NC's Health & Human Services budgets

By Rose Hoban

Each year, we slog through the budgets presented by each chamber of the General Assembly to compare and contrast what each set of lawmakers has set forth as their spending priorities for the year in health and human services.

In odd-numbered years, the legislative session starts in January or February to create a biennial budget and continues working through the end of the fiscal year on June 30. The tradition is that during the “long” session, the Senate presents its budget first. This year, the Senate ratified its spending plan on May 12 and sent that to the House for consideration. Last week, the House passed its plan.

Now the two bodies will meet in negotiations to hash out their differences, before sending their compromise plan to Gov. Roy Cooper to sign or veto.

We will update this chart later this year, once the two chambers finalize their compromise plan.

How to use this chart: The Senate budget is the baseline, any changes created by the House will be shaded in blue.

SENATE	HOUSE
CENTRAL MANAGEMENT AND SUPPORT	CENTRAL MANAGEMENT AND SUPPORT
Orders the Department of Health and Human Services to cooperate with the state Chief Information Officer to coordinate all health information technologies policies and programs in the state. Goals include protection of health information privacy, use of electronic health records to improve patient health care coordination, coordination of the health information exchange, facilitatation of research, early detection of outbreaks, etc.	Orders the Department of Health and Human Services to cooperate with the state Chief Information Officer to coordinate all health information technologies policies and programs in the state. Goals include protection of health information privacy, use of electronic health records to improve patient health care coordination, coordination of the health information exchange, facilitatation of research, early detection of outbreaks, etc.
	Cuts $3.2 million in one-time funding each year for contracted services. Reductions are not to be taken from any contracts/agreements that are providing direct services or supporting the US DOJ Settlement/Transitions to Community Living Initiative.
Orders DHHS to cooperate with the state Department of Information Technolgy to create standards compatable with national standards, develop a state plan for compliance with federal IT standards, and incorporate data about patients who are aged, have behavioral health issues, and other underserved populations into state and national databases.
	Orders a feasibility study of creating an electronic health record for inmates that can follow them around the state’s correctional system.
Appropriates an additional $200,000 in one-time funding each year for the Medication Assistance Program that provides assistance for people who are uninsured or underinsured and helps them obtain charity drugs from manufacturers.	Appropriates an additional $200,000 in one-time funding each year for the Medication Assistance Program that provides assistance for people who are uninsured or underinsured and helps them obtain charity drugs from manufacturers.
Earmarks $386,667 in receipts to match federal funds for enhancing Medicaid Management Info System standards and allows for the creation of 10 positions dedicated to the project.	Earmarks $386,667 in receipts to match federal funds for enhancing Medicaid Management Info System standards and allows for the creation of 10 positions dedicated to the project.
Directs $3,480,000 in new funds over the biennium for the IT projects above.	Directs $350,000 from the federal Social Services Block Grant to be used specifically for the Big Brothers/Big Sisters program. This means the Social Services Block Grant has a total of $4.2 million for all other competitive grants.
Allots $20 million in one-time funding and $11.9 million in earned revenue for the creation of software to track child services case management that will be integrated into the NC FAST system. Allots $179 million over two years in DHHS federal receipts to make the NC FAST child welfare case management system happen.	Allots $20 million in one-time funding and $11.9 million in earned revenue for the creation of software to track child services case management that will be integrated into the NC FAST system. Allots $179 million over two years in DHHS federal receipts to make the NC FAST child welfare case management system happen.
	Sets aside an additional $1.6 million annually from the federal Substance Abuse Prevention and Treatment Block Grant specifically for Durham’s TROSA, a substance abuse treatment program. TROSA receives $3.2 million from this block grant each year.
Appropriates $1.9 million in annual funds and 32 positions in FY 17-18 and $7.7 million in annual funds and 54 positions in FY 18-19 to provide ongoing maintenance for NC FAST. Over the two years, $25.5 million in departmental receipts are to be directed toward this work.	Appropriates $1.9 million in annual funds and 32 positions in FY 17-18 and $7.7 million in annual funds and 54 positions in FY 18-19 to provide ongoing maintenance for NC FAST. Over the two years, $25.5 million in departmental receipts are to be directed toward this work.
Cuts $7.7 million in the annual appropriation to Cape Fear Valley Medical Center to cover the costs of graduate medical education, while adding a one-time appropriation of up to $3 million. Why? In the last budget cycle, this money was appropriated to offset losses to CFVMC due to its redesignatation from an urban center to a rural one by CMS. But new changes in CMS policy means CFVMC will regain it’s urban hospital designation at the beginning of the federal fiscal year in October.	Cuts $7.7 million in the annual appropriation to Cape Fear Valley Medical Center to cover the costs of graduate medical education, while adding a one-time appropriation of $1 million. Why? In the last budget cycle, this money was appropriated to offset losses to CFVMC due to its redesignatation from an urban center to a rural one by CMS. But new changes in CMS policy means CFVMC will regain it’s urban hospital designation at the beginning of the federal fiscal year in October.
Orders DHHS to continue working with the Goverment Data Analytics pilot program, initiated in 2015, to get Medicaid analytics to generate information about population health, to optimize health care savings and efficiencies, and to create better health outcomes.	Orders DHHS to continue working with the Goverment Data Analytics pilot program, initiated in 2015, to get Medicaid analytics to generate information about population health, to optimize health care savings and efficiencies, and to create better health outcomes.
	Appoints $8.9 million in FY 17-18 and $11.1 million in FY 18-19 to create new functions in the NC FAST computer system that helps it meet new federal requirements around privacy and fraud detection. Allows for the personnel costs of four people in each year.
	Also allocates $1.9 million and 32 workers in continued funding in FY 17-18 and $7.7 million in continued funding and 54 workers in FY 18-19 for continued operations of NC FAST, the DHHS system for signing beneficiaries up for services. New projects are coming online include fraud detection (program integrity), Child Care Subsidy tracking and energy assistance programs.
Updates existing statutes around the state’s designated health information exchange that was created in 2015. The HIE aggregates and connects clinical and demographic data from hospitals, physicians, and other providers and the managed care organizations (prepaid health plans) that will be running Medicaid once the system changes from fee-for-service payment to managed care. Providers are required to make a technical connection to the HIE to submit clinical and demographic patient data for all state funded / Medicaid services.	Updates existing statutes around the state’s designated health information exchange that was created in 2015. The HIE aggregates and connects clinical and demographic data from hospitals, physicians, and other providers and the managed care organizations (prepaid health plans) that will be running Medicaid once the system changes from fee-for-service payment to managed care. Providers are required to make a technical connection to the HIE to submit clinical and demographic patient data for all state funded / Medicaid services.
Hospitals were required in an earlier statute to connect, this clarifies the language and expands to other providers, requiring them to connect in order to be paid for any state funded / health services provided. Mandates the submission of encounter and claims data for some providers. Proposes a study to look at providers who currently don’t collect clinical data, and see what’s really needed. All other providers of Medicaid services must connect by June 2019.	Hospitals were required in an earlier statute to connect, this clarifies the language and expands to other providers, requiring them to connect in order to be paid for any state funded / health services provided. Mandates the submission of encounter and claims data for some providers. Proposes a study to look at providers who currently don’t collect clinical data, and see what’s really needed. All other providers of Medicaid services must connect by June 2019.
Allows an additional delay until June 2020 for providers who are having trouble connecting to the HIE network, so long as they make a presentation to DHHS and the state-designated HIE about why they are delayed in connecting. Requires providers to add patient demographic, clinical and claims data to the HIE network, except for some therapy providers (respiratory, respite and speech therapy, among others) which will only be required to submit claims data to the HIE.	Allows an additional delay until June 2020 for providers who are having trouble connecting to the HIE network, so long as they make a presentation to DHHS and the state-designated HIE about why they are delayed in connecting. Requires providers to add patient demographic, clinical and claims data to the HIE network, except for some therapy providers (respiratory, respite and speech therapy, among others) which will only be required to submit claims data to the HIE.
