Ashley Rodriguez

State Budget Summary

SB 105 – 2021 Appropriations Act was signed into law by Governor Cooper on November 19, 2021. Highlights from the budget are included below, and additional information can also be found in the budget conference report released earlier last week.

In addition to the specific provisions summarized below, it is also important to note many of the changes NCMS opposed earlier this session, such as the SAVE Act and erosion of existing tort reform measures, were not included. The budget’s revisions to the Emergency Management Act also ensure the COVID-19 immunity provisions included in the COVID-19 Recovery Act remain in place.

 

State Budget Summary

 

Highlights of policy-related provisions include:

Joint Legislative Committee on Access to Healthcare and Medicaid Expansion

• Creates a joint legislative committee tasked with considering ways access to health care and health insurance can be improved for North Carolinians.

Continue Medicaid Coverage for Pregnant Women for Twelve Months Postpartum

• Allows pregnant women to remain eligible for coverage for 12 months postpartum effective April 1, 2022. This change will expire March 31, 2027.

Medicaid Reimbursement Contract for Residential Schools

• Requires the Department of Public Instruction to enter into a contract with a third-party entity for any administrative services necessary to receive maximum reimbursement for medically necessary health care services for which payment is available under the NC Medicaid Program provided to eligible students attending the Governor Morehead School for the Blind, the Eastern North Carolina School for the Deaf, and the North Carolina School for the Deaf.

The North Carolina Collaboratory

• Establishes the North Carolina Collaboratory to facilitate the dissemination of the policy and research expertise of The University of North Carolina and other higher education institutions within the State for practical use by the State and local governments.
• Specifies the Collaboratory’s duties and powers.
• Requires the Collaboratory to develop and deploy technologies to mitigate exposure to PFAS, including GenX, and health impacts from such exposure.

Virtual Behavioral Health Services Grant Program

• Requires the Office of Rural Health to use certain funds to award competitive grants to hospitals to fund expanded telepsychiatry capabilities to respond to the COVID-19 public health emergency by allowing patients begin served in primary care settings to access hospital-based virtual psychiatric assessments and consultations.

Creation of the HCBS Fund

• Establishes the HCBS Fund as a nonreverting special fund in the Division of Health Benefits consisting of the savings realized by DHB as a result of federal receipts arising from the enhanced federal medical assistance percentage for home and community-based services available to the State under the American Rescue Plan Act of 2021.

Waive Medicaid Provider Enrollment and Revalidation Fees

• States that providers revalidating enrollment or enrolling in the NC Medicaid program or the NC Health Choice program shall not be charged the $100 fee above the federally required fee for the enrollment or revalidation.

Expand North Carolina Innovations Waiver Slots

• Requires the Division of Health Benefits to amend the NC Innovations waiver to increase the number of slots by 1,000.

Modification of CON Exemption for Legacy Medical Care Facilities

• Modifies the CON exemption for Legacy Medical Care Facilities by allowing a person seeking to operate a Legacy Medical Care Facility to request an additional extension of time by which the facility must be operational in order to be exempt from CON review and provides the procedure for making that request.

Temporary CON Exemption

• Provides a temporary CON exemption a new general acute hospital in counties that meet certain specified criteria.

Adult Care Home Infection Prevention Requirements

• Revises the requirements for adult care homes’ written infection prevention and control policy including certain specified standard and transmission-based precautions, reporting requirements, and strategies for addressing potential staffing issues.

Use of Opioid Settlement Funds

• Establishes the Opioid Abatement Reserve in the General Fund to maintain funds received by the State as a beneficiary of the final consent judgment resolving the lawsuit against McKinsey and Company, Inc. and specifies how the funds shall be used to respond to the negative impacts of the opioid epidemic.

Emergency Management

• Revises the Emergency Management Act to require a vote by the Council of State to extend a statewide emergency beyond 30 days by the Governor effective January 1, 2023.

 

Highlights of budget-related provisions organized by category include:

Aging and Adult Services

• Provides $15M in NR funds from the State Fiscal Recovery Fund for rapid rehousing services, activities to increase local capacity for services to prevent homelessness, and home improvements and home repairs for vulnerable seniors ages 60 and older.
• Provides $3,585,000 in NR funds from the State Fiscal Recovery Fund for nutrition services for older adults in response to the COVID-19 pandemic.
• Provides $125K in NR funds from the State Fiscal Recovery Fund for Hospice of Davidson County, North Carolina, Inc.
• Provides $9.36M in recurring funds for the Home and Community Care Block Grant, which provides in-home and community-based services for older adults and their unpaid primary caregivers.
• Provides $300K to Memory & Movement Charlotte to support individuals with Alzheimer’s Parkinson’s, and other forms of memory and movement disorder.
• Provides $4M in recurring funds to increase support for the Key Rental Assistance Program to provide rental subsidies for eligible low-income, disabled individuals.

