Bill Update for the Week of May 23

Legislation With Activity This Week:

HB 115, North Carolina Health Benefit Exchange Act (Dockham, Brubaker, Wray, Murry Sponsors). HB 115 seeks to establish a Health Benefit Exchange to make available qualified health benefit plans beginning in 2014. This bill creates a version of the exchange that is governed by a board that includes insurers as voting members and is lacking in consumer protections. HB 115 passed the House this week with bipartisan support in an 83-34 vote. An amendment added to the bill adds language regarding the necessity of a conflict of interest policy but still allows current insurance company employees to serve on the board. The bill will now be referred to a Senate committee.




HB 188, Taxpayer Bill of Rights (Blust, Killian, Holloway, Dollar Sponsors). The bill seeks a constitutional amendment that would limit state spending to population growth plus inflation. Even though health care and other costs are increasing much faster than the overall inflation rate, the state could not adjust its spending to keep pace, which would result in massive cuts to healthcare and support services. HB 188 was heard but not voted on in the Judiciary A committee this week. The Treasurer’s office spoke against the bill, along with the Justice Center, but broad public comment in opposition was not allowed.



HB 233, Department of Correction/Ex-Offenders (Pierce, Bryant, M. Alexander, Frye Sponsors). This bill was a recommendation of the Joint Select Committee on Ex Offender Reintegration into Society. HB 233 designates the Department of Correction (DOC), Office of Research and Planning (ORP), as the single State agency responsible for the coordination and implementation of ex-offender reentry policy initiatives, including the StreetSafe Task Force, the Justice Reinvestment Initiative of the Council of State Governments (CSG), and the recommendations of the Joint Select Committee on Ex Offender Reintegration into Society. HB 233 received a favorable report from the House Government committee this week. It will next be voted upon by the full House.



HB 474, Protect Adult Care Home Residents (Weiss, Hollo, Farmer-Butterfield, Earle Sponsors). HB 474 proposes changes to Chapter 131D governing adult care homes to increase minimum continuing education, training, competency evaluation and inspection requirements for Adult Care Home medication aides, related to Infection Control Requirements. The House concurred in the Senate committee substitute this week and it now proceeds to the Governor for her signature.



HB 618, Streamline Oversight/DHHS Service Providers (Lewis and Hurley Sponsors). HB 618 seeks to streamline duplicate oversight of DHHS service providers through recommendations of a task force that would include Disability Rights NC. The bill was scheduled for a vote in the full House this week but was withdrawn from the calendar and re-referred to the House Appropriations committee.



HB 623, Eliminate Agency Final Decision Authority (McCormick, Stevens, Cleveland, Glazier Sponsors). HB 623 would remove final decision making authority from agencies in contested cases under Chapter 150B, including Medicaid appeals. HB 623 passed the full House this week after 2 amendments were made on the floor. One amendment addressed Article 3A hearing procedures (which governs “other” administrative hearings regarding agencies like the department of insurance, the building code council and the banking commission). The second amendment added language to the bill directing DHHS to seek a waiver from the single state agency requirements, which will ensure that the Medicaid appeals process continues to comply with federal law and CMS requirements.



HB 656, Photo ID for Certain Controlled Substances (Guice, Ingle, Faircloth Sponsors). HB 656 seeks to direct pharmacies to require photo identification prior to dispensing Schedule II Controlled Substances. Schedule II includes a number of drugs for pain relief, as well as any drug that contains amphetamine (like Adderall). A committee substitute received a favorable report from the House Judiciary B committee this week.



HB 823, Governance of the Dep’t of Public Instruction (Holloway, Hilton, Brubaker, Blackwell Sponsors). The legislation proposes a constitutional amendment that voters would decide in 2012. It would make the state superintendent of schools a voting member of the State Board of Education and give the House and Senate appointments to the board, among other changes. The bill, approved in a 106-10 vote, now heads to the Senate.



SB 316, Additional Section 1915 Medicaid Waiver Sites (Hartsell Sponsor). SB 316 authorizes DHHS to allow additional 1915 (b)/(c) Medicaid waiver sites and to allow third-party billing for state facilities. This would allow further expansion of 1915(b)/(c) waivers beyond PBH, Mecklenburg and Western Highlands, without legislative approval. The Senate concurred with the House amendment this week and the bill now proceeds to the Governor.



SB 512, Adult Day Care/Overnight Respite Program (Clary). SB 512 directs the Department of Health and Human Services to conduct a pilot program to assess the provision of overnight respite services in adult day care programs. The bill received a favorable report from the House Health and Human Services committee this week, as well as approval from the full House, and ratification by the Senate. It now proceeds to the Governor for her signature.