Consistent with federal rules, exempts some providers from submitting clinical data from drug and alcohol abuse encounters with patient identifying information to the HIE.	Consistent with federal rules, exempts some providers from submitting clinical data from drug and alcohol abuse encounters with patient identifying information to the HIE.
Previously, a person could opt out of having their information accessible through the HIE, except in the case of an emergency. Section 11A.5 repeals the ability to access the opted-out person’s information in the case of an emergency.	Previously, a person could opt out of having their information accessible through the HIE, except in the case of an emergency. Section 11A.5 repeals the ability to access the opted-out person’s information in the case of an emergency.
Requires LME-MCOs to comply with the data submission rules created in the budget.	Requires LME-MCOs to comply with the data submission rules created in the budget.
Orders DHHS to transfer $3 million in one-time funds and $1 million in annual funds to the Department of IT, Government Data Analytics Center to upgrade and support the maintenance and operations of the HIE.	Orders DHHS to transfer $3 million in one-time funds and $1 million in annual funds to the Department of IT, Government Data Analytics Center to upgrade and support the maintenance and operations of the HIE.
	Orders a study by the Joint Legislative Oversight Committee on Medicaid and NC Health Choice and the JLOC on Information Technology on the feasibility of connecting other, non-required providers to the HIE. The study is set to be completed by April 2018.
Appropriates $250,000 in one-time funding to help DHHS information technology workers to improve security, including the removal of people’s Social Security numbers from the system and replacing them with a unique ID number. This is a federal requirement set out by the Centers for Medicare and Medicaid Services and is required, by law, to be completed by April, 2019.	Appropriates $250,000 in one-time funding to help DHHS information technology workers to improve security, including the removal of people’s Social Security numbers from the system and replacing them with a unique ID number. This is a federal requirement set out by the Centers for Medicare and Medicaid Services and is required, by law, to be completed by April, 2019.
	Provides $844,412 in recurring funding through the biennium and $630,000 in one-time funding through the biennium for six contract IT workers to support the implementation and training for several new computer programs, such as HIV care database. Makes allowance for six positions.
Orders DHHS to spend $1.2 million annually develop and launch better analytics for the Controlled Substances Reporting System. This includes creating the ability for the CSRS to talk to the NC HIE (see above), creating analytics to detect “behavior indicative of misuse, addiction or criminal activity,” including unusual prescribing patterns, and help providers improve prescribing practices.	Orders DHHS to spend $1.2 million annually to develop and launch better analytics for the Controlled Substances Reporting System. Specifies $464,000 for four support people within Central Management and Support, $175,000 for two analytics positions in DMHDDSAS, and $561,000 for contract services. Orders the creation of the ability for the CSRS to interact with the NC HIE (see above), creating analytics to detect “behavior indicative of misuse, addiction or criminal activity,” including unusual prescribing patterns, and help providers improve prescribing practices.
Orders that any data analytics upgrades be written and implemented in collaboration with the Government Data Analytics Center.	Orders that any data analytics upgrades be written and implemented in collaboration with the Government Data Analytics Center.
Budgets $3.6M in federal receipts in FY 2017-18 and $4.8M in FY 18-19 to replace the old tracking system for case management for the Divisions of Voc/ Rehab and Services for the Blind. Also budgets money from county funding to upgrade assistance to county DSSs and Child Support offices to submit their reimbursement forms electronically.	Budgets $3.6 million in federal monies in FY 17-18 and $4.8 million in federal monies in FY 18-19 to replace the old case management computer programs used by several DHHS divisions, such as Services for the Blind. The money will also help get up and running with submitting invoices and getting paid online.
Changes the DHHS Community Health Center grant program, limiting grants to community and rural health centers, local health departments, and school-based health centers that 1) have at least 80 percent of their population who are uninsured, on Medicare, Medicaid or SCHIP, 2) provide primary and preventive services to low-income populations, and 3) are intended to increase access to primary and preventive care services, including such things as creating new services or replacing facilities and equipment/ technology. Limits the size of individual grants to no more than $150,000.	Changes the DHHS Community Health Center grant program, limiting grants to community and rural health centers, local health departments, and school-based health centers that 1) provide primary and preventive services to medically indigent and uninsured populations, and 2) are intended to increase access to primary and preventive care services, including such things as creating new services or replacing facilities and equipment/ technology. Limits the size of individual grants to no more than $150,000.
Establishes a Primary Care Advisory Committee to develop a process for grading applications: organizations contributing members to the Committee will include, the NC Cmty Health Center Assoc, the NC Assoc of Local Health Directors, the NC Assoc of Free and Charitable Clinica and the NC School-based Health Alliance, et al.	Establishes a Primary Care Advisory Committee to develop a process for grading applications: organizations contributing members to the Committee will include, the NC Cmty Health Center Assoc, the NC Assoc of Local Health Directors, the NC Assoc of Free and Charitable Clinica and the NC School-based Health Alliance, et al.
Restricts grant recipients from using money to increase pay for management, supplant existing funds, such as federal funds, or finance any debt.	Restricts grant recipients from using money to increase pay for management, supplant existing funds, such as federal funds, or finance any debt.
Increases funding for Community Health Grants to FQHCs, Rural Health Centers, free clinics, etc. by $7.5 million annually, also adds four positions on which DHHS is limited to $200,000 in funding.	Increases funding for Community Health Grants to FQHCs, Rural Health Centers, free clinics, etc. by $7.5 million annually, also adds four positions on which DHHS is limited to $200,000 in funding.
Orders the Office of Rural Health to create standard quality and outcome metrics for grant recipients and require grant recipients to report on their outcomes.	Orders the Office of Rural Health to create standard quality and outcome metrics for grant recipients and require grant recipients to report on their outcomes.
	Budgets $1.2 million annually for contract services to develop and roll out new software in the Controlled Substances Reporting System. Pays for six people to do the work of maintenance and support of the system.
	Provides a total of $3.6 million in one-time funding over the biennium, plus $627,134 in annual funding starting in FY 18-19 to replace outdated computer applications used by DHHS. The money is also intended to develop online hospital/clinic/ provider licensure and renewal in the Division of Health Service Regulation and eliminate the current paper-based process. This also means the licensure information can be provided to the NC Tracks Medicaid billing system.
Creates $1 million in annual funding and $3 million in one-time funding to upgrade the Health Information Exchange (where hospital records talk to one another to track patient care and billing). The funds will also provide ongoing support for the HIE’s database maintenance and support.	Creates $1 million in annual funding and $3 million in one-time funding to upgrade the Health Information Exchange (where hospital records talk to one another to track patient care and billing). The funds will also provide ongoing support for the HIE’s database maintenance and support.
Allows for up to $150,000 / year to be used to help grantees receive training and technical assistance on health information technology, etc.	Appropriates $600,000 to create a computerized registry of Alzheimer’s patients at the Institute of Medicine.
Orders the Office of Rural Health to combine several loan repayment programs targeted at physicians, psychiatrists and those who work in state facilities. This new program can be extended to primary care providers, general surgeons in Critical Access Hospitals and telemedicine providers.	Orders the Office of Rural Health to combine several loan repayment programs targeted at physicians, psychiatrists and those who work in state facilities. This new program can be extended to primary care providers, general surgeons in Critical Access Hospitals and telemedicine providers.
	Provides $3.86 million in one-time funding over the course of the biennium to determine what the NC Tracks Medicaid management system will need to align with federal standards. This is required to receive continued funding from CMS.