Central Management and Support

• Provides $7.5M in NR funds for mobile units to support service delivery for the Camino Community Development Corporation, Inc., a nonprofit in Mecklenburg County that serves low-income families through primary care, behavioral health, and wellness services.
• Provides $500K in NR funds for the city of Winston-Salem to create a hospital-based violence intervention program in response to the COVID-19 pandemic.
• Provides $375,232 in NR funds for the Duke University Hospital-Based Violence Intervention Program in response to the COVID-19 pandemic.
• Provides $250K in NR funds from the state fiscal recovery fund for Trellis Supportive Care, a nonprofit with offices in Davie, Forsyth, Stokes, and Rowan counties, to provide hospice and palliative care period.
• Provides $15M in NR funds for a directed grant to the North Carolina Association of Free and Charitable Clinics to respond to the public health emergency by supporting member clinics.
• Provides $10M in NR funds to the Office of Rural Health to establish a competitive grant program to support virtual behavioral health services.
• Provides $1M in NR funds to Atrium Health, Inc., to respond to the public health emergency by providing school-based virtual health services to classrooms in Anson County and Winston-Salem/Forsyth County school districts.
• Provides $1.5M in NR funds to the NC Statewide Telepsychiatry Program to respond to the public health emergency by providing virtual psychiatric assessments and consultations to patients using telemedicine technologies.
• Provides $4,909,144 in NR funds for FY 2021-22 by budgeting receipts made available through the American Rescue Plan Act of 2021 for the federal Small Rural Hospital Improvement Program to support small rural hospitals in NC with COVID-19 testing and mitigation.
• Provides $1.2M in NR funds for NC MedAssist for additional prescription assistance services for indigent and uninsured persons.
• Provides $4M in NR funds for loan repayment incentives to recruit doctors, physician assistants, dentists, nurse practitioners, and certified nurse midwives to rural areas.
• Provides $125K in NR funds to Ashe Memorial Hospital.
• Provides $150K in NR funds to Cabarrus Public Health Interest.
• Provides $250K in NR funds to Cumberland HealthNET, a collaborative network of community organizations with a primary focus of improving the health outcomes for the uninsured by linking them with a medical home and other needed health and community services.
• Provides $250K in NR funds to the Free Clinic of Rockingham County, Inc.
• Provides $300K to Davidson Medical Ministries, Inc., to support continued operations and facilitate healthcare services to those who are uninsured and/or unable to pay for medical services.
• Provides $5M in NR funds to Atrium Health to support the development of a FQHC or FQHC look-alike in Cleveland County.
• Provides $5M in NR funds to Healthreach Community Clinic, a free clinic that provides health services in Iredell County.
• Provides $500K in NR funds to the Stedman-Wade Health Services Inc., a community health center in Cumberland County.
• Provides $300K in NR funds to Surry Medical Ministries Foundation, Inc., in Mount Airy to support continued operations and facilitate healthcare services to those who are uninsured and/or unable to pay for medical services.
• Provides $750K in NR funds to develop and implement a two-year pilot program in Cumberland County to provide health care and job training services to veterans.
• Provides $1.5M in NR funds to the NCMS for the Foundation for Children with Neuroimmune Disorders to create a continuing medical education program for NC physicians for Pediatric Acute-onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
• Provides $300K in NR funds to the North Carolina Healthcare Quality Alliance, Inc., a nonprofit that promotes and facilitates the improvement of health care delivery across the State.

Child Development and Early Education

• Provides $1,208,000 in NR funds to Ready for School, Ready for Life, a nonprofit in Guilford County that provides children and their families with resources for healthy development.
• Provides $500K in NR funds to Child Development Center, Inc., a nonprofit in New Hanover County that provides services to preschool age children with special needs.
• Provides $500K in NR funds to Reach Out and Read, a nonprofit that works with pediatricians to provide books to children.

Health Benefits

• Provides funding for an additional 1,000 individuals with intellectual and developmental disabilities to access services through the State’s Medicaid Innovations waiver. The State share of costs, $3.9M in FY 2021-22 and $25.9M in FY 2022-23, will be paid from the HCBS Fund.
• Provides funding for at least 114 additional slots in the Community Alternatives Program for Disabled Adults Medicaid waiver. The State share of funding, $500K in FY 2021-22 and $1M in FY 2022-23 will be transferred from the HCBS Fund.
• Provides funding to add more slots to the following Medicaid waiver programs as determined by DHBL Innovations, Community Alternatives Programs, and Traumatic Brain Injury.
• Provides funding to increase the Medicaid reimbursement rates to HCBS providers for the purpose of increase direct care worker wages.
• Increases the Medicaid reimbursement rate for private duty nursing services to $11.25 per 15 minutes.
• Provides funding for approximately 1,900 new Medicaid recipients eligible due to State-County Special Assistance In-Home program changes.
• Increases funding for the Transitions to Community Living Initiative, which supports eligible Medicaid beneficiaries with mental illness in transitioning from institutions to community settings.
• Provides funding for a wage increase for direct care workers employed by intermediate care facilities for individuals with intellectual disabilities.
• Increases Medicaid beneficiary copayments to $4, effective July 1, 2022.
• Provides funds for the run out of Medicaid and NC Health Choice fee-for-service claims associated with beneficiaries enrolled in managed care.
• Provides funding for projected changes in Medicaid enrollment, enrollment mix, utilization, prices, and federal match rate, as well as the transition to managed care on July 1, 2021.
• Provides funds to support the transition to Medicaid managed care and the Healthy Opportunities pilot program.
• Provides funds to extend Medicaid benefits for the pregnant women eligibility category from 60 days postpartum to 12 months postpartum, effective April 1, 2022 through March 21, 2027.
• Provides funds to allow the parents of children temporarily placed into the child welfare system to retain Medicaid eligibility if the parent is making reasonable efforts to comply with the court-reunification plan.
• Budgets additional requirements and receipts to support the authorization for charter schools to certify public expenditures.

Health Service Regulation

• Provides $3M in NR funds for an adult care home accreditation pilot program to be administered by the Cecil G. Sheps Center for Health Service Research.
• Provides $420K in NR funds to New Hanover Regional Medical Center for the Community Paramedicine Program, which brings some medical services directly to the patient in their home, avoiding duplicate services and unnecessary trips to the hospital.