Coming Up Next Week:



HB 916, Statewide Expansion of 1915(b)/(c) Waiver (Barnhart, Burr, Insko Sponsors). HB 916 is scheduled to be heard in the House Health and Human Services committee on Tuesday at 10 am. HB 916 seeks to have the waiver statewide by July 1, 2013, and sets out specific requirements for the expansion of this managed care behavioral health Medicaid waiver: accountability for the development of a local system that ensures easy access to care, availability and delivery of necessary services, and continuity of care; fidelity to the PBH model; designate entities to manage the waiver through either merged LMEs or through interlocal agreement among LMEs; use of managed care strategies to reduce escalating costs in Medicaid while ensuring medically necessary care and deploy a system for the allocation of resources based on reliable assessment of intensity of need; phase out the CAP-MR/DD waiver; and design the Innovations waiver to serve the maximum number of individuals with intellectual and developmental disabilities within aggregate funding. It also specifies that county governments will not be financially liable for overspending or cost overruns associated with the operation of the waiver (i.e., the risk doesn’t shift). HB 916 specifies a number of conforming statute changes regarding the size of LMEs. Section 4 also exempts the Department from rulemaking in implementing, operating, or overseeing new Medicaid waiver programs or amendments to existing Medicaid waiver programs. For DRNC’s updated position paper on the 1915 b/c waiver, please click here.

BTC Proposes Reform to North Carolina’s Tax and Revenue System

by Holly Safi

People with disabilities in North Carolina are facing drastic cuts in funding to important services, $2 Billion from Medicaid alone. North Carolina’s 2012 revenue is expected to be $2.4 billion less than it needs to maintain the current level of expenditures. Under the existing tax structure the poorest North Carolinians pay a significantly greater percentage of their income to state and local taxes than do the wealthiest. Simply cutting funding, as proposed in the recent House and Senate budgets, is a short-term solution that will harm those with the greatest needs now and the NC economy in the long run.

The North Carolina Budget & Tax Center (BTC), a project of the North Carolina Justice Center, has developed a progressive plan to reform the NC system of revenue and taxation to ensure it will be equitable among its citizens and businesses, adequate to fund necessary public structures and investments, and stable enough to survive downswings of the economy. The BTC estimates that this plan could raise $1.3 billion in revenue over the next fiscal year. Some highlights of this plan are as follows:

Personal Income Tax Reform (anticipated benefit of $634 million)
• Increase the number of income tax brackets from three with rates of 6.00%, 7.00%, and 7.75% to six with rates ranging from 5.00% at the lowest bracket to 8.50% for the top bracket.
• Calculate taxable income based on adjusted gross income instead of federal taxable income which includes various deductions.
• Significantly increase the standard deduction but eliminate other deductions and credits except mortgage interest, medical expenses, and charitable contribution itemized deductions.
• Allow a 3% credit of either the standard deduction or the total of the three allowed itemized deductions to give a standard tax benefit to all income levels.
• Double the state Earned Income Tax Credit and merge the child tax credit and personal exemption into a $180 per-person credit so that tax benefits increase with family size, not income.

Sales Tax Reform (anticipated benefit of $500 million)
• Current sales tax that taxes primarily goods falls heaviest on the poor who tend to buy goods rather than depend on services.
• Decrease the state sales tax from 4.75% to 3.75%
• Expand the state sales tax to incorporate most consumer services.

Business Tax Reform (anticipated benefit of $202 million)
• Require multi-state corporations to file one single tax return rather than shifting their profits to states with lower taxes.
• Stop preferential treatment of LLCs and tax them the same as other corporations.
• Eliminate other “privilege” taxes that have shown ineffective in job creation.

Tax Expenditure Reform (anticipated benefit difficult to measure)
• Tax expenditures are funds that are “spent” by not collecting them in the first place: credits, deductions, exemptions, etc. They often do not get continued review of necessity and/or effectiveness once they are enacted.
• Give tax expenditures the same rigorous scrutiny as appropriations during each budget cycle.

Read the report for yourself here.

Senator Burr Co-sponsors Medicaid Improvement and State Empowerment Act

Another proposal to reform Medicaid from our own Senator Richard Burr.  The text of the bill is not yet available but will be posted online within the next few days.  The press release regarding the legislation is below. 

May 19, 2011 Thursday
PRESS RELEASE
SENATORS BURR, COBURN INTRODUCE BILL TO REFORM AND STRENGTHEN MEDICAID
Contact: David Ward (Burr) (202) 228-1616

WASHINGTON, D.C. - Today, U.S. Senators Richard Burr (R-North Carolina), Tom Coburn (R-Oklahoma), and Saxby Chambliss (R- Georgia) introduced the Medicaid Improvement and State Empowerment Act, a bill that will reform the Medicaid program to improve care for patients and empower states with the flexibility and financial predictability that they need to strengthen their programs.