Orders DHHS to cut $3.2 million per year for contracted services for both years. This money had been cut in FY 16-17, but Gov. Cooper had asked for this money in his budget for the coming two years. This money had been used in the past to pay consultants and other hirees from outside the department. But restricts DHHS from reducing funds earmarked for direct services.	Orders DHHS to cut $3.2 million per year for contracted services for both years. This money had been cut in FY 16-17, but Gov. Cooper had asked for this money in his budget for the coming two years. This money had been used in the past to pay consultants and other hirees from outside the department. But restricts DHHS from reducing funds earmarked for direct services.
Orders DHHS to deliver a report on the Office of Program Evaluation Reporting and Accountability (OPERA), which was created in the 2015, budget by December 2017. The report should include breakdowns of the office’s accomplishments, spending, organization and details of barriers to operation. OPERA was created to be an independent evaluator of programs within DHHS.	Orders DHHS to deliver a report on the Office of Program Evaluation Reporting and Accountability (OPERA), which was created in the 2015, budget by December 2017. The report should include breakdowns of the office’s accomplishments, spending, organization and details of barriers to operation. OPERA was created to be an independent evaluator of programs within DHHS.
Mandates a proposal from the UNC Chapel Hill School of Government for the creation and administration of a program to train management-level contract specialists in DHHS. These types of employees will be managing contracted services for the state once the Medicaid program switches from a fee-for-service program to being one under outside management.	Mandates a proposal from the UNC Chapel Hill School of Government for the creation and administration of a program to train management-level contract specialists in DHHS. These types of employees will be managing contracted services for the state once the Medicaid program switches from a fee-for-service program to being one under outside management.
Creates up to $3 million in one-time funding to support a residency program at Cape Fear Valley Medical Center affiliated with the osteopathic school at Campbell University School of Medicine. This money should be used to replace federal dollars lost when Cape Fear Valley changed from being classified as “urban” to “rural.” Requires that OSBM certify the amount that Cape Fear Valley MC has lost in federal payments. Also requires that CFVMC create residency programs with a minimum of 130 additional slots. Requires a report on expenditures by April 2018.	Creates up to $1 million in one-time funding to support a residency program at Cape Fear Valley Medical Center affiliated with the osteopathic school at Campbell University School of Medicine. This money should be used to replace federal dollars lost when Cape Fear Valley changed from being classified as “urban” to “rural.” Requires that OSBM certify the amount that Cape Fear Valley MC has lost in federal payments. Also requires that CFVMC create residency programs with a minimum of 130 additional slots. Requires a report on expenditures by April 2018.
Competitive grants for nonprofit organizations: Sets aside $10,653,911 in recurring funds for each year of the biennium, in addition to one-time funds of $4,508,754 in FY17-18 and $4,476,620 in FY18-19 (with $1.6M / year coming from the Substance Abuse Prevention and Treatment Block Grant) to fund nonprofit organizations which provide services with state dollars. Sets out procedures, etc, for the organizations to receive the funds. Specifically sets aside $350,000 for Big Brothers Big Sisters and a total of $3.225M for TROSA.	Competitive grants for nonprofit organizations: Sets aside $10,653,911 in recurring funds for each year of the biennium, in addition to one-time funds of $4,202,500 per year. (with $1.6M / year coming from the Substance Abuse Prevention and Treatment Block Grant) to fund nonprofit organizations which provide services with state dollars. Sets out procedures, etc, for the organizations to receive the funds. Specifically sets aside $350,000 for Big Brothers Big Sisters and a total of $3.225M for TROSA and $2.75M / year to the Boys and Girls Clubs for dropout prevention programs.
DIVISION OF CHILD DEVELOPMENT AND EARLY EDUCATION	DIVISION OF CHILD DEVELOPMENT AND EARLY EDUCATION
Establishes family income eligibility for NC Pre-K at 75 percent of the state median income, which maintains the current eligiblity criteria for the program. Up to 20 percent of the children in the program may have family incomes above that if they have other risks. Also creates places for children of military or reserve members who are either on active duty, have been on active duty within the past 18 months, or are expected to be called up within the coming 18 months.	Establishes family income eligibility for NC Pre-K at 75 percent of the state median income, which maintains the current eligiblity criteria for the program. Up to 20 percent of the children in the program may have family incomes above that if they have other risks. Also creates places for children of military or reserve members who are either on active duty, have been on active duty within the past 18 months, or are expected to be called up within the coming 18 months.
	New subsection adding a new oral health screening requirement to NC Pre-K rules, noting whether the child has passed a dental screening on the statewide standardized health screening tool.
Total NC Pre-K appropriation = $66.5M	Appropriates additional $6 million in annual funds in FY 17-18 and $12.2 mililon in FY 18-19 to “eliminate” the current waiting list for NC Pre-K services by providing an additional 4,700 slots. This money will be augmented by moving matching funds from the TANF Block Grant. According to the House calculations, this will serve an additional 2,300 children in FY 17-18 and 4,700 more children than current numbers in FY 18-19. Total NC Pre-K appropriation = $72.5M
Requires DCDEE to issue multi-year contracts for child care centers, specifies building and program standards, and orders an annual report to be delivered to the Legislative Oversight Committee on HHS by March 15 of each year.	Requires DCDEE to issue multi-year contracts for child care centers, specifies building and program standards, and orders an annual report to be delivered to the Legislative Oversight Committee on HHS by March 15 of each year.
Orders DHHS to collaborate with the Department of Public Instruction to create a “statewide vision for early childhood education.” Orders a follow-up report to be delivered by January 2018 and details what needs to be in the report. Also calls for DHHS & DPI to work together to create a standardized program to transition from Pre-K to kindergarten.	Orders DHHS to collaborate with the Department of Public Instruction to create a “statewide vision for early childhood education.” Orders a follow-up report to be delivered by January 2018 and details what needs to be in the report. Also calls for DHHS & DPI to work together to create a standardized program to transition from Pre-K to kindergarten.
Sets the following income limits for eligibility for Child Care Subsidy: for children ages 0 to 5 years, a family income below 200 percent of Federal Poverty Line; for children ages 6 to 12 years, a family income below 133 percent of FPL; for children with “special needs,” a family income of 200 percent of FPL. Sets cost sharing rates, based on 10 percent of family income. Sets new standards about cost sharing for families, requiring that care received at blended rate, that the copayment will = 83% of the full-time copayment.	Sets the following income limits for eligibility for Child Care Subsidy: for children ages 0 to 5 years, a family income below 200 percent of Federal Poverty Line; for children ages 6 to 12 years, a family income below 133 percent of FPL; for children with “special needs,” a family income of 200 percent of FPL. Sets cost sharing rates, based on 10 percent of family income. Sets new standards about cost sharing for families, requiring that care received at blended rate, that the copayment will = 83% of the full-time copayment.
	Moves additional TANF Block Grant moneys to incease the rate paid for Child Care Subsidies in the amounts of $13 million in FY17-18 and $17 million in FY18-19. The market rate for infants to 2 year olds in the 3-, 4- and 5-star centers in low-income counties will increase this October. Also effective in October, the market rate for older preschoolers will be increased in the same child care centers.
Increases child care subsidy rates beginning in October to market rates for 3-,4- and 5-star faciliites in tier 1 & 2 counties. Beginning in October, increases subsidy market rates by 70 percent of the difference between the current rates and recommended rates from a 2015 report. Then in July 2018, increase the rates in tier 3 counties to 100 percent of the recommended rate. Uses, for this purpose, the NC Dept of Commerce County Tier designations from 2015.	Increases child care subsidy rates beginning in October to market rates for 3-,4- and 5-star faciliites in tier 3 counties. Beginning in Oct, increases subsidy market rates by 30% of the difference between the current rates and recommended rates from a 2015 report in Tier 3 counties. Then in July 2018, increase the rates in tier 3 counties to 100% of the recommended rate. Uses, for this purpose, the NC Dept of Commerce County Tier designations from 2015.