Mental Health/Developmental Disabilities/Substance Abuse Services

• Provides $12.6M in NR funds for FY 2021-22 from the State Fiscal Recovery Fund to LME/MCOs for temporary funding assistance for intermediate care facilities for individuals with intellectual disabilities services on a per diem basis.
• Provides $25M in NR funds for FY 2021-22 from the State Fiscal Recovery Fund for Forsyth and Mecklenburg Counties for crisis behavioral health joint partnerships with local hospital systems, local behavioral health crisis centers, local emergency services providers, and LME/MCOS.
• Provides $25M in NR funds for FY 2021-22 from the State Fiscal Recovery Fund to replace the Incident Response Improvement System.
• Provides $500K in NR funds for FY 2021-22 from the State Fiscal Recovery Fund for Brynn Marr Hospital, Inc.
• Provides $3.2M in recurring funds to provide additional funding for TBI services.
• Provides $1.2M in NR funds to continue specified adult and pediatric TBI pilot programs.
• Provides $200K in NR funds to Mt. Olive Family Medicine Center, Inc., to support its Concussion Clinic and provide concussion education, baseline testing, and post-concussion assessment and care to schools and adolescent athletes in eastern North Carolina.
• Provides $3M in NR funds for a behavioral health urgent care pilot program at Dix Crisis Intervention Center in Onslow County.
• Provides $50M to support technology upgrades and electronic health record system development at State-operated healthcare facilities to enhance services and patient safety.
• Provides $20M in recurring funds to incentivize the development of Medicaid services to support the needs of recipients living in community-based group homes, to establish new rate models and methodologies, to increase the payments to LME/MCOs to facilitate the transition to a more appropriate and sustainable service funding model, and to continue the existing funding and rate structure to offset loss of bridge funding.
• Provides $500K in NR funds for Partners Health Management to address the needs of individuals in Surry County struggling with addiction.
• Provides $10M in NR funds to Hope Alive, Inc., a nonprofit in Robeson County, for substance use disorder treatment and recovery services.
• Provides $200K in NR funds to Aces for Autism, a nonprofit in Pitt County, to serve individuals with autism spectrum disorder.
• Provides $50K in NR funds to Anchor Holds, Inc., a nonprofit in Nash County, to provide services to individuals with substance use disorder.
• Provides $500K in NR funds to Wilkes Recovery Revolution, Inc., to address the needs of individuals struggling with addiction.
• Provides $100K in NR funds to Fellowship Hall, Inc., a nonprofit drug and alcohol recovery center in Greensboro.
• Provides $100K in NR funds to Reality Ministries, Inc., a nonprofit in Durham, that serves individuals with developmental disabilities.
• Provides $112,437 in NR funds to Ground 40 Ministries, a nonprofit in Union County that provides substance abuse treatment services.
• Provides $200K in NR funds to Dew4Him Ministries, Inc., a nonprofit in Wake County that provides substance abuse treatment and services to women.
• Provides $21.4K in NR funds to Living Free Ministries, Inc., a nonprofit in Alamance County that provides substance abuse treatment and recovery services.
• Provides $250K in NR funds to The Enrichment Center, a nonprofit in Winston-Salem that provides services for adults with intellectual and developmental disabilities.
• Provides funding from the Dorothea Dix Hospital Property Funds to Johnston Health Enterprises, Inc., Good Hope Hospital, and Harnett Health System, Inc., to construct mental health treatment beds.

Public Health

• Provides funds for health departments to expand communicable disease surveillance, detection, control and prevention activities to address COVID-19 and other communicable disease-related challenges impacted by the pandemic.
• Provides $150M in NR funds from the State Fiscal Recovery Fund to support lead and asbestos remediation in public schools and child care facilities.
• Provides $1.2M in NR funds and $1.2M in recurring funds to the Communicable Disease Branch for communicable disease prevention efforts including support for lab testing, connecting patients who test positive for a communicable disease to appropriate health care provider treatment options, and other efforts to prevent Hepatitis C, HIV, and other communicable diseases.
• Provides $200K in NR funds to Cabarrus Women’s Center for services and to purchase ultrasound equipment.
• Provides $50K in NR funds for the Pregnancy Resources Center or Cleveland County.
• Provides $6.4M in NR funds to the Human Coalition for a statewide expansion of the Continuum of Care Pilot Project which provides care coordination and medical support to women experiencing crisis pregnancies.
• Provides $3M to Nurse-Family Partnership to provide support for first-time parents.
• Provides $62,340,758 in federal receipts from the COVID-19 Cooperative Agreement for Emergency Response/Public Health Crisis Response to establish, expand, train, and sustain a State and local public health workforce.
• Budgets $20,230,000 in federal receipts from the American Rescue Plan Act of 2021 to provide resources for confinement facilities to address COVID-19.
• Budgets $1,439,232 in federal receipts from the American Rescue Plan Act of 2021 to provide resources to support COVID-19 testing and mitigation in homeless service sites, encampments, and other congregate settings.
• Budgets $14,144,928 in federal receipts from the American Rescue Plan Act of 2021 to provide resources to support the Nursing Home and Long-term Care Facility Strike Team and Infrastructure Project.
• Budgets $27,361,745 in federal receipts to support Disease Intervention Specialists, training and retention, and technological advances to address COVID-19 and other infectious diseases.
• Budgets $102,468,748 in federal receipts from the American Rescue Plan COVID-19 Vaccination Supplement to support statewide vaccination efforts.
• Budgets $142,473 from the federal Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement to support public health laboratory preparedness.
• Provides $21M from the North Carolina settlement with Juul Labs, Inc., to the Division of Public Health for tobacco and nicotine dependence prevention and cessation activities targeted at youth and young adults.

Social Services

• Provides $300K in NR funds to implement a child welfare and behavioral health pilot project to provide easier access to comprehensive health and trauma-related services for children in foster care.
• Provides $50K in NR funds to the Greater High Point Food Alliance.
• Provides $250K in NR funds to A Touch of the Father’s Love, Inc., a nonprofit ministry and food pantry in Nash County.
• Provides $10K in NR funds to The Pastor’s Pantry, a nonprofit in Davidson County that provides monthly groceries for low-income seniors and supplies emergency food for low-income individuals and families.
• Provides $10K in NR funds to the West Davidson Food Pantry.
• Budgets $17,105,002 in NR funds from the supplemental Low Income Household Water Assistance Program funding provided by the American Rescue Plan Act.

Vocational Rehabilitation Services

• Provides $300K in NR funds to the National Multiple Sclerosis Society to provide home modification services and home modification assistance grants to help NC residents with MS to remain in their homes.
• Provides $800K in NR funds to purchase equipment in order to maintain a statewide inventory of up-to-date assistive technology equipment to be used for assessments, training, and short-term equipment loans.

