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:
- $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.
- $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.