Total Subsidized Child Care appropriation = $56.29M; total Smart Start – subsidized child care appropriation = $63.68M	Total Subsidized Child Care appropriation = $55.99M; total Smart Start – subsidized child care appropriation = $63.68M
	Swaps out a total of $687,117 in TANF Block Grant funding on a one-time basis over the biennium to help fund the Child Care Subsidy program.
Orders DHHS to allocate Child Care Subsidy funds using money from local NC Partnership for Children organizations as the base. Sets the base amount for each county’s child care subsidy allocation. Modifications this year includes language that allows the Division to withhold up to 2% of available funds as a hedge against fraud/ program termination because of fraud and having to pay back federal funds as a result. Adds language allowing DHHS to set aside 4% of the subsidy funds for “vulnerable populations.” Allows for re-allocation of unused funds and sets out spending guidelines. Also sets out guidelines for market rate increases.	Orders DHHS to allocate Child Care Subsidy funds using money from local NC Partnership for Children organizations as the base. Sets the base amount for each county’s child care subsidy allocation. Modifications this year includes language that allows the Division to withhold up to 2% of available funds as a hedge against fraud/ program termination because of fraud and having to pay back federal funds as a result. Adds a new reporting requirement, for DHHS to report to JLOC on HHS on the funds withheld each year of the biennium 30 days after the withheld funds are distributed. Adds language allowing DHHS to set aside 4% of the subsidy funds for “vulnerable populations.” Allows for re-allocation of unused funds and sets out spending guidelines. Also sets out guidelines for market rate increases.
	Moves $913,972 from the Child Care and Development Fund Block Grant to create 12 positions in DCDEE to oversee infant-toddler projects, run the Child Care Subsidy program, and provide workers for compliance and fraud detection and policy/planning. The rest of the workers will support professional development, assessment and licensing. Most of these services are paid for by federal receipts. Moving the block grant money over allows for additional personnel and services with a minimum of General Fund money.
Sets out language to create general statute requirements for child care matching funds, loan funding and administrative allowances. They will appear in a new part of the state code entitled: Child Care Subsidy. For example, allows counties to set aside up to 4% of the child care subsidy funds (or $80,000, whichever is greater) for fraud detection.	Sets out language to create general statute requirements for child care matching funds, loan funding and administrative allowances. They will appear in a new part of the state code entitled: Child Care Subsidy. For example, allows counties to set aside up to 4% of the child care subsidy funds (or $80,000, whichever is greater) for fraud detection.
Orders DHHS and DCDEE to implement a plan created by a 2015 law to require parents who have custody of their children to cooperate with child support service programs as a condition of receiving the child care subsidy. DHHS / DCDEE needs to report on how this implementation is proceeding by October 2018.	Orders DHHS and DCDEE to implement a plan created by a 2015 law to require parents who have custody of their children to cooperate with child support service programs as a condition of receiving the child care subsidy. DHHS / DCDEE needs to report on how this implementation is proceeding by October 2018.
Orders NC Partnerships for Children to insure policies focus on assisting 1-, 2- and 3-star rated faciliites to improve their ratings and implementing Pre-K evidence-informed programs to increase literacy, provide parenting education, and improve child health. Caps administrative costs for local partnerships at 8 percent and orders the NC Partnership for Children to use a single statewide contract management system, with all local partnerships participating. Sets out salary criteria for Partnerships.	Orders NC Partnerships for Children to insure policies focus on assisting 1-, 2- and 3-star rated faciliites to improve their ratings and implementing Pre-K evidence-informed programs to increase literacy, provide parenting education, and improve child health. Caps administrative costs for local partnerships at 8 percent and orders the NC Partnership for Children to use a single statewide contract management system, with all local partnerships participating. Sets out salary criteria for Partnerships.
Sets fundraising match requirements for the statewide Partnership for Children and the local affiliates, ordering that they shall raise a matching amount of 100 percent of the budget for the program each of the two-years of the biennium, with cash contributions making up 13 percent of the match, in-kind services no more than 6 percent of the match, for total match of 19%. Sets out criteria for what constitutes and how to account for in-kind donations.	Sets fundraising match requirements for the statewide Partnership for Children and the local affiliates, ordering that they shall raise a matching amount of 100 percent of the budget for the program each of the two-years of the biennium, with cash contributions making up 13 percent of the match, in-kind services no more than 6 percent of the match, for total match of 19%. Sets out criteria for what constitutes and how to account for in-kind donations.
Mandates that failure to raise the required amount (above) will result in a dollar-for-dollar reduction in the program for the subsequent year. Also sets out bidding processes for contracted services.	Mandates that failure to raise the required amount (above) will result in a dollar-for-dollar reduction in the program for the subsequent year. Also sets out bidding processes for contracted services.
Orders allocations in smaller counties to not drop below 2012-13 levels, sets forth instructions for evaluation system, and sets expenditure restrictions	Orders allocations in smaller counties to not drop below 2012-13 levels, sets forth instructions for evaluation system, and sets expenditure restrictions
Orders that 2 percent of NC Partnership for Children funding be set aside to allow for access to Dolly Parton’s Imagination Library and stipulates that money not be subject to administrative cost requirements. Orders a report on literacy initiatives by March 2018. Appropriates $3.5M in FY17-18 and $7M in FY18-19.	Appropriates $1.2 million in annual funds in FY17-18 and $3.9 million in recurring funds in FY18-19 to allow for access to Dolly Parton’s Imagination Library, an early literacy program that mails age-appropriate books to registered children monthly. Appropriates $1.2M in FY17-18 and $3.9M in FY18-19. Adds additional $300,000 in annual funds to increase “Reach out and Read” program, where children can be “prescribed” reading by their physicians and provides free reading materials in medical waiting rules.
DIVISION OF SOCIAL SERVICES	DIVISION OF SOCIAL SERVICES
Notes approval of DHHS’ state plan for spending TANF (Temporary Assistance for Needy Families) monies covering October 1, 2016 – September 30, 2019. Designates Beaufort, Caldwell, Catawba, Lenoir, Lincoln, Macon and Wilson counties as “electing counties” with some flexibility in administering the plan and delivering services. (Those counties combined can contain no more than 15.5 percent of the state’s Work First/ welfare cases). Budget language holds those counties harmless for their allocations for the first year and stipulates what to do in the case of insufficient or excess funds.	Notes approval of DHHS’ state plan for spending TANF (Temporary Assistance for Needy Families) monies covering October 1, 2016 – September 30, 2019. Designates Beaufort, Caldwell, Catawba, Lenoir, Lincoln, Macon and Wilson counties as “electing counties” with some flexibility in administering the plan and delivering services. (Those counties combined can contain no more than 15.5 percent of the state’s Work First/ welfare cases). Budget language holds those counties harmless for their allocations for the first year and stipulates what to do in the case of insufficient or excess funds.
Appropriates $2.75 million in annual funds from the Social Services Block Grant to become grant funding for county social services. Several years ago, when the SSBG was reduced, NC replaced this money with General Fund dollars. The SSBG has increased again, and this move puts this money back into the General Fund and pays for the grants with SSBG money.	Appropriates $2.75 million in annual funds from the Social Services Block Grant to become grant funding for county social services. Several years ago, when the SSBG was reduced, NC replaced this money with General Fund dollars. The SSBG has increased again, and this move puts this money back into the General Fund and pays for the grants with SSBG money.
Stipulates that the Intensive Family Preservation Services Program to provide services to children and families in cases of abuse, neglect and dependency where a child is at imminent risk of removal from the home. These sections set out reporting, data collection and follow-up requirements for programs receiving federal and state monies to do this work.	Stipulates that the Intensive Family Preservation Services Program to provide services to children and families in cases of abuse, neglect and dependency where a child is at imminent risk of removal from the home. These sections set out reporting, data collection and follow-up requirements for programs receiving federal and state monies to do this work.