Capital

• Provides $75.25M in NR funds for the construction of a new Brody School of Medicine.
• Provides $46.75M in NR funds for the renovation of Carrington Hall Nursing School.
• Provides $11.37M in NR funds for the construction of a health science center at UNCP.
• Provides $4M to Fayetteville Technical Community College to renovate and convert an existing facility into a nursing school.
• Provides $350K in NR funds to the Alleghany Memorial Hospital Foundation for capital improvements at Alleghany Memorial Hospital.
• Provides $15M in NR funds to Cape Fear Valley Health System to address rural health disparities through development of the Medical Education & Research Center.
• Provides $1,129,519 in NR funds to Good Hope Hospital in Harnett County for the construction of mental health treatment beds.
• Provides $10M in NR funds to Granville Health Center for capital improvements.
• Provides $6,579,519 in NR funds to Harnett Health System, Inc. for the construction of mental health treatment beds at Betsy Johnson Hospital.
• Provides $3M in NR funds to Holly Hill hospital for capital improvements.
• Provides $10M in NR funds to Stokes County for capital improvements to the hospital.
• Provides $4M in NR funds to the American Healthcare Systems Foundation, Inc. for the construction of mental health treatment beds.
• Provides $300K in NR funds to UNC Rockingham Healthcare for capital improvements.
• Provides $3M in NR funds to WakeBrook UNC Healthcare for capital improvements.
• Provides $3.23M in NR funds to Burke County for the construction of a new substance abuse treatment facility.
• Provides $30M in NR funds to Cabarrus County for a new regional behavioral health crisis service center.
• Provides $1M in NR funds to Gateway of Hope Addiction Recovery Center for a new treatment facility.
• Provides $10.5M in NR funds to Mountain Area Health Education Center for the construction of a new parking deck.
• Provides $21.6M to Wake Forest Baptist Health for a new regional autopsy center.

Community College System

• Allocates $15M in NR funds to improve broadband access for 25 rural community colleges.
• Provides $500K in NR funds for a pilot program to expand career opportunities for students with intellectual and developmental disabilities.

Public Instruction

• Provides $25M to establish the Children with Disabilities Reserve for the FY 2021-22 school year.
• Reflects the transfer of 362 school psychologist positions from the Instructional Support Allotment and provides funding sufficient to hire an additional 115 school psychologist positions.
• Provides $13,175,727 in recurring funds to support an increase in the funding cap for the Children with Disabilities Allotment.
• Provides $2,824,616 in recurring funds for FY 2021-22 and FY 2022-23 and $175,384 in NR funds for FY 2021-22 for the new Transportation Reserve Fund for Homeless and Foster Children.
• Provides $250K in NR funds for FY 2021-22 to fund grants to schools for feminine hygiene products for students.

University of North Carolina

• Provides $6M in recurring funds to the Wake Forest Institute for Regenerative Medicine.
• Allocates $30M in NR funds to the North Carolina Policy Collaboratory to award research grants to monitor, assess, and address the public health and economic impacts of the COVID-19 pandemic.
• Allocates $20M in NR funds to the Collaboratory for a water and sewer project that establishes the Innovative Highly Treated Wastewater Pilot Program.
• Allocated $18M in NR funds to the Vice Chancellor for Research at UNC Chapel Hill for the Rapidly Emerging Antiviral Drug Development Initiative to advance development of therapeutics for the COVID-19 pandemic.
• Provides $9.2M in recurring funds for the UNC School of Medicine’s Asheville Campus.
• Allocates $1.5M in NR funds from DHHS for an adult care home accreditation pilot program to be administered by the Cecil G. Sheps Center for Health Services Research.
• Provides $9.6M in recurring funds to SR AHEC to support additional residencies in the SR AHEC service areas.
• Provides $5.9M in recurring funds to support the residency program at the Brody School of Medicine at ECU.
• Provides $500K in NR funds to Appalachian State University for the Rural Medical Resource Initiative.
• Allocated $500K in NR funds to the University of North Carolina at Pembroke for the operation of mobile medical units in rural and at-risk communities to respond to the impacts of the COVID-19 pandemic.

Agriculture, Natural, and Economic Resources

• Provides $40M in NR funds to be distributed equally to the six food banks in the State to meet the increased demand caused by the COVID-19 pandemic.
• Provides $10M in NR funds to Golden L.E.A.F. to grant funds to assist nonprofit organizations in becoming partner agencies with food banks and serving food security needs in their communities.
• Provides $5M in NR funds to Reinvestment Partners for its Produce Prescription Program.
• Provides $2M in NR funds to the Division of Workforce Solutions for a program that helps individuals battling substance abuse enter and stay in the workforce.
• Provides $487,275 in recurring funds to establish an Emerging Compounds Unit within the Division of Water Resources.
• Provides $400K in NR funds for the Waste Detection Elimination Program to identify and remediate groundwater contamination caused by straight pipes and failing septic systems.

Justice and Public Safety

• Provides $4M in recurring funds to support competitive grants to sheriffs’ offices to assist in expanding, maintaining, or establishing medication-assisted treatment of non-opioid, long-acting, injectable medication regimes as treatment for alcohol and/or opioid dependence as part of reentry programming in county jails.
• Provides $500K in NR funds to the Alamance County Sherriff’s Office to support the Stepping Up Initiative in developing a diversion center where nonviolent suspects with mental illness can receive necessary services.
• Provides $750K in NR funds to continue the implementation of a pilot project to establish a Quick Response Team to address the needs of opiate and heroin overdose victims.
• Budgets $8M of receipts from the Substance Abuse Prevention and Treatment Block Grant to expand the MAT Community Supervision pilot program to at least 5 tier one or tier two counties with the highest need.

General Government

• Provides $11.7M in NR funds for the North Carolina Pandemic Recovery Office to continue operations through the end of FY 2022-23.
• Provides $400K in NR funds for outreach, training, and other suicide prevention activities to veterans and active duty military personnel.
• Provides $29,995,000 in NR funds to match a potential federal grant to construct a new nursing facility in Wake County.
• Budgets patient receipts to provide funds for the opening of a new veterans nursing facility in Kernersville, NC.

Information Technology

• Provides federal broadband funds for competitive grants to providers to expand broadband availability in rural areas.
• Provides funds from the Coronavirus Capital Projects Fund for competitive grants to expand broadband availability in rural areas.
• Provides federal broadband funds to issue targeted grants addressing local infrastructure needs and connective unserved and underserved households.
• Provides funds for an awareness and digital literacy campaign.
• Provides funds for the preparation of statewide broadband maps.
• Provides $8.5M for the hardware and infrastructure costs associated with the growth of the HealthConnex system.