"This bill is an important first step in reforming our nation's health care system and fixing our broken entitlement programs," Senator Burr said. "States have a proven track record of being able to adopt innovative solutions to improve patient care. By giving them more control over their own Medicaid programs, we are allowing states to innovate and better meet their needs and, most importantly, the health care needs of their patients."
"If entitlement programs like Medicare, Medicaid and Social Security are not reformed they won't be able to provide promised benefits. It is that simple. Seniors and low-income Americans need Washington to produce solutions, not attack ads. Our broken Medicaid program shows that access to a government health care program does not guarantee access to health care. Our bill will help fix a program that denies patients' access to 40 percent of doctors," Dr. Coburn said. "The path to fiscal sustainability begins with the reform of our nation's entitlement programs," said Senator Chambliss. "The Medicaid Improvement and State Empowerment Act will give states such as Georgia the flexibility to design programs specifically tailored to support our most vulnerable beneficiaries and allow them the control to effectively plan for future budgets decisions."
Currently, Medicaid, a program rife with issues of waste and abuse, promises coverage to patients, but this promise does not result in access - 40% of physicians deny access to patients in this program. Additionally, states do not have the needed flexibility to make basic improvements to their programs, and are often forced to make drastic cuts to provider reimbursements, which further limit patients' access to care.
The Medicaid Improvement and State Empowerment Act frees states from bureaucratic red tape and empowers them to immediately make reforms that will improve care for patients. It repeals the new health care law and the maintenance of effort requirement contained in the stimulus, and transitions from the current FMAP model to a health grants model that provides medical assistance for low-income Americans and long-term care services and supports for low-income elderly and disabled individuals. The bill maintains the current FMAP model for acute care for dual eligible and disabled individuals; however, states are given the flexibility to enroll these patients into managed care.

Bill Update for the Week of May 16

HB 115, North Carolina Health Benefit Exchange Act (Dockham, Brubaker, Wray, Murry Sponsors). HB 115 seeks to establish a Health Benefit Exchange to make available qualified health benefit plans beginning in 2014. This bill creates a version of the exchange that is governed by a board that includes insurers as voting members and is lacking in consumer protections. HB 115 was scheduled to be voted on in the full House last week but was postponed until May 25. Given the opposition to the bill from both ends of the political spectrum - consumer advocates, including Disability Rights NC, and the John Locke Foundation at the other end, members may be re-thinking their support of their Insurance industry-backed bill. Click here for an article on the status in the News & Observer.

HB 474, Protect Adult Care Home Residents (Weiss, Hollo, Farmer-Butterfield, Earle Sponsors). HB 474 proposes changes to Chapter 131D governing adult care homes to increase minimum continuing education, training, competency evaluation and inspection requirements for Adult Care Home medication aides, related to Infection Control Requirements. The bill passed the full Senate last week, and is now back in the House for concurrence.

HB 493, Landlord Tenant Law Changes (Howard, Blust, Randleman Sponsors). HB 493 as originally filed sought to greatly weaken certain rights & protections of tenants. However, the bill has been modified to make clear that If the tenant fails to make rental payments during an appeal, as provided in the undertaking within five days of the day rent is due under the terms of the residential rental agreement, the clerk of superior court shall, upon application of the landlord, immediately issue a writ of possession, and the sheriff shall dispossess the tenant; raises the value of personal property that may be donated or disposed of after a tenant abandons or has been ejected; modifies the permitted uses of the deposit; and makes small changes to the laws on vacation rentals regarding cleaning fees. You may remember from last week’s post that the bill was postponed in the House while members sought an ethics opinion on whether any member who is a landlord has a conflict of interest with respect to the bill. After assurances on the issue, the bill passed the House unanimously. It has now been referred to the Senate Judiciary II committee.

HB 618, Streamline Oversight/DHHS Service Providers (Lewis and Hurley Sponsors). HB 618 seeks to streamline duplicate oversight of DHHS service providers. A Proposed Committee Substitute, supported by Disability Rights NC, was approved by the House Health and Human Services Committee last week, and is scheduled to be heard by the full House this week. The new version sets up a task force that includes advocates, consumers, providers, and legislators to make recommendations to align oversight of DHHS providers. There was an amendment in the committee to add 2 additional members to the Task Force - one who is a member of the NC Providers Council, and one member of the NC Psychiatric Assn. Some concerns have been raised that this now shifts the balance of membership on the committee toward providers, and away from advocates. The Senate version, SB 525, passed the full Senate last week and has been referred to the House Appropriations committee.


HB 623, Eliminate Agency Final Decision Authority (McCormick, Stevens, Cleveland, Glazier Sponsors). HB 623 would remove final decision making authority from agencies in contested cases under Chapter 150B, including Medicaid appeals. The legislation would affect all agencies - everything from personnel to permit disputes. The bill was schedule to be voted on in the full House last week but was postponed to allow the sponsors additional time to work with those parties who have concerns about the bill. It is scheduled to be heard tomorrow night in the House.

HB 658, Change Early Voting Period (Jones, Stam, Colins, Sager Sponsors). HB 658 seeks to shorten the early voting period by a week (by delaying the start of early voting from the third Thursday before an election to the second Thursday). The bill passed the House on 3d reading last week by a 60-58 vote, after adopting an amendment offered by Rep. Jones that would keep early voting sites open later, allowing people who get off work at 5 p.m. more time to vote. Six Republicans (Guice, Faircloth, Jordan, Lewis, McGrady and Torbett) joined 52 Democrats in voting against the bill. The bill now goes to the Senate.


