Benchmarks' Friday Membership Webinar
October 15, 2021
Benchmarks' Upcoming Webinars

Benchmarks' Child Welfare Webinar
Lisa Cauley Joins Karen McLeod
Date: Thursday, October 21, 2021
Time: 8:00 am thru 9:00 am

Benchmarks' Child Welfare Webinar
Lisa Cauley Joins Karen McLeod
Date: Thursday, November 11, 2021
Time: 8:00 am thru 9:00 am

Benchmarks' Friday Webinar
Dave Richard Joins Karen McLeod
Date: Friday, October 15, 2021 thru December 16, 2022
(This registration is for a recurring meeting)
Time: 8:30 am thru 9:30 am
Extension of Temporary Suspension of Prior Authorization for Post-Acute Placements
Due to the COVID-19 Public Health Emergency and to expedite a hospital’s ability to discharge patients to lower levels of care when medically appropriate, the prior authorization (PA) waiver is extended to Oct. 31, 2021 for:
  • medically necessary new admissions who are being directly discharged from a hospital setting into a nursing home; and
  • medically necessary Inpatient Rehabilitation and Long-Term Care Hospital admissions.


PCCM Agreement Advance Notice
This week or shortly thereafter, NC Carolina Community Care Networks (CCNC) will send a new primary care case management (PCCM) agreement to primary care providers who serve NC Medicaid Direct beneficiaries. In addition to providing PCCM services, CCNC also shares quality measure results with Carolina Access practices for beneficiaries enrolled in NC Medicaid Direct, such as well child visits and immunizations. Important: For a Carolina Access practices to receive or continue to receive practice assignment data or quality data it must sign the new 2-Party Agreement with CCNC.

Thank you for helping NC Medicaid encourage all Carolina Access practices to sign the new agreement. More information is available in this October 11 NC Medicaid Bulletin.

NCI Interviewer Advertisement
If you or anyone you know is interested in being an interview for National Core Indicators please see the attached announcement with directions on how to apply.

NCDHHS Releases Draft Olmstead Plan, Open for Public Comment Through Oct. 27
The North Carolina Department of Health and Human Services today released a draft of its Olmstead Plan designed to assist people with disabilities to reside in and experience the full benefit of inclusive communities. The plan is open for public comment through Oct. 27, 2021. NCDHHS encourages all interested individuals and organizations to provide comment on this draft plan. NCDHHS will publish the final, two-year plan in December and begin implementing activities outlined in the plan in calendar years 2022 and 2023.
The Olmstead Plan will serve as a blueprint for the way that NCDHHS and its state government partners make decisions central to improving the lives of people with disabilities. The plan will seek to divert people from entering institutions and support those wishing to leave by offering an array of community living services and supports. Access to housing, employment, transportation and other aspects of community life are addressed in the plan.

The draft plan incorporates efforts already underway across NCDHHS to refine and re-define policies and programs so they more clearly align with the U.S. Supreme Court’s imperative in the Olmstead v. L.C. ruling of community integration. It builds on the foundation of NCDHHS’ Transition to Community Living and Money Follows the Person programs, and it expands the work addressing social determinants of health that is at the heart of NCDHHS’ Healthy Opportunities initiative.

"This draft plan will commit North Carolina to a future where people with disabilities can access the array of publicly-funded services in their communities they need to live everyday life, side-by-side with friends, family and neighbors," said Dave Richard, NCDHHS Deputy Secretary for NC Medicaid. "Realizing the promise of the Olmstead ruling requires all of us working together."

Throughout the past year, the NCDHHS Office of the Senior Advisor on the Americans with Disabilities Act and its contractor, the Technical Assistance Collaborative (TAC), have relied and built upon the insights, expertise and lived experience of the Olmstead Plan Stakeholder Advisory (OPSA) to develop the state’s Olmstead Plan. The advisory’s 36 external stakeholders have met quarterly and in committee for 15 months, advising NCDHHS on all aspects of the plan.

North Carolina’s draft plan includes 11 priorities:
  • Strengthen individuals’ and families’ choice for community inclusion through increased access to home and community-based services and supports.
  • Address the direct support professional crisis. Implement strategies to recruit, train and retain the frontline staff who provide those daily services that allow people to live, work and thrive in their communities. 
  • Transition people to more independent living situations from placements in institutional and segregated settings and provide needed supports in the community for individuals who are at risk of entering these settings.
  • Increase opportunities for supported education and pre-employment transition services for youth and competitive integrated employment opportunities for adults with disabilities.
  • Increase access to safe, decent and affordable housing.
  • Address gaps in services.
  • Explore alternatives to guardianship.
  • Address disparities in access to services.
  • Increase input to public policymaking from families and individuals with lived experience. 
  • Increase access to transportation.
  • Use data for making quality improvements in the provision of services and for advancing the achievement of the plan’s goals.