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by Ashley Rodriguez

Senate Budget Summary

The Senate introduced its $25.7 billion budget proposal on June 21, 2021. A summary of key provisions from the proposal follows below, and the complete Bill Text and Committee Report are also available if more detail is desired.

Highlights from provisions related to Health and Human Services include:

AGING AND ADULT SERVICES

Rapid Rehousing for Individuals and Families at Risk of Homelessness

Appropriates $15M in nonrecurring funds for the 2021-2022 fiscal year to be allocated for rapid rehousing services to assist individuals and families at risk of homelessness due to COVID-19.

Key Rental Assistance Program

Provides $2M in fiscal year 2021-2022 and fiscal year 2022-2023 to increase funding of the Key Rental Assistance Program to provide rental subsidies for eligible low-income, disabled individuals.

CENTRAL MANAGEMENT

NC Association of Free & Charitable Clinics

Provides $8.5M in nonrecurring funds for fiscal year 2021-2022 to respond to the public health emergency by supporting member clinics.

Community Health Grant Program

Appropriates funds to the Office of Rural Health for each year of the 2021-2023 fiscal biennium to administer the Community Health Grant Program.

Atrium Health Virtual Behavioral Health Services

Provides $1.5M in nonrecurring funds for the 2021-2022 fiscal year to respond to the public health emergency by extending primary care provider access to the virtual behavioral health integration network.

Veterans Health Care Pilot Program

Appropriates $400K in nonrecurring funds for the 2021-2022 fiscal year and $350K in nonrecurring funds for the 2022-2023 fiscal year to be used to support the development and implementation of a two-year pilot program to provide health care services to veterans.

Funds for the Statewide Telepsychiatry Program

Appropriates $1.5M in nonrecurring funds to the Office of Rural Health for the 2021-2022 fiscal year to be allocated as a grant to the ECU Center for Telepsychiatry and e-Behavioral Health for the statewide telepsychiatry program known as NC-SteP to be used to respond to COVID-19 by providing virtual psychiatric assessments and consultations to patients utilizing telepsychiatry.

Competitive Grant/Nonprofit Organizations

Allocates $1,625,000 for each year of the 2021-2023 fiscal biennium and $1,600,000 in Substance Abuse Prevention and Treatment Block Grant funds in each year of the 2021-2023 fiscal biennium to Triangle Residential Options for Substance Abusers, Inc. for the purpose of assisting individuals with substance abuse addiction.

Cumberland HealthNET

Provides $250K in nonrecurring funds for the 2021-2022 fiscal year to support Cumberland HealthNET, a collaborative network of community organizations with a primary focus of improving the health outcomes for the uninsured by linking them with a medical home and other needed health and community services.

Rural Health Loan Assistance Repayment Program

Provides $1.5M in nonrecurring funds for the 2021-2022 fiscal year and the 2022-2023 fiscal year to provide funding for loan repayment incentives to recruit doctors, physician assistants, dentists, nurse practitioners, and certified nurse midwives to rural areas.

HEALTH BENEFITS

Volume Purchase Plans and Single Source Procurement

Permits the Division of Health Benefits to contract for services, medical equipment, supplies, and appliances by implementation of volume purchase plans, single source procurement, or other contracting processes in order to improve cost containment.

Waive Medicaid Provider Enrollment and Revalidation Fees

States that providers revalidating enrollment or enrolling in the NC Medicaid program or the NC health Choice program shall not be charged the fee of one hundred dollars above the federally required fee for the enrollment or revalidation.

Copayments for Medicaid Services

Increases the copayments for Medicaid services to $4.00.

Expand Community Alternatives Program for Disabled Adults Waiver Slots

Requires $650,000 in recurring funds for the 2021-2022 fiscal year and $1M in recurring funds for the 2022-2023 fiscal year of the funds appropriated to the Division of Health Benefits to be used to increase the number of Community Alternatives Program for Disabled Adults waiver slots.

Expand North Carolina Innovations Waiver Slots

Requires $7,110,600 in recurring funds for the 2021-2022 fiscal year and $25,880,000 in recurring funds for the 2022-2023 fiscal year of the funds appropriated to the Division of Health Benefits to be used to increase the number of NC Innovations Waiver slots by 1,000.

Continue Medicaid Coverage for Pregnant Women

Permits pregnant women to remain eligible for Medicaid coverage for 12 months postpartum.

Allow a Parent to Retain Medicaid Eligibility

Permits parents to retain Medicaid eligibility while their child is temporarily serviced by the foster care system if certain specified conditions are met.

Increase Rates to ICFS for Direct Care Worker Wage Increases

Requires $17.5M in recurring funds for the 2022-2023 fiscal year of the funds appropriated to the Division of Health Benefits to be used to provide a rate increase to intermediate care facilities for individuals with intellectual disabilities effective July 1, 2022, and upon approval by CMS. Any provider receiving a rate increase under this section must use at least 80% of the funding that results from the rate increase to increase the rate of pay paid to its direct care employees.

Use of Medicaid Transformation Fund for Medicaid Transformation Needs

Allows funds from the Medicaid Transformation Fund to be transferred to DHB for the 2021-2023 fiscal biennium as needed to pay claims related to services billed under the fee-for-service payment model for recipients who are being transitioned to managed care.

Permits the transfer of $133,078,000 in nonrecurring funds for the 2021-2022 fiscal year and $119,004,000 in nonrecurring funds for the 2022-2023 fiscal year from the Medicaid Transformation Fund to DHB to provide the State share for certain specified qualifying needs directly related to Medicaid Transformation.

Choice in Accreditation for LME/MCOs Operating BH IDD Tailored Plans

Prohibits DHHS from requiring any LME/MCO awarded a BH IDD tailored plan contract to be accredited by any one specific accreditation organization and requires DHB to create a process for approval of the accreditation organization selected by the LME/MCO.

Evaluate DHB Needs in Managed Care Environment

Requires DHHS to conduct an evaluation of current staffing and administrative needs and functions for the Medicaid and NC Health Choice programs and how those staffing needs and administrative functions will change was the programs transition to a managed care service delivery environment.