SB 316, Additional Section 1915 Medicaid Waiver Sites (Hartsell Sponsor). SB 316 authorizes DHHS to allow additional 1915 (b)/(c) Medicaid waiver sites and to allow third-party billing for state facilities. This would allow further expansion of 1915(b)/(c) waivers beyond PBH, Mecklenburg and Western Highlands, without legislative approval. SB 316 received a favorable report from the House Health and Human Services committee this week, where Sponsor Senator Hartsell referred to this bill as the "Free PBH" bill because the bill's main purpose is to allow PBH to expand its geographic coverage area. The bill was then voted upon favorably by the full House, where an amendment was passed to add the language directing the department to consult with stakeholders before approving additional sites. 15 members voted against the bill on 2d reading (Alexander, K.; Bell; Brandon; Bryant; Cotham; Earle; Floyd; Graham; Hall; Hamilton; Harrison; Jackson; Mobley; Parmon; Weiss) and on 3d (Alexander, K.; Bell; Brandon; Cotham; Earle; Graham; Hall; Hamilton; Harrison; Jackson; McGuirt; Mobley; Moore, R.; Parmon; Weiss). The bill will now proceed back to the Senate for concurrence.

SB 384, Conforming Changes/Persons with Disabilities Act (Hartsell). This is a Disability Rights NC agenda bill. It seeks to amend the North Carolina Persons with Disabilities Protection Act to conform to the Americans with Disabilities Amendments Act of 2008. The bill received a unanimous favorable report in the House last week and is now awaiting the Governor’s signature.

SB 512, Adult Day Care/Overnight Respite Program (Clary). SB 512 directs the Department of Health and Human Services to conduct a pilot program to assess the provision of overnight respite services in adult day care programs. The bill passed the full Senate last week and has now been referred to the House Health and Human Services committee.

SB 595, Voter Identification At Polls (Clary). SB 595 is the Senate version of the Voter ID bill (which is different from the House Voter ID bill, HB 351, which is awaiting a hearing in the House Appropriation committee). SB 595 would require voters to produce valid photo identification in order to vote. It would also require county boards of elections to make voter identification cards including a photo and other personal information available, without a fee, to any voter who does not have a valid driver’s license or state identification card. This bill would allow for voters without the required identification to vote a provisional ballot. The bill would also waive the fee for Special Identification Cards produced by the DMV for those who are blind, over age 70, homeless, or lack other valid photo identification but are registered to vote. The bill was discussed on Tuesday in the Senate Judiciary I committee. There was no public comment and no vote. Senator Tillman suggested the addition of a Medicaid card as a form of ID. There has been a fiscal memo of $3.1 mil but it doesn't include education costs. There has been speculation that the Senate scheduled this hearing in order to prompt the House to move on its version of Voter ID.

Proposals for Medicaid, Medicare, and Social Security Changes

by Holly Safi
Recently the national debt has received bipartisan attention in Washington. The current federal debt is rising faster than revenue such that, by 2025, revenue may be exhausted each year just to pay interest on debt and to fund Medicare, Medicaid, and Social Security. Two proposals have emerged. Here are some highlights of how each plan would affect some of the programs people with disabilities rely on most:

The House Commission on the Budget “Ryan” Plan, expected savings of $6.2 trillion:
• Medicaid changes to a “block grant” program where each state will receive a set amount of funding based on population growth and inflation. Beginning in 2022, Medicaid will no longer provide acute care for the elderly.
• Medicare changes to a “premium support model” where those eligible would shop a federally-managed exchange of private insurance plans and the government would provide a set grant to the insurer to assist the beneficiary in paying the premium for the plan. In addition, the eligible age for Medicare will increase to 67 by 2033.
• SNAP, SSI, unemployment would be part of a larger group of services that will have funding cut in half by 2021.
• Repeal some provisions of the Affordable Care Act (ACA), including the Medicaid extension and the CLASS Act.
• Increase the Dept. of Defense budget to $692.5 billion ($680 billion in 2010).
• Does not fundamentally change Social Security.

The National Commission on Fiscal Responsibility and Reform Plan , expected savings of $4 trillion:
• Establish a long-term budget for total federal health-care spending, limited to the GDP growth plus 1% each year.
• Place dual eligibles (Medicaid/Medicare) in a Medicaid managed care plan and extend the Medicaid drug rebate to them.
• Establish a single combined annual deductable for Medicare Plan A & B, while restricting Medicare supplemental insurance.
• Keep most of the ACA, except to repeal or reform the CLASS Act
• Lift the cap on taxable income for Social Security and increase the Normal Retirement Age to 68 by 2050, 69 by 2075.
• Repeal the Bush Administration’s tax cuts and reduce the Dept. of Defense budget $400 billion by 2023.
• Does not fundamentally change SNAP, SSI, unemployment.

