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Reports - Health and Human Services
North Carolina Needs to Strengthen Its System for Monitoring and Preventing the Abuse of Prescribed Controlled Substances (April 2014) 2014-05

In North Carolina, there are four mechanisms to monitor and prevent the abuse of prescribed controlled substances: oversight of prescribers and dispensers, the Controlled Substances Reporting System (CSRS), Medicaid lock-in, and law enforcement. Currently, prescribing guidelines and continuing education requirements for prescribers are insufficient. The CSRS is underutilized and lacks important features for security and data analysis. Meanwhile, the lock-in program has been non-operational since July 2013, costing the Medicaid program an estimated $1.3 million to $2 million. The General Assembly should direct the development and adoption of statewide prescribing guidelines and require continuing education, and should also direct the Department of Health and Human Services to modify the contract for the CSRS to improve performance, improve the effectiveness of the Medicaid lock-in program, and develop a strategic plan and performance management system.

Executive Summary

Final Report

Presentation

Handouts

Options for Creating a Separate Department of Medicaid Require Transition Planning (March 2013) 2013-03

The Department of Health and Human Services (DHHS) is the single state agency responsible for the Medicaid Program and must operate within federal guidelines. DHHS has broad flexibility to manage the Medicaid Program and has delegated Medicaid administrative functions to the Division of Medical Assistance, other DHHS divisions and offices, other state agencies, and local government agencies. Based on experiences in other states, options exist for changing the organizational structure of the North Carolina Medicaid Program including a Department of Medicaid, a Medicaid Program Authority, and a Department of Health Services. Creating a new Medicaid agency in North Carolina has implications for the Medicaid Program, DHHS, and statewide business functions and would require a 12 to 18 month transition period.

Executive Summary

Final Report

Presentation

Handout

The Division of Public Health Should Remain in the Department of Health and Human Services. (January 2013) 2013-01

North Carolina's public health system is an intricate network of partnerships between the Division of Public Health and local health departments, state agencies and universities, and other entities. North Carolina's public health system is seen as a model, but the State ranks in the bottom half of states for health outcomes because of high risk factors. The General Assembly should establish the North Carolina Public Health Council to develop a government-wide action plan and direct the Division of Public Health to explore ways to increase regionalization, improve the use the data, and strengthen quality improvement activities.

Executive Summary

Final Report

Presentation

Handout

Statutory Changes Will Promote County Flexibility in Social Services Administration (May 2011) 2011-03

North Carolina is one of 11 states providing social services programs through a state-supervised and county-administered system. Five alternative structures for administering social services programs could improve efficiency and reduce administrative costs for counties, but statutory and perceived barriers inhibit counties from considering different structures. Administering programs at the county level is considered a major strength of North Carolina’s social services system. The General Assembly should eliminate the population threshold to establish a consolidated human services agency, authorize district departments of social services, and direct the Department of Health and Human Services to develop a plan to simplify and streamline supervision of county departments of social services.

Executive Summary

Final Report

Presentation

Handout

Enhanced Services Package Implementation: Costs, Administrative Decision Making, and Agency Leadership
(July 2009)
2009-02

This follow-up to the Division's July 2008 report, Compromised Controls and Pace of Change Hampered Implementation of Enhanced Mental Health Services, examines expenditures, decision-making, and leadership associated with implementation of the Enhanced Services Package. Findings indicated a total of $2.4 billion was spent on enhanced services from April 2006 through February 2009, $827.2 million of which was North Carolina's share of the costs. Analyses suggest effective planning and better oversight could have avoided costs of $498.5 to $635.3 million, of which $177.4 to $226.2 million would have been North Carolina's share of the avoided costs.

Executive Summary

Final Report

Presentation

Handouts

Caring for Previously Hospitalized Consumers: Progress and Challenges in Mental Health System Reform
(December 2008)
2008-12-04

Building on the July 2008 Program Evaluation Division process evaluation, this report examines services delivered by the North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services after system reform. Analyses of services received by 22,516 individuals previously hospitalized in substance abuse or psychiatric facilities suggest that gaps in community-based services persist among those discharged from state-operated facilities, and among individuals with a history of one, versus multiple, hospital discharge. Individualized tracking across facilities, service types, and funding sources is needed to improve continuity of care and to generate comprehensive statewide data. System oversight and management should focus on increasing capacity and quality of community-based services.

Executive Summary

Final Report

Presentation

Handouts

Controlling the Cost of Medicaid Private Duty Nursing Services
(December 2008)
2008-12-05

The North Carolina Medicaid Program covers private duty nursing—medically necessary continuous, complex, and substantial nursing services provided by a licensed nurse in a recipient’s home. Under federal law, private duty nursing is an optional Medicaid service for adults and a required Medicaid service for children. The Division of Medical Assistance should adopt the cost-containment mechanisms used by other states for its private duty nursing benefit for adults. The Division of Medical Assistance should modify the Community Alternatives Program for Children, which is subject to budget limits, to encourage use of the waiver program by children in need of continuous skilled nursing.

Executive Summary

Final Report

Presentation

Handouts

Compromised Controls and Pace of Change Hampered Implementation of Enhanced Mental Health Services
(July 2008)
2008-05-03

Since 2006, the state has struggled to implement a new array of mental health, developmental disabilities, and substance abuse services. Several factors contributed to implementation problems, including the pace and scope of implementation, insufficient forecasting and monitoring, and lack of information about system performance. The Department of Health and Human Services should collaborate with other stakeholders to re-evaluate what information is needed about system performance, how it is collected, and how it is presented. Additionally, the evaluation recommends focusing analytic efforts within one specific office of the Division of Mental Health, Developmental Disabilities and Substance Abuse Services to ensure consistency, depth, and quality of analysis.

Executive Summary

Final Report

Presentation

Handouts

Program Evaluation Division, North Carolina General Assembly
Legislative Office Building, Suite 100
300 North Salisbury Street , Raleigh, NC 27603-5925
919-301-1404