Reimburse DME Prescribed by Podiatrists

Requires certain specified Medicaid clinical coverage policies to provide coverage for orthotic devices, prosthetic devices, and other durable medical equipment when there is a documented medical necessity for the equipment and the equipment is prescribed by a beneficiary’s treating podiatrist acting within that podiatrist’s scope of practice.

HEALTH SERVICE REGULATION

Modification of CON Laws

Modifies the definition of “diagnostic center”, “major medical equipment”, and “new institutional health services” by increasing the cost threshold amounts applicable to each term. Note this language mirrors SB 462 – CON/Threshold Amendments & Certificate Expirations previously summarized here.

Provides that a certificate of need issued for the construction of a health service facility issued on or after October 1, 2021, expires if the certificate’s holder fails to execute or commit to a contract for design services for the project authorized by the certificate within certain specified time frames. Note this language mirrors SB 462 – CON/Threshold Amendments & Certificate Expirations previously summarized here.

Impact of Prior Violations on Adult Care Home Licensure

Prohibits the issuance of a new license for any adult care home to an applicant responsible for the operation of a facility that had its license downgraded to provision status or had its admissions suspended as a result of violations until the earlier of the following: (1) 6 months from the date of restoration from provisional to full licensure, termination of the provisional license, or lifting or termination of the suspension of admissions, as applicable, or (2) until the home has substantially complied with the correction plan established by DHHS and substantial compliance has been certified by the Department.

Access to Patient Data Under the Medical Care Data Act

Requires the State to make available to any person or organization under contract with DHHS to provide medical care quality improvement services the same reports of compiled patient data prepared for release or dissemination by a statewide data processor to DHHS and prohibits any person/organization that receives patient data from using it for any purpose other than to fulfill its performance under the contract with DHHS.

MENTAL HEALTH/DEVELOPMENTAL DISABILITIES/SUBSTANCE ABUSE SERVICES

Use of Opioid Settlement Funds

Establishes the Opioid Abatement Fund and requires that all funds received by the State as a beneficiary of the final consent judgment resolving the case, State of North Carolina, ex rel. Joshua Stein, Plaintiff v. McKinsey and Company, Inc., to be deposited into the fund.

Requires that all moneys in the fund be used to (1) cover the costs incurred by the State in investigating and pursuing the claims in this case and (2) remediate the harms caused to the State and its citizens by the opioid epidemic.

Contract to Implement Electronic Health Records at State Psychiatric Hospitals

Directs DHHS, in coordination with the Department of Information Technology, to execute a contract providing for the implementation of a standard, uniform platform for electronic health records that most closely resembles the platform utilized by The University of North Carolina System within each of the State psychiatric hospitals under DHHS’ jurisdiction.

Local Inpatient Psychiatric Beds or Bed Days

Requires funds appropriated to the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services to continue to be sued for the purchase of local inpatient psychiatric beds, provides requirements related to the distribution and management of beds or bed days, and permits DHHS to contract with another LME/MCO to manage the beds or bed days if DHHS determines that LME/MCO is not effectively managing the beds or bed days or has failed to comply with prompt payment provisions.

Funds for Overdose Medications

Appropriates $100K in recurring funds for each fiscal year of the 2021-2023 fiscal biennium to the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services to be used to purchase opioid antagonists to be distributed to the NC Harm Reduction Coalition and to NC law enforcement agencies.

Youth Tobacco Enforcement Funding

Requires $300K in recurring funds for each year of the 2021-2023 fiscal biennium to be transferred to the Alcohol Law Enforcement Division of the Department of Public Safety to fund statewide compliance checks to enforce the State’s youth tobacco access law.

Resume Funding for the Adult and Pediatric Traumatic Brain Injury Pilot Program

Requires DHHS to resume its adult and pediatric traumatic brain injury pilot program, appropriates $600K in nonrecurring funds for the 2021-2022 fiscal year to be used to pay currently unfunded costs associated with the pilot program, and appropriates $300K in nonrecurring funds for the 2021-2022 fiscal year and $300K in nonrecurring funds for the 2022-2023 fiscal year to be used for the pilot program.

Funds for Student Athlete Concussion and Traumatic Brain Injury Prevention and Care

Provides $100K in nonrecurring funds for the 2021-2022 fiscal year and $100K in nonrecurring funds for the 2022-2023 fiscal year to be allocated to Mount Olive Family Medicine Center, Inc., to be used to support its Concussion Clinic and provide concussion education, baseline testing, and postconcussion assessment and care to schools and adolescent athletes in eastern NC.

Use of Dorothea Dix Hospital Property Funds for New Licensed Inpatient Behavioral Health Beds

Appropriates $4,261,444 in nonrecurring funds for the 2021-2022 fiscal year to be used to pay for any renovation or building costs associated with (1) the construction of new licensed inpatient behavioral health beds, (2) the conversion of existing inpatient acute care beds into licensed inpatient behavioral health beds, or (3) a combination of the following options:

1. $2,550,000 in nonrecurring funds to be used to pay for the construction of new licensed inpatient behavioral health beds at Good Hope Hospital in Harnett County.
2. $1,711,444 in nonrecurring funds to be used to create a new behavioral health unit in Betsy Johnson Hospital.

Behavioral Health Urgent Care Pilot Program

Provides $500K in nonrecurring funds for the 2021-2022 fiscal year and $1.5M in nonrecurring funds for the 2022-2023 fiscal year to be allocated to RI International for the Dix Crisis Intervention Center in Onslow County to be used for a behavioral health urgent care pilot program.

PUBLIC HEALTH

Local Health Departments/Competitive Grant Process to Improve Maternal and Child Health

Requires funds appropriated to the Division of Public Health for each year of the 2021-2023 fiscal biennium to award competitive grants to local health departments for the improvement of maternal and child health to be used to continue the administration of a competitive grant process for local health departments designed to (1) improve NC’s birth outcomes, (2) improve the overall health of children from birth to age 5, and (3) lower NC’s infant mortality rate.