The Fiscal Commission plan reduces spending in some areas but increases spending in others. The Ryan plan drastically reduces spending, but the Medicaid program that currently provides 60 million Americans with medical care, long-term care, and in-home care for people with disabilities will be cut by $1.4 trillion dollars over 10 years. In North Carolina alone, this could affect 514,000 seniors and people with disabilities on Medicaid, 112,000 direct care workers, and 1.7 million informal caregivers. In addition, Medicare that provides coverage for 47 million seniors and people with disabilities will be cut by $30 billion over a 10 year period. Families USA estimates that 45.6 million children and 7.6 million seniors would lose crucial health care under the Ryan plan.

Read more about the plans at the following links:
The Ryan Plan
The National Commission's Plan
Families USA Special Report
Families USA Special State Report on North Carolina

Bill Update for the Week of May 9

Updates on Bills with Activity Last Week:

HB 115, North Carolina Health Benefit Exchange Act (Dockham, Brubaker, Wray, Murry Sponsors). HB 115 seeks to establish a Health Benefit Exchange to make available qualified health benefit plans beginning in 2014. This bill creates a version of the exchange that is governed by a board that includes insurers as voting members and is lacking in consumer protections. For more information from AAPD about state health benefit exchanges, see post here. After several weeks in House Insurance, this bill moved through two House committees last week, receiving favorable reports from the House Insurance and Appropriations committees. Despite numerous concerns raised, the bill passed both committees with bipartisan votes. The bill will be heard in the full House this week.


HB 423, Enact First Evaluation Program (Hurley Sponsor); SB 437 (Hartsell Sponsor). HB 423 seeks to codify a piloted practice that allows the Secretary to waive the requirements for a physician or eligible psychologist to perform the initial examination for involuntary commitment and substitute a licensed clinical social worker, a master's level psychiatric nurse, or a master's level certified clinical addictions specialist at the request of an LME. A Proposed Committee Substitute was considered and approved by the House HHS subcommittee on Mental Health last week. New language was added to require reports on involuntary commitments from non-state facilities. The bill passed the full House last week and has been referred to the Senate Rules Committee. The Senate version of the bill passed the full Senate and was referred to the House Judiciary A committee. In order to become law, one version of the bill will need to be heard again in the other chamber.


HB 474, Protect Adult Care Home Residents (Weiss, Hollo, Farmer-Butterfield, Earle Sponsors). HB 474 proposes changes to Chapter 131D governing adult care homes to increase minimum continuing education, training, competency evaluation and inspection requirements for Adult Care Home medication aides, related to Infection Control Requirements. A committee substitute received a favorable report from the Senate Health committee last week and is scheduled to be heard in the full Senate today. After Senate approval, the bill will be sent to the Governor to be signed into law.


HB 493, Landlord Tenant Law Changes (Howard, Blust, Randleman Sponsors). HB 493 as originally filed sought to greatly weaken certain rights and protections of tenants. Due to a great deal of opposition, the bill has been modified to make clear that If the tenant fails to make rental payments during an appeal, as provided in the undertaking within five days of the day rent is due under the terms of the residential rental agreement, the clerk of superior court shall, upon application of the landlord, immediately issue a writ of possession, and the sheriff shall dispossess the tenant; raises the value of personal property that may be donated or disposed of after a tenant abandons or has been ejected; modifies the permitted uses of the deposit; and makes small changes to the laws on vacation rentals regarding cleaning fees. This committee substitute received a favorable vote from the House Judiciary A committee the week of 5/2 and was set to be heard in the full House last week but was postponed when a large number of House members announced that they have a conflict of interest on the bill as landlords. The bill was postponed until this week to address whether there was an actual conflict of interest.


SB 525, Streamline Oversight/DHHS Service Providers (Tucker, Hartsell sponsors) (HB 618 was also filed). SB 525 seeks to streamline duplicate oversight of DHHS service providers. A Proposed Committee Substitute, supported by Disability Rights NC, was approved by the Senate Mental Health Committee last week, and the bill is scheduled to be heard in the full Senate this week. The new version sets up a task force that includes advocates, consumers, providers, and legislators to make recommendations to align oversight of DHHS providers. There is also a budget provision that presents a much less specific plan for this process, and a House version of the bill that is scheduled to be heard in the House Health and Human Services committee this week. Hopefully all of these will be reconciled as we move forward.


HB 623, Eliminate Agency Final Decision Authority (McCormick, Stevens, Cleveland, Glazier Sponsors). HB 623 would remove final decision making authority from agencies in contested cases under Chapter 150B, including Medicaid appeals. It received a favorable report from the House Judiciary A committee last week despite contentions by a lawyer from the Attorney General's office representing DHHS that the change could run afoul of federal Medicaid rules when it comes to disputes over benefits eligibility for that program. The legislation would affect all agencies - everything from personnel to permit disputes. The bill will likely be heard in the full House this week.


