NCMS, Author at North Carolina Medical Society

SB 157 - Bridge to Recovery Funding

Primary Sponsor: Rep. Todd Johnson (R-Cabarrus)

Bill Summary

This bill would appropriate $300,000 in nonrecurring funds for the 2019-20 fiscal year to provide a grant in aid to Bridge Recovery Inc. Bridge Recovery Inc. is a non profit in Monroe, North Carolina that provides treatment and recovery services to individuals with substance abuse disorders.

Bill Movement

This bill was filed on February 28, 2019.

This bill was referred to the Senate Appropriations/Base Budget Committee. If found favorable there, it will move to the Senate Rules Committee,

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Joint Health Appropriations Meeting - Child Development

The Joint House and Senate Health Appropriations Committee met on March 5, 2019.

Child Development and Early Education

Deborah Landry, Fiscal Research provided a presentation on the Division of Child Development and Early Education Base Budget Overview.

One significant legislative action mentioned was the requirement of the Division to develop a separate birth through 2 years of age, star related licenses for child care facilities.

Landry noted that County Departments of Social Services receive 4% of the county's total child care subsidy allocation for administrative cost or $80,000 whichever is greater. Counties may use up to 2% of their allocation for fraud detection.

65,247 children utilized the Child Care Subsidy in 2018. The waitlist includes over 29,000 children.

NC Pre-K and Smart Start

Deborah Landry, Fiscal Research provided a presentation on NC Pre-K and Smart Start Overview.

NC Pre-K

The NC Pre-K Program had 29,791 slots in 2018-2019. The estimated unmet slot need is 4,219. Private child care centers, public schools, and Head Start are the three participating Pre-K avenues.

There were 33 counties who did not request additional slots for one or more of the following reasons: no waiting list, inability to locate qualified teachers, capacity, no local dollars to supplement state funding.

Smart Start

Smart Start is a network of 75 nonprofit local partnerships that serve all 100 NC counties. $7 million was appropriated for FY 2018-2019 for the Dolly Parton Imagination Library. 208,488 children are currently enrolled in the program. 35% of these children are under the age of 5. As of February 2019, 1.46 million books have been mailed to NC kids.

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HB 243 - State Human Resources Act Amendments

Primary Sponsors: Rep. Dennis Riddell (R-Alamance), Rep. George Cleveland (R-Onslow), Rep. Elmer Floyd (D-Cumberland)

Bill Summary

This bill would amend the State Human Resources Act relating to technical assistance provided to State Workplace Safety Programs by the Office of State Human Resources. This would directly relate to workplace safety and health programs and to address specific technical problems.

Bill Movement

This bill was filed on February 28, 2019.

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HB 75 - School Mental Health Screening Study

Primary Sponsors: Rep. John Torbett (R-Gaston), Rep. David Lewis (R-Harnett), Rep. Josh Dobson (R-Avery), Rep. John Bell (R-Wayne)

This bill would direct the Department of Health and Human Services (DHHS) and the Department of Public Instruction (DPI) to study developing a mental health screening process for children in NC public schools. This was recommended by the House Select Committee on School Safety.

The study would examine at least the following issues:

Should the state require a mental health screen to identify children at risk of harming themselves or others?
Which health professionals should conduct the screening?
What behaviors or mental health diagnoses should the screen try to identify?
Screening format
Should the screen be uniform throughout the State or should the state create guidelines for local school units?
Create a policy of referring children identified as at risk to the appropriate provider type.
Create a policy regulating the storage, access, and confidentiality of the screening.
Determination of the optimal age to start the screening and if/how often the screening should continue.
Can parents opt out of the screening?
Should individuals who preform mental health screenings be immune from suit for their actions and omissions in performing those screens?

The Departments would be required to report their findings by February 15, 2020.

Bill Movement

This bill was filed on February 13, 2019.

This bill was referred to the House Education, K-12 Committee. If it is found favorable there, it will move to the House Rules Committee.

This bill was withdrawn from House Education K-12 Committee and re-referred to the House Health Committee on February 21, 2019.

This bill passed the House Health Committee on February 26, 2019.

This bill passed the House Rules Committee on March 4, 2019.

This bill will now move to the House floor.

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HB 185 / SB 143 - Nurse Scope Expansion

SB 143 / HB 185 - The SAVE Act

*This bill was filed jointly in the House and Senate.

Primary Senate Sponsor: Sen. Ralph Hise (R-Madison)

Primary House Sponsors: Rep. Donny Lambeth (R-Forsyth), Rep. Josh Dobson (R-Avery), Rep. Sarah Stevens (R-Surry), Rep. Gale Adcock (D-Wake)

Bill Summary

This bill defines Advanced Practice Registered Nurses as the following:

Nurse Practitioner (NP)
Certified Nurse Midwife (CNM)
Certified Nurse Specialist (CNS)
Certified Registered Nurse Anesthetist (CRNA)

Nurse Anesthesia Definitions

The bill defines nurse anesthesia activities as the following:

Preparation

Performing health assessment
Recommending, requesting, and evaluating diagnostic studies
selecting and administering preanesthetic medications

Anesthesia induction, maintenance, and emergence

Providing safety checks
Selecting, implementing, and managing anesthesia
performing tracheal intubation and extubation and providing mechanical ventilation
Managing blood, electrolyte, fluid, and acid base balance
Evaluating client's response from anesthesia, and implementing pharmaceutical treatment

Postanesthesia care

Providing follow up care: evaluations, complications, implementing corrective actions, requesting consultations
Administering respiratory support via pharmacological or fluid suport
Documenting all aspects of care to provider that assumes patient's care following anesthesia
Releasing clients from care

Other Care Scopes

Central vascular access catheters and epidural catheters
Emergency situations including cardiopulmonary resucitation
Consultations on respiratory and ventiltor care
Initiating and managing pain relief therapy

Population Focus Areas

The bill outlines the following APRN population focus areas:

Family/Individual across life span
Adult gerontology
Neonatal
Pediatrics
Women's health/Gender-related issues
Psychiatric/Mental Health

The bill outlines the scope of CNMS, CRNAs, CNS, and NPs, practicing independently.