Provides a one-time appropriation of $1 million for Child Advocacy Centers, in addition to $207,000 / year coming from the Social Services Block Grant.	Provides a one-time appropriation of $1 million for Child Advocacy Centers, in addition to $207,000 / year coming from the Social Services Block Grant. Up to $100,000 will go to centers in good standing and $100,000 to Children’s ‘Advocacy Centers of NC, Inc for operations.
Sets out temporary rules for setting rates for child care institutions funded by DHHS; limits reimbursement rates for the institutions to the rate established by the Dept/ Controller until the Social Services Commission sets standardized rates.	Sets out temporary rules for setting rates for child care institutions funded by DHHS; limits reimbursement rates for the institutions to the rate established by the Dept/ Controller until the Social Services Commission sets standardized rates.
Moves $338,000 annually from the Social Services Block Grant to fund the Child Medical Evaluation Program, which pays for evaluations of children who may have been physically or sexually abused. Funding in DSS is primarily for children who are not Medicaid-eligible because Medicaid pays for the evaluation for Medicaid and CHIP eligible children. Also increases the rate paid for Medicaid eligible children who are suspected of being abused or neglected to $575/ exam. This will cost $385,000 in one-time funds each year. Senate appropriates a total of $8.6M for Family Preservation and Support.	Moves $338,000 annually from the Social Services Block Grant to fund the Child Medical Evaluation Program, which pays for evaluations of children who may have been physically or sexually abused. Funding in DSS is primarily for children who are not Medicaid-eligible because Medicaid pays for the evaluation for Medicaid and CHIP eligible children. Also increases the rate paid for Medicaid eligible children who are suspected of being abused or neglected to $575/ exam. This will cost $385,000 in one-time funds each year. House appropriates a total of $10.36M for Family Preservation and Support.
Sets out budget guidelines for how DHHS Division of Social Services can use funds to support the provision of foster care services. Limits the expenses to be incurred for the Guardianship Assistance Program. Sets out that GAP rates paid to legal guardians will be at the same rate as previously established foster care room and board rates.	Sets out budget guidelines for how DHHS Division of Social Services can use funds to support the provision of foster care services. Limits the expenses to be incurred for the Guardianship Assistance Program. Sets out that GAP rates paid to legal guardians will be at the same rate as previously established foster care room and board rates.
Sets the rate for how much DHHS can pay for the educational needs of foster youth aging out of the foster care system and special needs children adopted when they were older. Appropriates $50,000 per year to administer the scholarship funds for these foster children. Also appropriates $339,493 per year for a contract to administer the child welfare post-secondary support program. Stipulates the money can only be used to pay for attendance at a public institution in NC.	Sets the rate for how much DHHS can pay for the educational needs of foster youth aging out of the foster care system and special needs children adopted when they were older. Appropriates $50,000 per year to administer the scholarship funds for these foster children. Also appropriates $339,493 per year for a contract to administer the child welfare post-secondary support program. Stipulates the money can only be used to pay for attendance at a public institution in NC.
Orders DHHS / Child Support Services Section (NCCSS) to retain up to 15 percent of annual federal incentive payments and allocate no less than 85% to enhance child support services by consulting with county officials to see what would improve centralized services, use the money for improvement. The money cannot be used to supplant state expenditures for those services, and write new rules for calculating and distributing the funds. This has been modified since 2015 budget.	Orders DHHS / Child Support Services Section (NCCSS) to retain up to 15 percent of annual federal incentive payments and allocate no less than 85% to enhance child support services by consulting with county officials to see what would improve centralized services, use the money for improvement. The money cannot be used to supplant state expenditures for those services, and write new rules for calculating and distributing the funds. This has been modified since 2015 budget.
NCCSS is to use the rest of the money noted above to improve effectiveness and efficiency, using the measures established by federal officials. That means looking at current ways of distributing funds and seeing if there’s a better way. If another method is determined, phase it in over a four-year period.	NCCSS is to use the rest of the money noted above to improve effectiveness and efficiency, using the measures established by federal officials. That means looking at current ways of distributing funds and seeing if there’s a better way. If another method is determined, phase it in over a four-year period.
NCCSS is to have county DSS’s submit annual plans on how any funding will improve their programs as a condition for receiving incentive funding and report on how that funding has improved the programs, providing proof and explaining any deviations from their plans. Finally, NCCSS has to report to the legislature on their progress by November 1 of each year.	NCCSS is to have county DSS’s submit annual plans on how any funding will improve their programs as a condition for receiving incentive funding and report on how that funding has improved the programs, providing proof and explaining any deviations from their plans. Finally, NCCSS has to report to the legislature on their progress by November 1 of each year.
Appropriates recurring funding for the changes required by federal officials in response to North Carolina’s failing grade on the Child Welfare review program improvement plan. The funding is $8.7 million in annual funds, increasing to $9.146 million in FY18-19 with an additional $330,521 in one-time funding in FY18-19. The money is intended to allow for the professional development and training of child care workers in counties. It will also provide in-home services and services for children who have been adopted. The money also will support “medical homes” for adoptive children. The non-recurring money in the second year is to create a program for preventing unnecessary out-of-home placement for youth with behavioral and emotional needs and to perform a County Child Welfare workforce study.	Appropriates recurring funding for the changes required by federal officials in response to North Carolina’s failing grade on the Child Welfare review program improvement plan. The funding is $8.7 million in annual funds, increasing to $9.146 million in FY18-19 with an additional $330,521 in one-time funding in FY18-19. The money is intended to allow for the professional development and training of child care workers in counties. It will also provide in-home services and services for children who have been adopted. The money also will support “medical homes” for adoptive children. The non-recurring money in the second year is to create a program for preventing unnecessary out-of-home placement for youth with behavioral and emotional needs and to perform a County Child Welfare workforce study.
Changes to the Child Welfare System – DHHS is ordered to continuing implementing changes driven by a federal program improvement plan to bring NC into compliance with national standards for child welfare policy and practices. Orders Division of Social Services to work with county DSSs to create oversight plans that include staff training, quality improvement and data analysis. Report to the legislature every six months in February and August.	Changes to the Child Welfare System – DHHS is ordered to continuing implementing changes driven by a federal program improvement plan to bring NC into compliance with national standards for child welfare policy and practices. Orders Division of Social Services to work with county DSSs to create oversight plans that include staff training, quality improvement and data analysis. Report to the legislature every six months in February and August.
Changes to the Child Welfare System – orders DHHS to get child welfare component of NC FAST system online by the end of 2017 and to report to the NCGA on development and deployment of the software quarterly.	Changes to the Child Welfare System – orders DHHS to get child welfare component of NC FAST system online by the end of 2017 and to report to the NCGA on development and deployment of the software quarterly.
Orders DHHS/ DSS to continue implementing an evidence-based pilot program started in 2016 to improve care and access to benefits for dual eligible seniors to improve their health and independence while reducing costs. DSS is working with a not for profit (sources say senators are thinking of Benefits Data Trust) to identify seniors eligible for SNAP, create an outreach program, sign seniors up for benefits and do measurement and evaluation. Orders a report due on February 1, 2018 and stipulates that any leftover funds not revert to the state, but rather remain available for implementation of the pilot.	Orders DHHS/ DSS to continue implementing an evidence-based pilot program started in 2016 to improve care and access to benefits for dual eligible seniors to improve their health and independence while reducing costs. DSS is working with a not for profit (sources say senators are thinking of Benefits Data Trust) to identify seniors eligible for SNAP, create an outreach program, sign seniors up for benefits and do measurement and evaluation. Orders a report due on February 1, 2018 and stipulates that any leftover funds not revert to the state, but rather remain available for implementation of the pilot.