HB 658, Change Early Voting Period (Jones, Stam, Colins, Sager Sponsors). HB 658 seeks to shorten the early voting period by a week (by delaying the start of early voting from the third Thursday before an election to the second Thursday). The bill received a favorable report from the House Elections committee in a 16-14 vote last week and passed 2d reading in the full House in a largely partisan vote, 61-53, with 3 Republicans (Faircloth, McGrady and Murry) joining Democrats in voting No. 3d reading is scheduled for tonight in the House.


SB 384, Conforming Changes/Persons with Disabilities Act (Hartsell). This is a Disability Rights NC agenda bill. It seeks to amend the North Carolina Persons with Disabilities Protection Act to conform to the Americans with Disabilities Amendments Act of 2008. The bill received a favorable report in the House Judiciary A committee last week, and will next be voted on in the full House.

SB 498 Modify Law re: Corporal Punishment (Pate, Purcell Sponsors). SB 498 seeks to amend the law related to corporal punishment of children in public schools to allow parents of all students to opt out of a school’s corporal punishment policy. The bill received a unanimous favorable report in the Senate last week and has now been referred to the House Education committee.

SB 512, Adult Day Care/Overnight Respite Program (Clary). SB 512 seeks to allow adult day care  programs to provide overnight respite. A proposed committee substitute was approved by the Senate Health Care committee last week and the bill is scheduled to be voted upon in the full Senate this week. The committee substitute now directs the Department of Health and Human Services to conduct a pilot program to assess the provision of overnight respite services in adult day care programs. The bill is set to be heard in the full Senate this week.

SB 648, Amend Law Re: School Discipline (Preston; Tillman; Hartsell). SB 648 seeks to make a number of changes to Chapter 115C regarding school discipline with the goal of keeping students in school. It is a consensus bill supported by Disability Rights NC that numerous entities representing schools and students contributed to. It passed the full Senate in a unanimous vote last week and will next be heard in the Senate. The House version, HB 736, has already passed the full House and has been referred to the House Education committee. One version will have to be heard in the other chamber before the bill can go to the Governor to be signed into law. Press coverage of the vote last week stated that the National Center for Education Statistics says North Carolina ranks third nationally in the rate of short-term school suspensions of between one and 10 days out of school behind South Carolina and Delaware.


SB 669, Dix Property Mental Health Trust Fund (Atwater) SB 669 seeks to require that proceeds from any sale of the Dorothea Dix Hospital Property be placed in the State’s Trust Fund for Mental Health to be used for people with mental illness. The bill was approved by the full Senate last week and will next be heard in the House Finance committee.

House Subcommittee Hears Presentations on ER Waits and Three-Way Contracts

guest post by Holly Safi

On Tuesday, staff from four NC hospitals presented the House HHS Subcommittee on Mental Health with information regarding services to patients with mental health care needs, particularly long waits in emergency departments (EDs) and the three-way bed contracts the state operates to expand access to inpatient mental health care. A Randolph Hospital official indicated that facility does not have internal capacity for psychiatric care so must hold patients in the ED until transfer is available to an appropriate mental health facility for a psychiatric evaluation. Other hospitals, including the Moses Cone Health System, have psychiatric services but are not equipped to handle some violent patients, and again must hold those patients in their EDs until transfer may be arranged.

A few highlights from their comments:
• One hospital reports the local LME’s crisis team does not respond to emergencies beyond the Monday-Friday work day and encourages consumers with mental health crises to go to EDs on evenings and weekends.
• The same hospital indicated that if a patient has a LME contracted psychiatrist, that psychiatrist ceases service to the patient while in the ED, so psychiatric assessment and treatment is not available until transfer.
• According to the presenters, patients in need of a bed at a state psychiatric hospital wait, on average, 5 days. Some wait as much as 18 days in an ED.
• Long waits contribute to some patients leaving without being seen (approximately 2%).
• Presenters reported this results in disruption of the ED, strains on the hospital staff and security, strains on the resources of local law enforcement, and a safety risk for others in the ED.

Two presenters, one from Pitt County Memorial Hospital and the other from Forsyth Medical Center, discussed the program of three-way beds. The presenters shared the following:
• Goals of the program:
- Increase capacity for inpatients with mental illness.
- Treat patients within their own communities.
- Reduce unnecessary admissions to state hospitals.
- Shorten emergency room waits.
- Facilitate placement of higher needs patients from EDs by giving them priority in transfers to state facilities.
• The three-way bed contracts are contracts between a local hospital, DHHS, and the LME assigned to the area to purchase an expansion of capacity for inpatient psychiatric patients.
• Hospitals are paid a rate of $750 per day per bed by the state. This rate is inclusive of all medical care the patient receives, providing predictable costs for the state but shifting risk to hospitals.
• Many three-way bed patients have medical needs in addition to their mental health needs.
• Robust community supports are necessary to minimize hospitalization.
• Specialty beds for children and adolescents or other patients with special needs are scarce.
• Providers suggested that tiered rates for different levels of care might make the program workable for more providers.

