Legislative Update for the Week of February 11

Budget Update

Joint Appropriations subcommittees met this week to give an overview of the budget process and background for new members. The HHS subcommittee meetings were the most eventful, with Secretary Wos presenting on Wednesday, and State Auditor Beth Wood presenting on Thursday on the Medicaid audit.  Handouts are online.  The committees were given a calendar that projects a Governor's budget by March 18; Senate budget consideration from April 15 - 30, with votes the week of May 6; House budget consideration from May 13-24, with votes the week of May 27; and a final budget passed by June 13 after conference consideration the first two weeks of June.  The subcommittees will meet next week to hear reports on non-profits funded through the state budget.

Bill Updates

HB 4 (Howard, Warren, Starnes, Setzer), Unemployment Insurance Fund Solvency and Program Changes.  HB 4 modifies the state's Unemployment Insurance program to reduce the amount of benefits and length of time that benefits are available to the state's unemployed; and to remove a number of good cause qualifications for benefits, including provisions that allow for benefits when an individual must leave employment because of disability or other health concern; disability or health concern of a minor child, aged or disabled parent, or disabled immediate family member; or inability to accept work during a particular shift because of concerns related to child care, elder care, or care of a disabled family member. HB 4 cleared the legislature this week and has been sent to the Governor for his signature.

HB 74 (Murry, Moffitt, Samuelson, Bryan), Periodic Review and Expiration of Rules will provide for automatic expiration for all rules unless re-adopted within ten years after effective dates. The bill proposes expiration dates per title of the Administrative Code during 2016-2019 for existing rules. HB 74 was discussed but not voted upon in the House Regulatory Reform committee last week.  Reps. Murry and Samuelson presented the bill, stating that the bill was intentionally broad but they are taking suggestions and are open to ways to improve the bill.  One suggestion was to allow members of the public to flag rules for review, with the intent of narrowing the number of rules to be reviewed upfront.

SB 4, No NC Exchange/No Medicaid Expansion (Apodaca, Brown, Rucho).  SB 4 seeks to prohibit Medicaid expansion and a state-federal partnership health benefit exchange.  SB 4 was approved by the House Health and Human Services committee and the full House last week.  Rep. Lewis (R-Harnett) joined a unanimous group of House Democrats in voting against the bill.  The bill now returns to the Senate for a concurrence vote due to minor changes in the language, and then will be on to the Governor for his signature.

New Legislation Filed This Week

HB 99, Caregiver Relief Act (Adams, Hall).  The Caregiver Relief Act would extend protections and leave under the Family Medical and Leave Act to eligible employees to care for a sibling, grandparent, grandchild, stepparent, or parent‑in‑law.  It has been referred to the House HHS committee, Judiciary and then Appropriations.

HB 100, Healthy Family & Workplaces/Paid Sick Days (Adams, Hall).  This legislation would provide for paid sick days for all employees.  It has been referred to the House Commerce committee, and then to Judiciary.

HB 102, Online Voter Registration (Alexander).  HB 102 would add a fillable online form for voter registration in NC.  It has been referred to the House Elections committee, and then Appropriations.

SB 91, Prohibit Expunction Inquiry (Daniel, Goolsby, Kinnaird).  SB 91 would prohibit an employer or educational institution from requiring an applicant for employment or admission to disclose information concerning any arrest, criminal charge, or criminal conviction of the applicant that has been expunged. It has been referred to the Senate Judiciary II committee.

Legislative Update for the Week of February 2

Week 2 of the 2013 session was another active week at the General Assembly.  Joint Appropriations meetings were held this week to hear a report on projected revenues and a brief overview of state budget allocations.  Appropriation subcommittees (i.e., HHS, JPS, Education, etc.) will start meeting next week to hear from the departments and to give members an overview of past budget allocations.  However, we don't expect to see an actual budget from the Senate (they get the first crack this year) until after April 15.