Specifies required components of the plan for administering the grant process and establishes reporting requirements.

Report of Premium Assistance Program within AIDS Drug Assistance Program

Requires the Division of Public Health to adhere to specified reporting requirements upon the determination that, in 6 months or less, it will no longer be feasible to operate the health insurance premium assistance program implemented within the NC AIDS Drug Assistance Program on a cost-neutral basis or in a manner that achieves savings to the State.

Carolina Pregnancy Care Fellowship Funds

Limits the amount of funds that may be used for administrative purposes of those appropriated to the Division of Public Health for the Carolina Pregnancy Care Fellowship to no more than 15% of the funds allocated for the 2021-2022 fiscal year and for the 2022-2023 fiscal year.

Mountain Area Pregnancy Services Funds

Limits the amount of funds that may be used for administrative purposes of those appropriated to the Division of Public Health for Mountain Area Pregnancy Services to no more than 15% of the funds allocated for the 2021-2022 fiscal year and for the 2022-2023 fiscal year.

Statewide Expansion of the Continuum of Care Pilot Program

Appropriates $1.2M in nonrecurring funds for the 2021-2022 fiscal year and $1.2M in nonrecurring funds for the 2022-2023 fiscal year to the Human Coalition, a nonprofit organization, to expand the continuum of care pilot program.

Specifies that the purpose of the statewide continuum of care program is to (1) encourage healthy childbirth, (2) support childbirth as an alternative to abortion, (3) promote family formation, (4) assist in establishing successful parenting techniques, and (5) increase the economic self-sufficiency of families.

Requires all providers rendering services under the program to be physically located in NC.

Specifics eligibility requirements to receive services under the program.

Lead and Asbestos Remediation in Public School Units and Child Care Facilities

Appropriates $32,812,500 in nonrecurring funds to the Division of Public Health to be used to fund a program for the testing and remediation of lead levels in drinking water at public school units and child care facilities.

Appropriates $117,187,500 in nonrecurring funds to the Division of Public Health to be used to fund a program for lead paint abatement and asbestos abatement in public school units and child care facilities.

Statewide COVID-19 Vaccination Efforts

Provides $10,468,748 in nonrecurring funds for fiscal year 2021-2022 to support Statewide vaccination efforts.

Crisis Response Workforce Fund

Provides $62,340,758 in nonrecurring funds for fiscal year 2021-2022 to establish, expand, train, and sustain a State and local public health workforce to support jurisdictional COVID-19 prevention, preparedness, response, and recovery initiatives.

Disease Intervention Workforce

Provides $27,361,745 in nonrecurring funds for fiscal year 2021-2022 to support Disease Intervention Specialists and DIS-related training and retention and related technological advances to address COVID-19 and other infectious diseases.

SOCIAL SERVICES

Child Welfare/Behavioral Health Pilot Program

Requires the Division of Social Services, in collaboration with the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services to establish a two-year child welfare and behavioral health pilot program designed to provide easier access to comprehensive health services for children in foster care.

HHS MISCELLANEOUS

Medical Billing Transparency

Includes language requiring contract requirements for limitation on billing by in-network health services facilities. Note that this language mirrors SB 505 – Medical Billing Transparency previously summarized here.

Allow Employers to Offer EPO Benefit Plans

Includes language permitting employers to offer exclusive provider benefit plans. Note that this language mirrors HB 373/SB 228 – Allow Employers to Offer EPO Benefit Plans previously summarized here.

 

Other pertinent provisions include:

 

NC HealthConnex

Appropriates $3.25M in fiscal year 2021-2022 and $3.25M in fiscal year 2022-2023 to provide funding for the hardware and infrastructure costs associated with the growth of the HealthConnex System.

Community College Programs Serving IDD Students

Requires the State Board of Community Colleges to establish a two-year pilot program at two community college campuses for training programs that provide opportunities for a micro-credential or other credentials that lead to increase employment outcomes for individuals with intellectual and developmental disabilities.

Funds for Children with Disabilities

Requires the State Board of Education to allocate additional funds for children with disabilities on the basis of $4,549.88 per child for fiscal years 2021-2022 and 2022-2023.

School Psychologists Allotment

Requires the State Board of Education to establish a funding allotment for school psychologist positions and requires local boards of education to ensure that each local school administrative unit employs at least one full-time, permanent school psychologist.

Provides $40,862,520 in fiscal year 2021-2022 and fiscal year 2022-2023 to hire an addition 115 school psychologists and to reflect the transfer of 362 school psychologist positions to a new School Psychologist Allotment.

Transportation Reserve Fund for Homeless and Foster Children

Provides $3M to establish a fund that will be used to support the extraordinary transportation costs of qualifying students.

School Health Support Personnel Professional Entry Report

Requires the State Board of Education to study and report policies and practices related to school health support personnel (including school psychologists, school counselors, school nurses, and school social workers), barriers persons face when entering each school health support profession.

School Safety Grants Program

Provides up to $350K in each year of the 2021-2023 fiscal biennium for the Superintendent of Public Instruction, in consultation with DHHS, to award grants to public school units to contract with community partners to address school safety by providing training to help students develop healthy responses to trauma and stress.

Feminine Hygiene Products Grant Program

Requires the Department of Public Instruction to establish a Feminine Hygiene Products Grant Program for the 2021-2022 fiscal year to provide grants of up to $5K to publish school units to provide feminine hygiene products for students and provides $250K in nonrecurring funds for fiscal year 2021-2022 to support the program.

Wake Forest Institute for Regenerative Medicine

Provides $7M in nonrecurring funds for fiscal year 2021-2022 to support the Institute’s “Body of a Chip” research project to accelerate the development of treatments to harmful chemical and biological agents.

Western School of Medicine – Asheville

Provides $4.6M in fiscal year 2021-2022 and fiscal year 2022-2023 to provide additional funds for the UNC School of Medicine’s Asheville Campus.

Southern Regional AHEC

Provides $4.8M in fiscal year 2021-2022 and fiscal year 2022-2023 to support additional residencies.

ECU Residency Program

Provides $2.3M in fiscal year 2021-2022 and $3.6M in fiscal year 2022-2023 to support the residency program at the Brody School of Medicine.