Mike Watson, Deputy Secretary for DHHS, also spoke. Some highlights:
• The State recognizes that wait times in EDs are unacceptable, and much of it is due to lost funding over the last few years which caused hospitals to reduce the number of beds available.
• The State is working to develop additional three-way contracts and increase the number of three-way beds available.
• The 1915 b/c waiver would create incentives for LMEs to keep people out of EDs by requiring them to pay for ED services.

In a March 1, 2011 study by the NC Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, the state gathered information regarding admissions and wait times for the month of November 2010 from 68% of EDs located throughout the state. Some information from that study:
• More than 3% of all admissions to the reporting EDs presented primary behavioral health crises (MH/DD/SA) with a total average ED wait time of 9 hours 38 minutes.
• Of those, 51.1% of behavioral health admissions were discharged home with an average ED wait time of 6 hours 38 minutes.
• 24.3% of behavioral health admissions resulted in psychiatric hospitalization.
- 21.7% were admitted to community psychiatric hospitals with an average ED stay of 14 hours 11 minutes
- 2.7% were admitted to state psychiatric hospitals with an average ED stay of 26 hours 38 minutes

Bill Update for the Week of May 2

New Bills Filed This Week:


HB 894, Borderbelt AIDS Resources Team Funds (Pierce, Graham sponsors). HB 894 seeks to appropriate $50,000 to the Borderbelt AIDS Resources Team (BART), a nonprofit organization, to enable the organization to continue to provide community based HIV/AIDS services to people living in Robeson County and surrounding areas. It was introduced in the House this week and has been referred to the House Rules committee.

HB 916, Statewide Expansion of 1915(b)/(c) Waiver (Barnhart, Burr, Insko Sponsors). HB 916 seeks to expand the waiver statewide by July 1, 2013, and sets out specific requirements for the expansion of this managed care behavioral health Medicaid waiver: accountability for the development of a local system that ensures easy access to care, availability and delivery of necessary services, and continuity of care; fidelity to the PBH model; designate entities to manage the waiver through either merged LMEs or through interlocal agreement among LMEs; use of managed care strategies to reduce escalating costs in Medicaid while ensuring medically necessary care and deploy a system for the allocation of resources based on reliable assessment of intensity of need; phase out the CAP-MR/DD waiver; and design the Innovations waiver to serve the maximum number of individuals with intellectual and developmental disabilities within aggregate funding. It also specifies that county governments will not be financially liable for overspending or cost overruns associated with the operation of the waiver (i.e., the risk doesn’t shift). HB 916 specifies a number of conforming statute changes regarding the size of LMEs. Section 4 also exempts the Department from rulemaking in implementing, operating, or overseeing new Medicaid waiver programs or amendments to existing Medicaid waiver programs. It was introduced in the House this week and referred to the House Health and Human Services committee, and then to Finance.

HB 923, Local Inpatient Psychiatric Bed Assessment (Insko Sponsor). HB 923 seeks to increase the assessment on hospitals to provide additional funding for local inpatient psychiatric beds. It was introduced in the House last week and has been referred to the House Health and Human Services committee, then to Finance and Appropriations.


Action on Bills Previously Filed:

HB 397, DHHS Penalties and Remedies Revision (Lewis Sponsor). HB 397 seeks to amend facility penalty provisions under 122C, 131D and 131E to split Type A violations into Type A1 (violations that result in result in death or serious physical harm, abuse, neglect, or exploitation) and Type A2 violations (violations that result in substantial risk that death or serious physical harm, abuse, neglect, or exploitation will occur). HB 397 had been referred to House Finance because of the penalties imposed by the legislation. However, the bill was withdrawn from committee this week and voted on by the full House without any changes. The vote was 115-1, with Representative Collins (R-Nash) the sole No vote. The bill will now proceed in the Senate.

HB 423, Enact First Evaluation Program (Hurley Sponsor) (Senate version: SB 437 (Hartsell Sponsor)). HB 423 seeks to codify a practice that has been piloted that allows the Secretary to waive the requirements for a physician or eligible psychologist to perform the initial examination for involuntary commitment and substitute a licensed clinical social worker, a master's level psychiatric nurse, or a master's level certified clinical addictions specialist at the request of an LME. HB 423 is scheduled to be heard in the House Health and Human Services subcommittee on Mental Health next week on Tuesday, May 10.

HB 474, Protect Adult Care Home Residents (Weiss, Hollo, Farmer-Butterfield, Earle Sponsors). HB 474 proposes changes to Chapter 131D governing adult care homes to increase minimum continuing education, training, competency evaluation and inspection requirements for Adult Care Home medication aides, related to Infection Control Requirements. After receiving approval from the House, HB 474 has been received in the Senate and referred to the Senate Health care committee.