	Appropriates $600,000 in one-time funding during FY18-19 to increase access to SNAP benefits for people who are dually eligible for Medicare/ Medicaid. The money provides outreach to these potential beneficiaries and assistance with completing applications. Funding for FY 17-18 comes from leftover funds in the FY16-17 budget and some grant money obtained by DHHS.
Creates a “Foster Care Transitional Living Initiative Fund” to support transitional living services that produce good outcomes for foster youth aged 17-21. Fund will support a demonstration project with services provided by Youth Villages. Goals are to support young people as they transition from foster care, identify cost savings in services that facilitate that transition, and establish a best-practices program availabale to all kids in transition from foster care. Part of the strategy is to form public-private partnership with state matching funds for the biennium.	Creates a “Foster Care Transitional Living Initiative Fund” to support transitional living services that produce good outcomes for foster youth aged 17-21. Fund will support a demonstration project with services provided by Youth Villages. Goals are to support young people as they transition from foster care, identify cost savings in services that facilitate that transition, and establish a best-practices program availabale to all kids in transition from foster care. Part of the strategy is to form public-private partnership with state matching funds for the biennium.
	Provides $750,000 in annual funds to Youth Villages to provide services to improve outcomes for youth ages 17 to 21 who are transitioning from the foster care program. This means the program will receive $2.5 million each year in total funds.
	Appropriates additional funding in $750,000 in one-time funding each year to support the Permanency Innovation fund, which works to find permanent homes for foster care youth. This money will be combined with $218,878 in receipts.
Makes some changes to the Permanency Innovation Initiative Oversight Committee to broaden the committee’s look at initiatives and oversight for programs that support foster care kids transitioning to adulthood.	Makes some changes to the Permanency Innovation Initiative Oversight Committee to broaden the committee’s look at initiatives and oversight for programs that support foster care kids transitioning to adulthood.
	Provides $750,000 in continued funding for the Eckerd Kids / Caring for Children/ Angels Watch programs which helps place children ages 0 to 6, with siblings up to age 10 into non-state foster care when parents are temporarily unable to care for those children (e.g. in case of the death of a spouse). Parents are also provided mentorship to help them address issues and better parent their children while they are placed elsewhere. Requires report about number of families/ children served, with a comparison to other similarly-situated chidren, to be delivered by Dec. 2018.
Orders a final report on the transfer of responsibility over some social services from the state of NC to the Eastern Band of the Cherokee. Eliminates a quarterly report that was due on how this transition was progressing.	Orders a final report on the transfer of responsibility over some social services from the state of NC to the Eastern Band of the Cherokee. Eliminates a quarterly report that was due on how this transition was progressing.
Moves $1.27 million annually from DSS account over to the Division of Medical Assistance. This is the funding for non-emergency transportation to be charged to Medicaid rather than to Social Services.	Moves $1.27 million annually from DSS account over to the Division of Medical Assistance. This is the funding for non-emergency transportation to be charged to Medicaid rather than to Social Services.
Requires those applying for Supplemental Nutrition Assistance Program (SNAP) to be current on any child support owed in order to be eligible for the benefits, as allowed under federal law. Anyone subject to this would be notified in writing. (Only affects federal budget)
Cuts off SNAP benefits to people who qualify for another benefits program. NC currently provides SNAP benefits to people who earn up to 200 percent of the federal poverty level. This provision would eliminate the eligibility that federal law allows for people who qualify for other benefits to also qualify for SNAP. (Only affects federal budget)
Appropriates $300,000 in one-time funding each year to support Marketing Association for Rehabilitation centers. This program focuses on business development and creates new job opportunities for people who are chronically unemployed.	Appropriates $300,000 in one-time funding each year to support Marketing Association for Rehabilitation centers. This program focuses on business development and creates new job opportunities for people who are chronically unemployed.
Establishes the “Family / Child Protection Accountability Act” (SB 594/ HB 608) which was heard in the Senate Health Care Committee on April 19. The act would regionalize county social services departments into no more than 30 regions by January 2022. This part of the budget sets out deadlines for development of the preliminary plan, process of transition and final plan. It also creates a working group consisting of a three senate appointees, three house appointees, three DHHS appointees, one from the Chief Justice of the NC Supreme Court, four county commissioners, two appointees from the NC Association of County Directors of Social Services and someone from the NC Association of Social Services Attorneys, with stakeholder subcommittees. The language sets out what issues need to be considered by the working group in how to create these new regions and how they’ll be governed and requires an interim report by December 2018. The bill also creates a role for the School of Government to help with convening and facilitiating the working group and providing technical assistance. To make this all happen, appropriates $161,439 in FY17-18 and $3,229,695 in FY18-19, both one-time funding.
Appropriates $48,400 to the SOG for FY 17-18 and then $25,700 for FY 18-19 for this work.
Allots $38,039 to DHHS for working group activities in FY 17-18 and $16,303 for FY 18-19
Orders the Office of State Budget and Management (in consultation with DHHS) to create a request for proposal by Jan. 2018. The RFP will be for a third-party consultant to develop a reform plan for the state’s child welfare system. The plan should include reviews of Child Protective Services, child fatality oversight, foster care, preventive services for “struggling” families, family reunification, etc. It should also include plans to make changes to the structural components of the state’s child welfare system, including state, regional and local leadership and governance. That includes consulting with the regionalization working group noted above.
Orders the creation of a “Child Welfare System Transparency and Wellness Dashboard” that will collect data from NC FAST and provide a standardized way of looking at data and outcomes in each county’s or region’s child welfare agency to see how well it’s working. Also lays out steps to improving the child welfare system, including reviewing and revising old policies and adopting new ones. Reports are due to NCGA no later than September 2019.
Appropriates $3.1 million in one-time funds in FY 18-19 to make child welfare improvements within DSS.
Section 11C.12 (p) makes language changes to statutes around corrective action plans for county department of social services. It changes all the language to reflect the regional social services departments created above. It also orders the HHS Secretary to develop standard performance and outcome metrics for child social services and lays out consequences for failure to meet performance requirements for three consecutive months, or five months out of a 12 month period. The language allows for the NC DHHS to take over a failing regional department for as long as 18 months, while the regional department works through a corrective action plan. This language is similar to what was enacted in 2016 budget for social service departments failing to process Medicaid eligibility in a timely way.
Section 11C.12 (r) creates a new Child Well-Being Transformation Council, sets forth the purpose and makeup of the council, qualifications of those 17 members and how to address vacancies, and funding and staffing for the council. The section also lays out the powers and duties of the council, which is to map the network of child-serving agencies in the state, catalogue failures in coordination and collaboration around child protective services and review similar work being done in other states. Beginning in 2020, the council would monitor the regionalization process set out above, monitor the process of child welfare reform, and recommend the changes in law or policy to remedy gaps.
Increases the funding to support an anticipated increase in foster care caseloads by $270,903 in FY17-18 and by $2.45 million in FY18-19.	Increases the funding to support an anticipated increase in foster care caseloads by $270,903 in FY17-18 and by $2.45 million in FY18-19.
Creates a pilot program to allow foster youth to attain driver’s licenses to be created and administered by the DHHS Division of Social Services. Appropriates $75,000 in annual funding to support the pilot program.
Creates a pilot program to waive the employment requirement for people who are therapeutic foster parents in the Intensive Alternative Family Treatment program. Sets out benchmarks for success. Requires a report on the pilot program by December 2018.
Changes statute to shorten the time it takes to appeal and to terminate parental rights from 180 days to 30 days for filing an appeal plus 65 days after that. Sets out the process for appealing an order to terminate parental rights and the process for reunification.
Sets a 90-day deadline for approving applications for foster care or therapeutic foster care.