Codify NC Collaboratory

Establishes the NC Collaboratory to facilitate the dissemination of the policy and research expertise of The University of North Carolina and other institutions of higher education within NC for practical use by State and local governments.

Collaboratory/2021 Water Safety Act/Firefighting Foam Registry

Requires the Collaboratory to conduct targeted and nontargeted analysis for PFAS, conduct statewide water sampling, testing, and monitoring, and develop and deploy technologies to mitigate exposure to PFAS.

Allocates $15M in nonrecurring funds for the 2021-2022 fiscal year to the University of North Carolina at Chapel Hill for the Collaboratory and requires a minimum of $10M be directed to development within UNC of a technology that utilizes water filtration or other chemical or physical technologies to remove or mitigate the presence of PFAS from water supplies where it is present.

Collaboratory/COVID-19 Research Initiatives

Requires the Collaboratory to facilitate various research activities related to monitoring, assessing, and addressing the public health and economic impacts of COVID-19, including best practices and strategies to maximize resources and achieve a comprehensive research response to COVID-19.

Permits up to $18M of funds allocated to the Collaboratory to be used to advance development of therapeutics for COVID-19 and other viruses that pose a pandemic threat.

Food Bank and Food Assistance Program Funds

Appropriates $40M to the Department of Agriculture and Consumer Services to be distributed to NC food banks to be used for the purchase and distribution of food, infrastructure and equipment, capacity-building for the food banks and their partner agencies, benefits counseling, and partnerships with community workforce development organizations.

Appropriates $8M to the Department of Agriculture and Consumer Services to be distributed to Golden LEAF, a nonprofit corporation, to provide grants to nonprofit organizations to assist those organization in becoming partner agencies to any NC food bank.

Appropriates $2M to the Department of Agriculture and Consumer Services to be distributed to Golden LEAF to provide grants to nonprofit organizations that are not NC food bank partner agencies for school-based weekend food assistance programs for students.

Create Division of Juvenile Justice

Requires the Department of Public Safety to reimburse providers and facilities providing approved medical services to juvenile offenders outside the juvenile facility the lesser amount of either a rate of 70% of the provider’s then-current prevailing charge or two times the then-current Medicaid rate for any given service.

Authorizes the Department of Public Safety to audit providers as needed to ensure compliance.

Assessment of and Long-Term Care Planning for Veterans

Appropriates $250K in nonrecurring funds for the 2021-2022 fiscal year to the Department of Military and Veterans Affairs to be used to assess, in consultation with DHHS, the long-term care needs of veterans across the State for the purpose of developing a plan to guide the State in enhancing long-term care and other services for veterans.

State Recovery Funds/NC GREAT Grant – Federal Broadband Funds/Coronavirus Capital Projects Fund/Broadband Stopgap Solutions

Provides $330M in nonrecurring funds for the 2021-2022 fiscal year for competitive grants to private providers of broadband service for expanding broadband availability in rural areas.

Provides $277,060,855 in nonrecurring funds for the 2021-2022 fiscal year for competitive grants to private providers of broadband service for expanding broadband availability in rural areas.

Provides $90M in nonrecurring funds for the 2021-2022 fiscal year to issue targeted grants addressing local infrastructure needs and connecting underserved households.

Capital Improvements

Appropriates $1.6M for the2021-2022 fiscal year to DHHS for a new Broughton Hospital.

Appropriates $21.5M for the 2021-2022 fiscal year and $53.7530M for the 2022-2023 fiscal year to ECU for the Brody School of Medicine.

Appropriates $9.1M for the 2021-2022 fiscal year and $22.75 for the 2022-2023 fiscal year to UNC Pembroke for the Health Sciences Center.

Provides $15M for the 2021-2022 fiscal year to Cape Fear Valley Health System to address rural health disparities through development of the Medical Education and Research Center.

Provides $10.5M for the 2021-2022 fiscal year to Mountain Area Health Education Center for the construction of a new parking deck.

Provides a $5M grant to Healing Transitions for the construction of a recovery center and purchase of recovery beds.

Provides a $6,288,556 grant to Harnett Health Systems for the construction of mental health treatment beds at Betsy Johnson Hospital.

Provides a $3M grant to Washington County for the construction of a new EMS facility.

Provides a $3.25M grant to Burke County for the construction of a new substance abuse treatment facility.

 

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by Ashley Rodriguez

HB 555/SB 622 – 2021 Governor’s Budget

HB 555/SB 622 – 2021 Governor’s Budget

Primary House Sponsors: Rep. Jason Saine (R-Lincoln); Rep. Donny Lambeth (R-Forsyth); Rep. Dean Arp (R-Union); Rep. John Faircloth (R-Guilford)

Primary Senate Sponsors: Sen. Brent Jackson (R-Duplin, Johnston, Sampson); Sen. Kathy Harrington (R-Gaston); Sen. Ralph Hise (R-Madison, McDowell, Mitchell, Polk, Rutherford, Yancey)

Summary

This bill includes the Governor’s budget proposal.

Movement

HB 555

Filed – 4/13/2021

SB 622

Filed – 4/6/2021

This bill was re-referred to the following Senate Committees:

Appropriations/Base Budget

Rules and Operations

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by Ashley Rodriguez

SB 538 – DHHS Contract/EPIC at State Psych. Hospitals

SB 538 – DHHS Contract/EPIC at State Psych. Hospitals

Primary Senate Sponsors: Sen. Joyce Krawiec (R-Davie, Forsyth); Sen. Jim Burgin (R-Harnett, Johnston, Lee); Sen. Jim Perry (R-Lenoir, Wayne)

Summary

This bill directs DHHS, in coordination with the Department of Information Technology, to execute a contract providing for the implementation of Epic software as the standard platform for electronic health records within each of the State psychiatric hospitals under DHHS’ jurisdiction.

This bill also appropriates $10.9M in nonrecurring funds for the 2021-2022 fiscal year and $20M in nonrecurring funds for the 2022-2023 fiscal year to cover the contract’s costs.

Movement

Filed – 4/5/2021

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by Ashley Rodriguez