HB 509, Exclusions from Licensure: Home Services (Hurley Sponsor). HB 509 seeks to allow people with disabilities who receive MH/DD/SA services to live together as roommates without their home being considered a facility for licensing purposes. Specifically, it excludes from licensure: “A home in which up to three adults, two or more having a disability, co own or co rent a home in which the persons with disabilities are receiving three or more hours of day services in the home or up to 24 hours of residential services in the home. The individuals who have disabilities cannot be required to move if the individuals change services, change service providers, or discontinue services.” After receiving approval from the House, HB 509 has been received in the Senate and referred to the Senate Health Care committee.

HB 808, Revise Laws on Adult Care Homes (Burr). HB 808 seeks to waive annual inspections of Adult Care Homes that achieve the highest rating, and to develop an informal dispute resolution procedure that allows Adult Care Homes to dispute cited inspection deficiencies. The intent of the department is to focus more time on the homes with more problems. After receiving approval from the House, HB 808 has been received in the Senate and referred to the Senate Health Care committee.

SB 401, ACH Pilot on Crisis Intervention Training (Sponsors). SB 401 directs the Division of MH/DD/SAS to coordinate a pilot program in 10 adult care homes identified as having a significant percentage of residents with a primary diagnosis of mental health problems and where crisis management has been a concern in the past to evaluate the effectiveness of crisis intervention training. It also directs the Division to consider modification of the current North Carolina Interventions (NCI) Prevention training to a one-day training program appropriate for adult care home staff, including personal care aides, medication aides, and supervisors employed by the participants in the pilot program. After receiving approval from the Senate, SB 401 has been received in the House and referred to the House Health and Human Services committee.

SB 421, GAST Training Pilot (Bingham Sponsor). SB 421 directs the DHHS Division of MH/DD/SAS to establish a pilot training program using Geriatric/Adult Mental Health Specialty Teams to conduct training in Adult Care Homes on preventing the escalation of behaviors leading to crisis, based on a recommendation of the NC Institute of Medicine Task Force on the Co-Location of Different Populations in Adult Care Homes. After receiving approval from the Senate, SB 421 has been received in the House and referred to the House Health and Human Services committee.

SB 498, Modify Law re: Corporal Punishment (Pate, Purcell Sponsors). SB 498 seeks to amend the law related to corporal punishment of children in public schools to restrict corporal punishment only to students whose parent or guardian has stated in writing that corporal punishment may be administered on that student (an Opt-in). The bill received a favorable report from the Senate Education committee several weeks ago, but ran into some opposition from the NC Family Policy Council when it was set to be heard in the full Senate. The Family Policy Council, which is dedicated to the preservation of the family and traditional family values, objected to the opt-in procedure of the bill, which, oddly enough, gives parents the absolute right to decide whether their child will be subjected to corporal punishment. The bill was heard again in Senate Education this week where the opt-in procedure was changed to an opt-out. While this is disappointing, after the bill was passed last year allowing parents of children with disabilitis to opt-out, several more school districts banned corporal punishment, so this wider opt-out may lead to even more school districts abandoning the practice and certainly to less children being subjected to corporal punishment.  The bill is scheduled to be voted upon in the full Senate next Tuesday, May 10.

SB 524, Strengthening Residential Placement (Tucker, Hartsell Sponsors) (HB 377 (Brisson Sponsor) was approved earlier in the session by the House Health and Human Services committee). SB 524 seeks changes to the budget special provision regarding the restructuring of Level III and IV mental health residential placements to add that an assessment shall be completed to ensure the appropriateness of placement before admission to such a placement; to extend the length of stay to 180 from 120 days (180 is the average length of stay); and to specify that the authorization approval is not conditional upon all signatures and that LMEs shall designate appropriate individuals who can sign the discharge plan within 24 hours of receipt. SB 524 received a favorable report from the Senate Mental Health committee this week and has been referred to the Senate Finance committee.

SB 607, Conform Medical Record Laws (Stein). SB 607 seeks to amend various sections in the General Statutes to make it easier to share currently protected health information, including information regarding mental health (See the April 18 and 25 bill update for more details about the bill and the changes made in the Senate). The bill was approved by the full Senate on Thursday, with an amendment providing that confidential information shared by a 122C facility shall not be used or disclosed for discriminatory purposes including, without limitation, employment discrimination, medical insurance coverage or rate discrimination, or discrimination by law enforcement officers.

SB 648, Amend Law Re: School Discipline (Preston; Tillman; Hartsell). SB 648 seeks to make a number of changes to Chapter 115C regarding school discipline with the goal of keeping students in school. It is a consensus bill supported by Disability Rights NC that numerous entities representing schools and students contributed to. It was approved by the Senate Education committee this week and will be voted on by the full Senate on Tuesday.

SB 669, Dix Property Mental Health Trust Fund (Atwater) SB 669 seeks to require that proceeds from any sale of the Dorothea Dix Hospital Property be placed in the State’s Trust Fund for Mental Health to be used for people with mental illness. The bill was approved by the Senate Committee on Mental Health & Youth Services on Wednesday, and will be voted on by the full Senate on Tuesday.