To submit public comment regarding the draft Olmstead Plan, email [email protected].

Olmstead v. L.C. is a U.S. Supreme Court case that laid the groundwork for people with disabilities to live their lives as fully included members of the community. The case addressed the Americans with Disabilities Act’s "integration mandate." The integration mandate requires all public entities, including the state of North Carolina, "administer services, programs, and activities" for people with disabilities in the most integrated setting appropriate to the person’s needs. In the Olmstead ruling, the Supreme Court also urged states to develop a "comprehensive, effectively working plan" for transitioning people to the community. NCDHHS has initiated the development of its Olmstead Plan under the leadership of the Office of the Senior Advisor on the ADA.
 
An Olmstead Plan cannot remedy every need and challenge a state faces in serving and supporting individuals with disabilities. NCDHHS’ draft plan is intended to highlight how its current work, its future efforts and its use of resources are viewed through "an Olmstead lens" to achieve NCDHHS’ mission under this plan to "assist people with disabilities to reside in and experience the full benefit of inclusive communities." For more information, visit www.ncdhhs.gov/about/department-initiatives/nc-olmstead.

You can also find this press release posted on the NC DHHS website at: NCDHHS Releases Draft Olmstead Plan, Open for Public Comment Through Oct. 27 | NCDHHS

Feedback for State Funded Service Definitions (Residential Supports and Supported Living Periodic)
The Division of Mental Health, Developmental Disabilities and Substance Abuse Services has posted for 45-day public comment at

State-Funded service definitions for Residential Supports (revised) and Supported Living Periodic (new) for your feedback. The public comment review period is from September 21 TO November 6, 2021 to [email protected]. Below you will find a brief summary of the proposed service definitions. Please note that although the services mirror Medicaid funded services, there are differences noted.  

Supported Living Periodic – New definition
  • Supported Living Periodic provides a flexible partnership that enables an individual 18 years and older to live in their own home with support from an agency that provides individualized assistance in a home that is under the control and responsibility of the individual. 
  • This service requires a NC Support Needs Assessment Profile (Level 2 or lower), Supports Intensity Scale (Level B or lower), or TBI Assessment requiring a low level of supervision and support in most settings, such as in the community, home, work, etc. 
  • Supported Living Periodic may include the following the services and supports: 
  • Direct assistance as needed with activities of daily living, household chores essential to the health and safety of the individual budget management, attending appointments, and interpersonal and social skill building to enable the individual to live in a home in the community.  
  • Assistance with monitoring health status and physical conditions, and assistance with transferring, ambulation and use of special mobility devices.  
  • This service may not exceed 28 hours a week. 
  • Transportation to and from the residence and points of travel in the community as outlined in the PCP or ISP is included to the degree that they are not reimbursed by another funding source and not used for personal use.  

Residential Services – Amended definition
  • Residential Supports provides individualized services and supports to enable an individual 16 years and older to live successfully in a Group Home or Alternative Family Living (AFL) setting of their choice and be an active participant in the individual’s community. 
  • This service requires a NC Support Needs Assessment Profile (Level 2 – Level 4), Supports Intensity Scale (Level C – Level E), or TBI Assessment requiring a moderate to high level of supervision and support in most settings, such as in the community, home, work, etc. 
  • The service includes learning and practicing new skills and improvement of existing skills to assist the individual to complete an activity to their level of independence. 
  • Respite may also be used to provide temporary relief to individuals who reside in Licensed and Unlicensed AFLs, but it may not be billed on the same day as Residential Supports. Please feel free to share widely with your networks. 
  • Transportation to and from the residence and points of travel in the community as outlined in the PCP or ISP is included to the degree that they are not reimbursed by another funding source and not used for personal use.  

HCBS Stakeholder Updates

Below are HCBS updates from the DHHS HCBS Internal Team. 

