that the 6.75 million dollars over two years is...

evenly distributed to the agencies, not only including the Children's Home Society, but all the others that are in foster care and adoption work in the state? [SPEAKER CHANGES] This particular demonstration is directed at Children's Home Society in terms of its expertise in having use this family finding and the other methods they want to expand in the state. [SPEAKER CHANGES] Follow-up, Mr. Chairman. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] Maybe a question for the Children's Home Society. I'm sure you're aware of the total number of children in foster care and adoptions. What percentage does the Children's Home Society serve of the total? And what is the total? [SPEAKER CHANGES] If you would, identify yourself again. Sure. My name is Brian Maness with the Children's Home Society. Any given year, we will serve about 250 children in our foster care programs. We will place about 120 or so children for adoption from foster care this year, and you can compare that percentage to the total population of about 8600 children in care, about 2000 of whom have a plan of adoption. In terms of the scope of adoption work, we do 25% of all the adoption work for children in foster care in the state, and a little bit more than half of the work that is done by private, non-profit organizations in the state. We're by far the largest adoption provider in the state and I believe we're the largest provider of foster care as well. We'll serve over 1000 children and families that are involved in the public system this year. [SPEAKER CHANGES] Representative Szoka, your're recognized. [SPEAKER CHANGES] Thank you, Mr. Chair. I have a question in the adoption promotion fund. What exactly does--does that do? How do those dollars affect what you're talking about? [SPEAKER CHANGES] Sure. [SPEAKER CHANGES] And again, every time you speak, just recognize yourself. [SPEAKER CHANGES] Got it. Brian Maness with the Children's Home Society of North Carolina. So the adoption promotions fund, my understanding, has existed for about 15 years now, and it supports adoption work for both public, meaning county departments of social services, and private organizations like the Children's Home Society. And there are well over a dozen private organizations that receive support for the adoption promotions fund. It's administered in different ways for the public sector versus the private. The public sector agencies, the county DSS's, have an established baseline based on their past performance of a number of adoptions they've completed, and they get an incentive from the adoptions promotions fund for every adoption that exceeds their established baseline. For all the private organizations, we work under performance-based contracts. So we don't get any funding for our adoption program unless we complete adoptions. And that reimbursement comes after the decree of adoption is issued. And about roughly half of the adoption promotions fund is awarded to private organizations, and about half to public county departments of social services. [SPEAKER CHANGES] Representative Pierce, you're recognized. [SPEAKER CHANGES] Another question for the gentleman. I know he's tired of giving us his name [laughter]. What age is it hard to place children? I mean, what--I know you said that some will stay in your system until they age out, but what--what age does it get difficult for young men and young women get to be adopted by families, please sir. [SPEAKER CHANGES] My--my answer with that--and I'll say I 'm not a social worker--although I've worked with the Children's Home Society for a long time, but it's all based on the needs of the child. So you can have very young children with very complex needs, and finding the right family for those kids can be a real challenge. It is--understood--it's harder to find families for older children and those with more complex needs. That's given. I think one of the things that we've learned and we've really challenged assumptions is that we've placed a lot of older kids for adoption. So, if you look at three different age brackets: 0-5; 6-12; and 13 and over, we--our placements are roughly a third in each category. So, we can find homes for older children. It's different. When people typically think of adoption, they're thinking of infants and younger--young children. But there are families that are interested in providing families for the--for those older kids as well [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] How many sibling groups do you handle with that? Brother-sister, that--is that common in your business? [SPEAKER CHANGES] Very common. I don't have a statistic for you, but we work with sibling groups all the time. And it's a real priority of ours to keep siblings together whenever we can. [SPEAKER CHANGES] I've got three more members at this time. Members, we will take a vote by ten minutes 'till [sic]. Representative Palmer-Butterfield. [SPEAKER CHANGES] Thank you, Mr. Chair. I wanted to ask the gentleman a couple of questions. [SPEAKER CHANGES] Okay. You're recognized for a question. [SPEAKER CHANGES] Thank you. The first question [end of data]

The pasta, opened a memo from the UK and 42522 and the same approach La soul Wednesday of funding for life in Foster Care so we're paid as a Foster Care organization in this traded CL 202 families to train families to support those families and supervise this family sure providing Foster Care to children and I don't know exactly what that figure rose 1/2 ago but has less than $1000 a month per channel by the family's also receive a payment a Foster Care board payment that pays some of their cost of providing care to those children but by no means covers their entire cost of this price, partial support for their care for children , (SPEAKER CHANGES) I'm Liane band to deflect the company's the two KIETF, at 6:00 in the update the strongest and then we can share with our adoption program is just a step with options that were able to successfully complete and 120 are so adoptions this year , that's one thing we know that all speak to this service is good and the five specifically and health bill 971, I think about it, from myself 5 minutes with the children from Tucson from that good job specific recruitment and the model of program that we followed was developed by the day, starvation for adoption as companies were for kids and it says the children in the program were three times to play older children are three times more likely to achieve adoption and children that were not in that program this was severe mental health issues for 127 times more likely to that realization that option and that was proven to know when the mouse control from valuation for family fun in our results of them really phenomenal and I think that's one of the reasons why we were awarded this investment from the Federal social nation five were extremely successful engaging family so they really challenges to the assumption that for children in Foster Care and the biological family exist for the vast majority of children that we serve label find their family and not just a few family members upwards of 50 family members for each job search were able to engage this family members and received commitments from this family members on two things once just being involved in the shelf life in the future to publish a relational commandments and also for the coliseum is that this family members are other resources that one be considered permits a great source of much of that answers the commission as undecided if you would just a divisive one sign for each member of the places you'll have to have followed state to members of medicine is 10%, and now allow have represented Babel formation and again we have 3 minutes if I keep your questions and answers as brief as possible representatives cannot message NAIN Yeltsin for micros microstrategy left EL with the structure of the E and the report's two-SQ all about that later slipped in and they keep the presents a go for a second, 1997 and quick question for represent them look in the original bill Lyons fired question was much larger news section five national norm one decreased nine civilians were tears and they added #they should have M5 V a transfer from one place to another just nine mathematical errors represented ally you recognize formation of thinking is chairman and the one coming to form a commission as a I’m the presentation and you might have missed the reference that they May 2 the significant number of county DSS is that they were four a lot of this work to maintain a steady trying this DSS System to the type of work that they do with five when these wonderful kids program as well as family 58 seven it's not just for limited two what the CR organizational be able to do with this program is how they'll be able to straighten out to be the locals and as a boy,(SPEAKER CHANGES) Mr. Chairman I'd like to take half of mission for favorable report two PCs are house till 971 unfavorable to the original list referral two appropriations represent about 1,000,005 am report that today's committee said 684 after 971 and farewell to the original as referral to appropriations holiday receive at the same high holidays nine the ice that still passes slices in the seven meeting is adjourned making members ??......

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