Unemployment Insurance and (No) Medicaid Expansion continued to make their way through the legislature this week.  Both are scheduled for votes next week. Also set for February 18: The Governor will give the state of the state address.

Bill Updates

HB 4 (Howard, Warren, Starnes, Setzer), Unemployment Insurance Fund Solvency and Program Changes.  HB 4 modifies the state's Unemployment Insurance program to reduce the amount of benefits and length of time that benefits are available to the state's unemployed.  It also removes a number of good cause qualifications for benefits that exist under the current state law, including provisions that allow for benefits when an individual must leave employment because of disability or other health concern; disability or health concern of a minor child, aged or disabled parent, or disabled immediate family member; or inability to accept work during a particular shift because of concerns related to child care, elder care, or care of a disabled family member. HB 4 was approved by the full House and the Senate Finance committee this week.  It is worth noting that Representative Glazier moved to to amend the bill on the House floor to continue the good cause qualifications based on disability or sickness and family hardship.  Although the Amendment failed, four Republican Representatives (Arp, Blust, Catlin and Jordan) joined all but one Democrat in voting for the amendment.  The bill is expected to be approved by the Senate next week.

HB 5 (Dollar, Burr), Temporary Funding Extension for Group Homes, allows group homes to access the $39.7 million allocated in the state budget for temporary, short‑term financial assistance to Adult Care Homes on behalf of a resident who loses eligibility for Medicaid covered personal care services (PCS) after an independent assessment.  HB 5 passed the House unanimously last week but remains in the Appropriations committee in the Senate.

HB 68 (Torbett), Establish Ombudsman/Foster Care/ Gaston County, seeks to establish a pilot ombudsman program for children in foster care in Gaston County. It has been referred to the House Committee on Government.

HB 70 (Brandon), North Carolina Health Plan, seeks to establish a state-funded insurance plan for those without health insurance in 2017, when the Affordable Care Act allows states to offer their citizens alternatives to the Health Insurance Exchanges. The bill directs the Department of Insurance and the Department of Health and Human Services to study the issues and propose statutory changes to facilitate the operation of the NC Health Plan, and report to the Joint Legislative Oversight Committee on Health and Human Services no later than March 1, 2014. It has been referred to the House Insurance committee, with re-referrals to HHS, Finance and Appropriations.  Representative Brandon filed the bill in response to SB 4, which will prevent medicaid expansion for adults under the ACA.

HB 74 (Murry, Moffitt, Samuelson, Bryan)/SB 32 (Hartsell), Periodic Review and Expiration of Rules will provide for automatic expiration for all rules unless re-adopted within ten years after effective dates.  The bill proposes expiration dates per title of the Administrative Code during 2016-2019 for existing rules. HB 74 has been referred to the House Regulatory Reform committee and SB 32 has been referred to the Senate Program Evaluation committee.

SB 4, No NC Exchange/No Medicaid Expansion (Apodaca, Brown, Rucho).  SB 4 seeks to prohibit Medicaid expansion and a state-federal partnership health benefit exchange.  SB 4 was approved by the Senate this week despite a request from the Governor's office to slow the measure down. It is scheduled to be heard in the House Health and Human Services committee on Tuesday at 10 am.

SB 10 (Apodaca, Hunt, Rabon), Eliminate Obsolete Boards and Commissions, proceeded through the Senate this week. In addition to seeking to overturn the current Democrat-appointed members of several boards and commissions, it seeks to eliminate all special Superior Court judge positions, except for the three business court positions.   The bill will now proceed to the House.

SB 45 (Randleman), Incapacity to Proceed Amendments, is legislation previously sponsored by then Rep. Randleman that would amend the state criminal law regarding individuals who do not have the capacity to proceed in a criminal matter.  It has been referred to the Senate Judiciary I committee.

The Legislature is back in action!