  • County Transitions
  • The DHHS HCBS Internal Team continues to support with transitioning counties within the HCBS Database for HCBS Provider Self-Assessments per the DHHS approved county transition date. 
  • HCBS Database
  • Additional updates were made to support overall functionality for the LME-MCO and CAP-DA reviewing entities. These include:
  • Adding an additional option for possible reasons an HCBS Provider Self-Assessment is being archived to account for HCBS employment settings that are no longer being utilized. 
  • Adding a color key to the review all page of the HCBS Database to assist reviewers in identifying the current status of an HCBS Provider Self-Assessment.
  • Creating a Heightened Scrutiny Assessment History Page to ensure Heightened Scrutiny review information is maintained.
  • Updates in process:
  • The ability to track HCBS setting demographic information changes when an HCBS Residential setting changes from unlicensed status to licensed
  • The ability to mass archive
  • Duplicate information notification
  • HCBS Validation
  • North Carolina is currently 73.02% validated statewide.
  • Due to delays caused by the COVID-19 pandemic, DHHS is amending the Statewide Transition Plan to include a virtual telehealth monitoring option to support North Carolina reaching 100% validation by March 17, 2023.
  • The DHHS HCBS Internal Team met with CMS on 9/29/21 to discuss options and is drafting the update to the Statewide Transition Plan prior to submitting for CMS approval.
  • DHHS HCBS Validation Look-Behind
  • Quarter 1: CLOSED
  • Quarter 2: In process
  • 4 LME-MCOs CLOSED
  • 2 LME-MCOs OPEN
  • 1 LME-MCO and CAP-DA N/A (no sample sites selected)
  • Quarter 3: In process
  • 7 LME-MCOs OPEN
  • CAP-DA OPEN
  • Quarter 4: List of sample sites as well as needed replacements sites will be generated following the close of Quarter 2 and Quarter 3. 
New CCNC Primary Care Case Management Agreement
This week or shortly thereafter, NC Carolina Community Care Networks (CCNC) will send a new primary care case management (PCCM) agreement to primary care providers who serve NC Medicaid Direct beneficiaries. In addition to providing PCCM services, CCNC also shares quality measure results with Carolina Access practices for beneficiaries enrolled in NC Medicaid Direct, such as well-child visits and immunizations.
 
Important: For a Carolina Access practice to receive or continue to receive practice assignment data or quality data it must sign the new 2-Party Agreement with CCNC.
 
More information is available in this October 11 NC Medicaid Bulletin.
 
 New Medicaid Bulletin Available as of Oct. 12, 2021
The NC Division of Health Benefits (DHB) has recently published a new Medicaid Bulletin article:
 
Prior Approval Requirements Resume for Children’s Developmental Services Agency Providers
With the exception of behavioral health services, effective Oct. 15, 2021, Children’s Developmental Services Agencies (CDSAs) and independent practitioners providing individualized family service plan (IFSP) services are required to resume the submission of prior approval (PA) requests to the applicable NC Medicaid vendor. More information
 
 
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage
From 10 to 25 is a new, collaborative storytelling card game designed to build understanding about adolescence and what we can all do to support adolescent development.
Together with many partners, the FrameWorks Institute and the UCLA Center for the Developing Adolescent are working to change the narrative about adolescent development. Last year, FrameWorks launched a toolkit to help communicators advance well-framed information to help their audiences understand, support, and demand policies that would improve the lives of all adolescents. Today we’re sharing a new, different kind of resource for engaging people in an immersive, compelling, and fun experience that reframes their understanding of adolescence.
From 10 to 25 is a collaborative storytelling card game about adolescent discovery. We designed this game to be played by adults who have influence on the lives of young people. Players take on the role of a young person making their way through adolescence (ages 10 to 25).
As you play, you’ll combine life experiences with relationships and resources to tell a story about growing up. The game builds understanding of what adolescence is, why it's such an important time, and what young people need to do well on the journey to adulthood, especially when they face systemic injustices.
Today we’re asking you to do 3 things:
  •  Play the game. Play with your colleagues and stakeholders. Play with teachers, administrators, and school board members. Play with elected officials, policymakers, researchers, community organizers, and advocates. Build the game into an event you’re planning. 
  • Send a testimonial about your game experience to [email protected]
  • Share photos of you playing on social media and tag @FrameWorksInst and @develadolescent

The game can be played in-person or virtually. Visit from10to25.org to find game instructions, play online, and request card decks.

Thank you for being a partner in this work. We hope you find this game to be a useful tool in your outreach, engagement, and advocacy on behalf of adolescents. If you have any questions, don’t hesitate to email us. We look forward to seeing how you play!
Our new study with the Health Workforce Research Center on Long-Term Care at UCSF examines COVID-displaced workers.

We work with individual states to create a tailored direct care workforce strategy rooted in our field’s best thinking.

PHI's Stephen McCall explains what our new research shows about direct care workers during the first year of COVID-19. 