DIVISION OF AGING AND ADULT SERVICES	DIVISION OF AGING AND ADULT SERVICES
Orders a two-year $34 per month per resident increase in funds to adult care homes that can accept state-county special assistance payments for indigent residents. Orders counties to pay half that amount, sets limitations on the funds, and excludes extra payments to residents whose application for SA is pending. Limits the administrative expenditures by DHHS on this to $250,000/year. Provides $5M in non-recurring funding per year to cover costs.	Appropriates $4.4 million in FY17-18 and $5.8 million in FY18-19 to increase the rate paid for adult care homes that receive state-county special assistance funding payments for low-income patients. Increases the rate by $34/month per resident on an ongoing basis.
Sets the monthly rate for state-county special assistance at $1,182/ month and $1,515/ month for residents of Alzheimer’s/ dementia special care units (this is the same as in the past biennium).	Sets the new rate for state-county special assistance at $1,216/ month and $1,549 / month for residents of Alzheimer’s / dementia special care units.
	Provides $969,999 in each year of the biennium to enhance the Home and Community Care Block Grant, which pays for services such as Meals on Wheels. This is a continuation of non-recurring funding from prior years and does not address the waiting list for services.
Moves $771,871 in funding from the federal Social Services Block Grant to provide an increased rate paid to corporate guardians and to serve some extra people. Total budget for guardianship = $3,992,213	Moves $545,777 in funding from the federal Social Services Block Grant to provide an increased rate paid to corporate guardians and to serve some extra people. Total budget for guardianship = $3,766,119
Changes the timeline for submitting biennial plans for the division to July of odd-numbered years (the first year of the biennium) and stipulates the contents of the biennial plans. This aligns the reporting period with federal deadlines.	Changes the timeline for submitting biennial plans for the division to July of odd-numbered years (the first year of the biennium) and stipulates the contents of the biennial plans. This aligns the reporting period with federal deadlines.
	Recommends the formation of an Aging subcommittee to the Joint Legislative Oversight Committee on Healht and Human Services. Reports: interim report March, 2018 and Final report Nov. 2018.

DIVISION OF PUBLIC HEALTH	DIVISION OF PUBLIC HEALTH
Alters and codifies language around state law around the use of school nurse funding and notes any money for extra school nurses not be used for other efforts and can’t be used to pay for nurses working at state agencies. Also sets stipulations on the funding, including county/school eligibility for the funding and what the nurses can and can’t do.	Alters and codifies language around the use of school nurse funding and notes any money for extra school nurses not be used for other efforts and can’t be used to pay for nurses working at state agencies. Also sets stipulations on the funding, including county/school eligibility for the funding and what the nurses can and can’t do.
Allocates $690,594 in annual funds for the Children’s Developmental Service Agencies (CDSAs). The appropriation is enough money for eight positions to address deficiencies identified in a federal corrective action plan in two of the CDSAs – New Bern and Blue Ridge. The funds will provide for an OT, PT and SLT for each CDSA, a psychologist for New Bern and an additional OT for Blue Ridge.	Allocates $690,594 in annual funds for the Children’s Developmental Service Agencies (CDSAs). The appropriation is enough money for eight positions to address deficiencies identified in a federal corrective action plan in two of the CDSAs – New Bern and Blue Ridge. The funds will provide for an OT, PT and SLT for each CDSA, a psychologist for New Bern and an additional OT for Blue Ridge.
Directs $600,000 in annual funds to expand the home visiting services of the Nurse Fmaily Partnership. This brings the total appropriation for NFP to $2.3 million per annum.	Directs $2.5 million in annual funds to expand the home visiting services of the Nurse Fmaily Partnership. This brings the total appropriation for NFP to $4.2 million per annum.
Orders DHHS to begin providing Medicaid/ Health Choice coverage for an infant home visiting program modeled on the Nurse Family Partnership, either as statewide program or as a pilot program. Orders DHHS to design the program, define the scope of the program, and determine the fiscal impact of such a program by July 2018. The plan should also include plans on how to leverage state dollars to find private dollars and a timeline for implementation.	Orders DHHS to begin providing Medicaid/ Health Choice coverage for an infant home visiting program modeled on the Nurse Family Partnership, either as statewide program or as a pilot program. Orders DHHS to design the program, define the scope of the program, and determine the fiscal impact of such a program by July 2018. The plan should also include plans on how to leverage state dollars to find private dollars and a timeline for implementation.
Appropriates $500,000 in annual funds to expand the Quitline NC and You Quit, 2 Quit, a smoking cessation program for pregnant women. Quitline received about $800,000 in appropriations last year and also earns receipts from the State Health Plan which uses the service for its members.	Appropriates $500,000 in annual funds to expand the Quitline NC and You Quit, 2 Quit, a smoking cessation program for pregnant women. Quitline received about $800,000 in appropriations last year and also earns receipts from the State Health Plan which uses the service for its members.
	Appoints $2 million in one-time funding for youth tobacco prevention programs to prevent the use of new and emerging tobacco products, including e-cigarettes.
Asks for a report – due in March 2018 – to address how to reduce the budget deficit at the State Public Health Lab in Raleigh. Asks for recommendations including what currently free services could be changed to require a fee, creation of a billing system, and the feasibility of altering the state’s Medicaid plan to take advantage of federal cost settlement.	Asks for a report – due in March 2018 – to address how to reduce the budget deficit at the State Public Health Lab in Raleigh. Asks for recommendations including what currently free services could be changed to require a fee, creation of a billing system, and the feasibility of altering the state’s Medicaid plan to take advantage of federal cost settlement.
	Provides $2 million in one-time funding and $1 million in annual funding for the state public health lab to address a structural deficit. The deficit was created several years ago when the state stopped charging Medicaid for the infant genetic/metabolic panel, which costs about $100/infant. Last year, the state allowed for the lab to charge about $40 for infant testing, but there remains a deficit.
Sets up competitive process for granting funds to local health departments for improving maternal and child health, based in part on current health indicators and whether grant proposals incorporate evidence-based programs. Creates priority for proposals that “leverage non-state funds in addition to the grant award” and stipulates that any funding received by the state for this purpose not supplant existing funds for maternal or child health. Orders the HHS Secretary to announce grant recipients by July 1 and orders health department reports on grant spending and impact by December 1 of each year. Senate appropriates $11.9M in towards “Maternal and Infant Health” programs.	Sets up competitive process for granting funds to local health departments for improving maternal and child health, based in part on current health indicators and whether grant proposals incorporate evidence-based programs. Creates priority for proposals that “leverage non-state funds in addition to the grant award” and stipulates that any funding received by the state for this purpose not supplant existing funds for maternal or child health. Orders the HHS Secretary to announce grant recipients by July 1 and orders health department reports on grant spending and impact by December 1 of each year. House appropriates $15.3M in towards “Maternal and Infant Health” programs.
	Appropriates $1.2 million per year for communicable disease testing with an emphasis on testing for Hepatitis C and other priority diseases. The money may also be used by the DPH to assist people who test positive to access the appropriate health care treatment.
States that no state funds shall go to any provider that performs abortions. However, it does not prevent those providers from being paid for services billed to Medicaid or the State Health Plan.	Appropriates $1.3 million annually to the Carolina Pregnancy Care Fellowship to buy durable medical equipment for clinics. Up to $30,000 annually may be used for administration and up to $170,000 / year may be used to train staff on how to use the DME.
Directs $100,000 in start-up funding for the Advisory Council on Rare Diseases, which was established by law in 2015 and is housed at the School of Public Health at UNC Chapel Hill.	Directs $100,000 in start-up funding for the Advisory Council on Rare Diseases, which was established by law in 2015 and is housed at the School of Public Health at UNC Chapel Hill.