The legislature roared back into session on Wednesday this week.  Despite only being in town for two working days, they managed to file dozens of bills and pass major policy decisions out of committee.  We will be back with weekly updates throughout the session. For now, here is a brief summary of legislation filed this week related to the work of Disability Rights NC.

HB 4 (Howard, Warren, Starnes, Setzer)/SB 6 (Rucho, Rabon, Brock), Unemployment Insurance Fund Solvency and Program Changes.  HB 4 modifies the state's Unemployment Insurance program to reduce the amount of benefits and length of time that benefits are available to the state's unemployed.  It also removes a number of good cause qualifications for benefits that exist under the current state law, including provisions that allow for benefits when an individual must leave employment because of disability or other health concern; disability or health concern of a minor child, aged or disabled parent, or disabled immediate family member; or inability to accept work during a particular shift because of concerns related to child care, elder care, or care of a disabled family member.  The bill was filed on the first day of session on Wednesday, approved by the Finance committee on Thursday morning, and by the full House on Thursday afternoon.

 

HB 5 (Dollar, Burr), Temporary Funding Extension for Group Homes, allows group homes (meaning any facility that (i) is licensed under Chapter 122C of the General Statutes, (ii) meets the definition of a supervised living facility under 10A NCAC 27G .5601, and (iii) serves adults whose primary diagnosis is mental illness or a developmental disability but may also have other diagnoses) to access the $39.7 million allocated in the state budget for temporary, short‑term financial assistance to a group home on behalf of a resident who loses eligibility for Medicaid covered personal care services (PCS) after an independent assessment.  It was filed on the first day of session on Wednesday, and approved by the Appropriations committee on Thursday morning.  It is scheduled to be heard in the full House on Monday night. 

 

SB 4/HB 16, No NC Exchange/No Medicaid Expansion (Apodaca, Brown, Rucho/Burr, Avila, Hollo, Collins).  SB 4 seeks to prohibit Medicaid expansion and a state-federal partnership health benefit exchange.  SB 4 was filed on the first day of session on Wednesday, and approved by the Senate Insurance committee on Thursday.  It will be heard by the full Senate on Monday night.  On a somewhat related note, Governor McCrory and Secretary Wos spoke about a Medicaid Audit completed by the state auditor this week, indicating that their first order of business was to get the Medicaid program administrative costs under control, and possibly leaving the door open on Medicaid expansion.

 

HB 20 and HB 21 (Moore), Joint Session State Board of Education Confirmation, seeks to approve appointments by the Governor to membership on the State Board of Education that are subject to confirmation by the General Assembly in joint session. The appointees will fill vacancies in Regions 1 and 7, Rebecca H. Taylor and Gregory M. Alcorn, as well as appoint one at-large board member William W. Cobey, Jr.  HB 20, which seeks the joint session, was passed by the House on Thursday and sent to the Senate. HB 21, which names the new members, will be heard in the House Education committee next Tuesday.

 

HB 53 (Tillis, Moffitt, Murry), NC Right to Work/Secret Ballot Amendments.  HB 53 proposes constitutional amendments be placed on the ballot in October 2013 to amend the state constitution to prohibit collective bargaining.

 

HB 56 (Howard), Amend State Contract Review Laws, directs the Attorney General, in consultation with the Dept. of Administration, to establish procedures for the review of contracts; notice to the Dept. of Administration of contracts exceeding $1 mil.; and for the Dept. of Administration to adopt procedures for the identification and record-keeping of contracts.  It is based on recommendations of the Program Evaluation Division.

HB 58 (Howard), Nonprofit Grants/Increase Accountability, would require the Office of State Budget and Management to implement additional rules for grants to nonprofits, including a requirement of concrete, measurable benchmarks against which to measure success; and the Identification of program performance measures that will be used to compare quantifiable outputs and outcomes against the benchmarks established in contracts pursuant to this subdivision; criteria for when grant monies may be withheld; periodic reporting requirements; and also limits the amount an agency can withhold for its own oversight to 2%.  Note that “grants” as defined in the statute do not include any payment by the Medicaid program. It is based on recommendations of the Program Evaluation Division. 