Please join an October 19 virtual panel of state and national experts discussing the direct care landscape. Register here. 
Malnutrition in Hospitalized Adults
Main Points
  • Association Between Malnutrition and Clinical Outcomes
  • Patients requiring intensive care unit (ICU) care and diagnosed with malnutrition (using Subjective Global Assessment [SGA]) may have higher hospital mortality compared to well-nourished patients requiring ICU care.
  • Patients requiring ICU care and diagnosed with malnutrition (using SGA) are likely to experience prolonged hospital length of stay compared to well-nourished patients requiring ICU care.
  • Patients requiring ICU care and diagnosed with malnutrition (using Mini Nutritional Assessment [MNA]) may experience more hospital acquired complications compared to well-nourished patients requiring ICU care.
  • Patients hospitalized due to traumatic injury and screened at risk of malnutrition (using Nutritional Risk Screening [NRS]-2002) may experience more hospital acquired conditions compared to well-nourished patients.
  • Patients hospitalized with heart failure and diagnosed with malnutrition (using several different measurement tools) may have higher mortality compared to well-nourished patients with heart failure.
  • Patients hospitalized with cancer and diagnosed with malnutrition (using SGA) may experience prolonged hospital length of stay compared to well-nourished patients.
  • Patients hospitalized with cirrhosis awaiting transplantation and diagnosed with malnutrition (using SGA) may have higher pre-transplant mortality compared to well-nourished patients.
NEWS FROM THE FIELD: Scientists Discover Brain Cells That Compete to Sustain or Suppress Traumatic Memories
Two clusters of brain cells compete to promote either the persistence or disappearance of traumatic memories, according to a new study conducted in mice. The findings could provide important insights into human conditions—such as posttraumatic stress disorder (PTSD), anxiety disorders, and associated problems such as alcohol use disorder (AUD)—that can arise from the persistence of traumatic memories.
In the largest genome-wide association study of bipolar disorder to date, researchers found about twice as many genetic locations associated with bipolar disorder as reported in previous studies. These and other findings help improve our understanding of the biological origins of bipolar disorder.
Brain activity patterns after trauma may predict long-term mental health
Study shows link between post-trauma brain activity and symptoms of anxiety, PTSD six months later.

The way a person’s brain responds to stress following a traumatic event, such as a car accident, may help to predict their long-term mental health outcomes, according to research supported by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. The research, published in the American Journal of Psychiatry, is part of the NIMH-funded AURORA study(link is external), a large-scale, multisite study that followed more than 3,000 people for up to a year after exposure to a traumatic event.
Mental Health: Social Media & the Workplace 
The COVID-19 pandemic and its resulting changes in daily life have negatively impacted Americans’ mental health while also creating new barriers for seeking help. Between 2019 and 2021, addressing mental health challenges at work underwent a normalization process. There is also increasing awareness of the mental health impact of social media on youth. 

Initiatives & Resources:
  • Horizon Blue Cross Blue Shield of New Jersey launched a virtual program that provides evidence-based treatment for eating disorders, the second deadliest mental health condition.
  • NIHCM Grantee, WBUR, released Pandemic Generation, exploring COVID-19’s impact on the mental health of children and young adults.
Health Care Workers & Caregivers 
Nationally, the demand for health care workers has often outweighed the supply; this trend has been exacerbated by COVID-19. Since the start of the pandemic, nearly two years ago, 18% of health care workers have quit, citing COVID-19, poor pay, burnout, and vaccination mandates and 12% have been laid off.
  • Shortages: In health care, 79% of workers reported that the shortage has impacted them and their workplace. Staffing shortages may force 78% of nursing homes to close and the disability community is facing staffing challenges, due mainly to low wages and burnout.
  • Mandates: As vaccine mandates begin to roll out nationwide, employers fear they could make staffing even more difficult. With the CDC’s recent guidance that pregnant women should receive the COVID-19 vaccine, it is unclear whether or not pregnant health care workers will be exempt. 

Initiatives & Resources:
Upcoming Events
New: Monday, October 18, 2021
NCCDD Hosts Virtual Forum on North Carolina's Draft Olmstead Plan! 


Time: 2:00 pm thru 3:00 pm
  
Tuesday, October 19, 2021
Federal Level Advocacy

Time: 9:00 am thru 11:30 am
  
Tuesday, October 19, 2021
How Should States Invest in the Direct Care Workforce?

Time: 2:00 pm thru 3:00 pm
  
Wednesday, October 20, 2021
The Science of Scaling-Up High-Quality Early Childhood Programs

Time: 2:00 pm thru 3:00 pm
  
New: Wednesday, October 20, 2021
Interactive Monthly Update

Time: 2:00 pm thru 3:00 pm
  
Thursday, October 21, 2021
Benchmarks' Child Welfare Webinar with Karen McLeod and Lisa Cauley

Time: 8:00 am thru 9:00 am
  
New: Thursday, October 21, 2021
Back Porch Chat: Medicaid Managed Care Hot Topics

Time: 5:30 pm thru 6:30 pm
  
Tuesday, November 2, 2021
NC Children with Complex Needs Training Series

Evidence-Based and Promising Practices to Support the Workforce and Partners Serving Individuals with Mental Illness and Intellectual and Developmental Disabilities

Session 3: Psychopharmacology for Children with Complex Needs: 1.5 Contact Hours

Time: 10:00 thru 11:30 am