The bill changes the language of supervision to collaboration between dentists and CRNAs.

The bill also removes the subcommittee of the Nursing Board to work jointly with the NC Medical Board to develop rules and regulation on medical acts and to determine fees.

The bill also sets fees for APRNS.

The bill also allows the Board to have grandfathering exemptions for APRNS.

Bill Movement

This bill was filed in the House and Senate on February 26, 2019.

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HB 230 / SB 160 Life Changing Experiences School Pilot Program

HB 230 / SB 160 - Life Changing Experiences School Pilot Program

Primary House Sponsors: Rep. Josh Dobson (R-Avery), Rep. Greg Murphy (R-Pitt), Rep. Jason Saine (R-Lincoln)

Primary Senate Sponsors: Sen. Ralph Hise (R-Madison), Sen. Ted Alexander (R-Cleveland), Sen. Don Davis (D-Pitt)

Bill Summary

This bill would allow the Department of Public Instruction to establish the Life Changing Experiences School Pilot Program for the 2019-2021 fiscal biennium.

The program is for students in grades 6-11 in the following schools:

Lincoln County Schools
McDowell County Schools
Mitchell County Schools
Pitt County Schools

The Project includes themes that address alcohol, drugs, dangerous driving, violence, and bullying. The goal of these programs is to increase positive intentions and behavioral outcomes.

The bill provides $360,000 in nonrecurring funding for this program.

Bill Movement

This bill was filed on February 28, 2019.

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Joint HHS Appropriations Committee - Medicaid Managed Care

The Joint Appropriations Health and Human Services Committee met on February 26, 2019.

Medicaid Transformation Implementation

Department of Health and Human Services Secretary, Mandy Cohen, MD provided the Committee an update on Medicaid Managed Care.

She stated that Regions 2 and 4 will go first iim the process in November of 2019. The remaining Regions will roll out in February 2020.

She noted that there has been a protest filed, but they anticipated moving forward with their proposed timeline.

Dave Richard provided an overview on the beneficiary experience. Beneficiaries who don't choose a health plan automatically based on this criteria:

Where they live
If they are a member of a special population (ex. federally recognized tribes BH or I/DD Tailored Plan eligible)
Plan assignments of other family members
Beneficiary has a historic relationship with particular PHP

Timeline

Provider Experience

One time credentialing process instead of credentialing for each process
Single statewide drug formulary all PHPs are required to utilize
Same services covered in Medicaid managed care and fee for service
Department's definition of "medical necessity" will be used in all PHPs in making coverage decisions
Providers are offered some contracting "guardrails"

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SB 163 - Require Parental Notification for DNR Orders

Primary Sponsors: Sen. Joyce Krawiec (R-Forsyth), Sen. Warren Daniel (R-Avery), Sen. Ralph Hise (R-Madison)

Bill Summary

This bill requires parental notification and agreement prior to issuing an order to withhold cardiopulmonary resuscitation and other life prolonging measures from patients who are unemancipated minors.

The bill would require a physician not to issue an order to withhold pulmonary resuscitation or life prolonging measures unless the physician has done one of the following:

informed at least one of the patient's parents or legal guardians
made a reasonable attempt to inform the patient's other parent

The bill states that physicians are responsible for ensuring that all communications made or attempted are documented in the patient's medical record. The bill also requires the following information to be included: date, time, persons contacted, if the communication was oral or written.

The bill states that if a parent/guardian objects to a DNR that the physician shall document this in the medical record.

The bill states that if the patient's parents/legal guardians are unable to agree on the issuance of a DNR, the parent or legal guardian may petition the district court in the county in which the legal guardian resides, or where the patient is receiving treatment for an order in violation of this section. The bill prohibits a physician from issuing a DNR in any case where the parents/legal guardians are unable to agree on the issuance of a DNR order.

Bill Movement

This bill was filed on February 27, 2019.

This bill was referred to the Senate Rules Committee on February 28, 2019.

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Take Action Against Nurse Independent Practice!

Yesterday, legislation was introduced in the NC Senate and NC House to eliminate the physician supervision requirement of Advanced Practice Registered Nurses (APRNs). Supervision is an important patient protection. Eliminating supervision of Nurse Practitioners (NP), Certified Nurse Midwives (CNM), Certified Nurse Specialists (CNS) and Certified Registered Nurse Anesthetists (CRNA) will create significant additional risks or patients.

We believe this bill is also counterproductive to our efforts to move to value. Our NCMS Medical Team Taskforce continues to work to find a pathway towards reflecting the best practices across NC, but this bill does not accomplish that goal.

NCMS opposes this bill. You can find a summary of the bill here:

https://www.ncmedsoc.org/hb-sb-143-nurse-scope-expansion/

Please ask your House and Senate members asking them NOT to sponsor this bill by participating in this NCMS Action Alert.

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