SB 10 (Apodaca, Hunt, Rabon) and SB 34 (Hartsell), Eliminate Obsolete Boards and Commissions, is a considerably scaled down version of the bill filed last year.  It does seek to eliminate the Committee on Dropout Prevention. SB 34 differs from SB 10 in that it additionally recommends that the Chief Justice abolish the Actual Innocence Commission, as the Innocence Inquiry Commission has been established.

SB 12 (Tillman), Appoint Superintendent of Public Instruction, seeks a constitutional amendment for the Governor to appoint the state superintendent, rather than be elected by the state.

SB 39 (Tillman, Goolsby), Restore Partisan Judicial Elections, would require all state Supreme Court, Court of Appeals, superior and district court judges to run by party affiliation.

SB 42 (Daniel, Tillman, Tucker), Charter School/Government Unit, provides that a charter school is a governmental unit for the purpose of a lease or transfer of personal or real property between a charter school and another governmental unit.


 

Administrative Procedure Oversight Committee Recommendations

The Joint Legislative Administrative Procedure Oversight Committee met on Wednesday, December 19th to discuss several reports, the committee recommendations, and areas of future study.  Of note:

• Judge Julian Mann, Chief Administrative Law Judge with OAH, and Melanie Bush, Assistant Director of Administration at DMA, reported that a decision on the waiver request for final decisions in Medicaid cases is expected by the end of the month.
• The committee is recommending a new proposal to eliminate unnecessary boards and commissions. In contrast to the legislation filed last year, this only recommends repeal of boards that have no members, no funds, and/or have not met in several years.  However, the committee also recommends that the Appropriations committees review the list of legislatively created boards and commissions in connection with their review of state agency budgets.  They should consider elimination, reduction, or consolidation of boards and commissions which are deemed unnecessary, too large, or redundant.
• There were also a few items of interest on the list of issues for future consideration: (1) Policies adopted by agencies that do not go through the rulemaking process: there was a discussion using DPI as an example; and (2) amending the APA to broaden the category of appeals that proceed to the Court of Appeals directly.

The committee voted to approve its draft recommendations, so that should be the last meeting until after the 2013 session.

Blue Ribbon Commission on Transitions to Community Living Final Report

The full Blue Ribbon Commission met on Wednesday, December 19th to approve its full committee report and recommendations. The subcommittees met last week to hear some last presentations and to approve the subcommittee reports to the full commission.  The full report (online here) incorporates all of these recommendations, which are briefly listed below:

Housing Subcommittee Recommendations:

1. Explore Alternatives for Large Adult Care Homes.
2. Mitigate the Loss of Medicaid Eligibility by those Exiting an Adult Care Home.
3. Establish a Long-Term Care Continuum Workgroup.
4. Explore establishing a process to allow payment to be paid on behalf of a resident who has last their eligibility for PCS.
5. Study Tiered PCS.
6. Study the State-County Special Assistance Rate Structure.
7. Establish Habilitation Services for IDD Adults using a 1915(i) option.
8. Explore service delivery options for individuals with mental illness.
9. Expand the number of CAP-IDD (Innovations) slots.

Adult Care Home Subcommittee Recommendations:

1. Direct expanded funding to the Housing Trust Fund, Key Program and other housing assistance programs to increase the number of permanent housing units.
2. Any funds unspent from the money allocated (e.g. the $10.3 million this year) should revert to the Housing Trust Fund, to be placed in a special reserve account, and be used to provide supportive housing to persons with mental disabilities.
3. Evaluate the capacity of the databases used by state agencies to monitor the inventory of available rental housing.
4. Explore the possibility of increasing the percentage of Targeted Units in new developments from 10% to a greater percentage.
5. Develop a plan to establish a tenant-based rental assistance program specifically designated for the 3,000 persons who must be transitioned to community-based housing as required by the US DOJ settlement agreement.
6. Encourage LMEs to form partnerships with existing non-profit and other agencies that currently provide supportive housing assistance and other services to persons with disabilities in home and community-based settings.
7. Directs DHHS and the LMEs to determine additional services and resources needed to support the tranistion of the 3,000 people with mental illness from adult care homes to community based settings by 2020.
8. Direct DHHS and LMEs to identify assistive technology that can be used to divert or transition people with mental disabilities from institutional settings; and a plan to maximize the use of assistive technology in the implementation of the US DOJ settlement agreement.

Reports to the HHS Committee

FYI - reports made to the Joint Legislative Oversight Committee on Health and Human Services are posted online.  It includes reports from certain non-profits that receive state funds as well as DHHS reports on LME Efforts in Mental Health Crisis Management and the MH/DD/SAS Statewide report.

Joint Legislative Subcommittee on Mental Health Meeting

The Joint Legislative Oversight Committee on Health and Human Services, Subcommittee on Mental Health met on Monday, December 10 to discuss the following items.  The committee also discussed proposed committee recommendations.

• Laura White, Division of State-Operated Healthcare Facilities, presented on the history and process of determining facilities' catchment areas.  In the past, the Division attempted to keep all counties served by a single LME in the same region and thus served by a single state  facility.  However, the increased size of LMEs will prevent this in the future.
• Beth Melcher presented on Three-way contract Payments, in follow-up to questions raised at the last committee meeting.  They are proposing that hospitals that have had trouble being paid promptly can submit an alternative claim directly to state (the claims must go through the LME now).  The LMEs still need to manage and pay long-term but this will help with cash flow issues for now.  There was also discussion about using a higher rate for higher acuity patients to be served in certain units (but not numbers or specifics).  They are due to review the rates in 2013.
• Sheila Davies from the Albemarle Hospital Foundation and Edward Spencer from the South Carolina Division of Mental Health discussed the use of Telepsychiatry.  Ms. Davies spoke about a grant-funded expansion in NC that is showing reduced length of stay, reduced readmissions, patient satisfaction on surveys, and reduction of unnecessary Involuntary Commitments (223 IVCs overturned). She also discussed their challenges to growth: credentialing/privileging with multiple LMEs, navigating the Medicaid waiver with LMEs, sustainability (indigent care reimbursement), limited resources (bed availability, lengthy wait times for outpatient referrals, and law enforcement strain).  Mr. Spencer discussed the expansion of telepsychiatry in South Carolina. They have reduced length of stay by 50%; 43% of patients are discharged the same day as the consult; and reduced involuntary commitments by 60%.
• Mark Botts from the School of Government gave an overview of the Involuntary Commitment process in North Carolina.  Mr. Botts highlighted the laws and procedures, as well as areas where there are issues or a lack of knowledge, including underutilization of outpatient commitment (vs. inpatient); the stress of law enforcement for transportation, particularly when no beds available; and the need for better communication between LMEs and magistrates.
• Finally, there were presentations from the NC IOM, Durham Veterans Administration, and National Guard regarding services for members of the military and veterans with PTSD.

Proposed Findings and Recommendations to HHS Oversight were discussed:

• To direct DHHS to determine the cost to increase the number of beds in state psych hospitals, explore creating a south central mental health region, and investigate the possibility of placing a new psych facility in that region.
• Work with community hospitals to develop a plan to revise three- way contract payments from a single rate model to a tiered rate structure based upon the patient's acuity level.  Submit a plan by October 1, 2013.
• Direct DHHS to investigate, develop and provide incentives to increase the overall supply of psychiatrists, psychologists and other MH professionals, especially in rural and underserved areas of the state.  Submit a written report by Oct 1, 2013.
• Members also mentioned adding recommendations  around training on Veterans' issues and telepsychiatry.