NORTH CAROLINA

In 2003, the North Carolina Department of Health and Human Services (DHHS) issued two plans that are directly responsive to Olmstead mandates.

• Serving People with Disabilities in Appropriate Settings: The North Carolina Plan-Final was released in April 2003. The plan is available at http://www.dhhs.state.nc.us/docs/olmstead.htm. The April 2003 plan builds on work released in an interim Olmstead plan issued in December 2000. (A link to the interim plan is on the Web site.)
• The second plan, released in July 2003, is Blueprint for Change: State Plan 2003-North Carolina's Plan for Mental Health, Developmental Disabilities and Substance Abuse Services. It builds on a plan first issued in 2001 in response to a legislative mandate for a change in the state's mental health, developmental disabilities and substance abuse system. An update to the plan is published each July. The July 2003 plan is available at http://www.dhhs.state.nc.us/mhddsas/stateplanimplementation/index.html#draftstateplan. (The Web site also includes links to earlier documents.)

The DHHS Web site says of the two plans issued in 2003, "While Olmstead issues cover more than mental health, substance abuse and substance abuse services, the mental health plan and the Olmstead plan should be consistent where they overlap. "

The April 2003 plan, Serving People with Disabilities in Appropriate Settings: The North Carolina Plan-Final, identifies seven areas that are critical to development of a plan to meet Olmstead requirements.

1. Outreach to inform potential candidates for community-based services about their options and choices (also referred to as informed choice);
2. Assessment and identification of appropriate candidates for community placement;
3. Development of service plans for community transition;
4. Operation of waiting lists;
5. Inventory of existing community-based resources and supports;
6. Identification of needed community resources to support community integration; and
7. Ongoing monitoring and quality assurance efforts.

For each of the seven areas, the plan sets forth short-term and longer-term actions for appropriate response to the issue area.

The plan provides illustrations of the state's activities to move individuals to the least restrictive settings. Activities cited include a reduction of the census in state psychiatric hospitals, an increase in the number of people served through Independent Living programs, a reduction in the residential census in mental retardation centers, and a rate of growth in Medicaid-funded home and community-based waiver expenditures that exceeds the growth rate in nursing home expenditures.

Although the plan is labeled final, its authors say that the plan "... would not be a static instrument, but rather a guide with provisions for periodic evaluation and adjustment."

The July 2003 Blueprint for Change provides an update of activities that have been accomplished and strategies that will be undertaken in the upcoming year. Among the major themes of the plan are:

1. Including people with disabilities in decision making;
2. Providing choice to consumers and their families;
3. Focusing on practices that provide positive outcomes for consumers;
4. Serving people in community settings; and
5. Engaging in continuous quality improvement.

The plan discusses achievements during the past year, including clarification in policies for local business plans, cost modeling, provider qualifications, information systems, and training and education. A new element of the 2003 plan is an operations that plan focuses on management and leadership, finance, programmatic issues, and administration and contracts. Each of the four areas has an associated specific set of tasks.

In 2001, North Carolina received a Systems Change grant totaling $1.6 million. CMS's summary of the grant identifies its goals as 1) reducing institutional bias and 2) improving the size, stability, and quality of the state's direct care work force.