	Allots $2.2 million in one-time funding each year to create and conduct a pilot preterm pregnancy program in Robeson and Columbus Counties. The project will fund in-home prenatal care for prevention of preterm birth and use 17-P to prevent preterm births in at-risk pregnant women.
Orders DHHS to continue administering an evidence-based diabetes prevention program and asks for annual report to be delivered to the NCGA by December 1 of each year.	Orders DHHS to continue administering an evidence-based diabetes prevention program and asks for annual report to be delivered to the NCGA by December 1 of each year.
Implements new federal standards for the definitions of “elevated blood lead level” and “confirmed lead poisoning” used in North Carolina, introducing more stringent standards. It lowers the level of lead found in the blood of a child or a pregnant woman that requires immediate action to remove lead from the immediate environment, as recommended by the CDC.	Implements new federal standards for the definitions of “elevated blood lead level,” “confirmed lead poisoning” and “readily accessible substance” (a substance that can be eaten by a child or pregnant woman) used in North Carolina, introducing more stringent standards. It lowers the level of lead found in the blood of a child or a pregnant woman that requires immediate action to remove lead from the immediate environment, as recommended by the CDC.
Budgets federal Medicaid receipts to conform the state’s elevated blood level standard with the federal standard. These receipts, totalling about $557,000 in FY17-18 and $559,000 in FY18-19 will fund six full-time positions to handle the workload.	Budgets federal Medicaid receipts to conform the state’s elevated blood level standard with the federal standard. These receipts, totalling about $557,000 in FY17-18 and $559,000 in FY18-19 will fund six full-time positions to handle the workload.
	Budgets federal receipts of $3.8 million from the WIC program to move recipients from paper vouchers to an electronic benefits transfer (ATM-like) card for purchasing food.
Instructs DHHS to work with the Department of Public Safety to buy HIV medications for those in prison who have been diagnosed in a manner that allows the state to draw federal matching funds.	Instructs DHHS to work with the Department of Public Safety to buy HIV medications for those in prison who have been diagnosed in a manner that allows the state to draw federal matching funds.
Orders a study by DHHS of using ADAP funds to purchase health insurance or provide premium/copay/deductible assistance for patients using federal “Ryan White” funds, completed by March 2018. Sets limit on how much can be spent on the premium assistance program to only match the total cost of maintaining the same number of people using the traditional ADAP program.	Orders DHHS to continue using ADAP funds to purchase health insurance or provide premium/copay/deductible assistance for patients with HIV to use federal “Ryan White” funds to pay for insurance that guarantees them access to medication. Orders a study of the program that demonstrates cost neutrality, gives data on health outcomes and describes any obstacles to implementation by March 2018.
Sets the eligibility determination for ADAP recipients by calculating “modified adjusted gross income,” which brings the program in line with other benefit program eligibility determinations.	Sets the eligibility determination for ADAP recipients by calculating “modified adjusted gross income,” which brings the program in line with other benefit program eligibility determinations.
Moves the “On-site Water Protection Branch” of the Environmental Health section of the Division of Public Health from DHHS to the Department of Environmental Quality. Also, this section changes the membership of the Board of Environmental Health Specialist Examiners, adding an environmental sanitation educator from an accredited college or university and one local health director.
Also expires all the current Board of Environmental Health Specialist Examiners members on July 31 to be replaced, mostly by the governor (with the exception of the members who are appointed by the Secretary), but limits five of the nine members to two-year appointments. The section also makes changes to the Local Health Department Accreditation Board to align with the changes in the Environmental Health Section Branch. Also makes changes to the Environmental Management Commission to conform with the above changes.
Moves responsibility for overseeing wastewater systems from the Environmental Management Commission to the Commission on Public Health.
Moves the On-site Water Protection Branch from Department of Public Health to DEQ and moves those 13 staff and moves $1.2 million + $25,000 annually to DEQ.
Moves the Well-Construction Unit from the Department of Public Health to DEQ and moves the two staff members and $254,392 annually to DEQ.
	Orders a study of eating disorders in NC with the intention of identifying the number of different disorders, the number of people affected, those being treated, and how to increase awareness, etc. Report to be delivered to the JLOC on HHS by November 2017.
	Provides $2.2 million per annum in one-time funds to launch a three-year demonstration of the “Every Week Counts” program that is intended to improve infant mortality outcomes in Robeson and Columbus counties. Researchers from UNC Chapel Hill’s School of Public Health will lead the project, which will provide in-home prenatal care for low-income multiparous women. They will also conduct a randomized controlled trial of the use of 17-p, a drug used to reduce the risk of preterm birth, among women deemed to be at risk of preterm birth. Lays out inclusion criteria for program participants. Final report to be submitted three months after conclusion of the program.
DIVISION OF MENTAL HEALTH/ DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES & DIVISION OF STATE OPERATED HEALTHCARE FACILITIES	DIVISION OF MENTAL HEALTH/ DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES & DIVISION OF STATE OPERATED HEALTHCARE FACILITIES
Adds statutory language to the state’s Executive Organization Act that stipulates that money for the NC Child Treatment Program should be used to train providers in evidence-based treatments, to create statewide standards for measuring accountability and outcomes, to create a roster of clinicians able to provide the above treatments, and to work with management of LME MCOs to make these treatments available to kids in juvenile justice and mental health facilities.	Adds statutory language to the state’s Executive Organization Act that stipulates that money for the NC Child Treatment Program should be used to train providers in evidence-based treatments, to create statewide standards for measuring accountability and outcomes, to create a roster of clinicians able to provide the above treatments, and to work with management of LME MCOs to make these treatments available to kids in juvenile justice and mental health facilities.
Directs the use of funds for the Child Treatment Program, which does clinical training on evidence-based mental health treatment for children. Directs DHHS to develop a secure online database to provide individual and aggregate level data and it stipulates that all data entered into this database and other databases, such as NC FAST, remain state property.	Directs the use of funds for the Child Treatment Program, which does clinical training on evidence-based mental health treatment for children. Directs DHHS to develop a secure online database to provide individual and aggregate level data and it stipulates that all data entered into this database and other databases, such as NC FAST, remain state property.
	Allocates $500,000 of one-time funding in each year of the biennium for the NCSTART pilot program, which is a community-based, crisis prevention service for adult I/DD patients, performed in conjunction with Disability Rights NC.
Changes how cash is paid to LME/MCOs during the first month of the fiscal year (July) in order to relieve cash-flow problems experienced by the LME/MCOs at that time.	Changes how cash is paid to LME/MCOs during the first month of the fiscal year (July) in order to relieve cash-flow problems experienced by the LME/MCOs at that time.
Decreases single stream funding paid to LME/MCOs by a total of $36.7 million annually and by $32.7 million in one-time funds in FY 2017-18 and by a total of $67.7 million in annual funds and $33.8 million in one-time funds in FY 2018-19. Orders the LME-MCOs to maintain the same level of service provision as during the past FY. Specifies how those cuts will be distributed among all seven LME/MCOs. Orders the HHS Secretary to report to the legislature by March 2018 with detailed explanations about any needed adjustments in these recurring reductions in future years. If there is a Medicaid surplus at the end of each fiscal year, LME/MCOs may receive $30 million to offset the reductions.	Decreases single stream funding paid to LME/MCOs by a total of $20.1 million annually and by $37.4 million in one-time funds in FY 2017-18 and by a total of $30.9 million in annual funds in FY 2018-19. Specifies how those cuts will be distributed among all seven LME/MCOs. Orders the LME-MCOs to maintain the same level of service provision as during the past FY. Orders the HHS Secretary to report to the legislature by March 2018 with detailed explanations about any needed adjustments in these recurring reductions in future years. If there is a Medicaid surplus at the end of each fiscal year, LME/MCOs may receive $30 million to offset the reductions.
Sets aside $6.2M / year in annual funds and a one-time allocation of $26,914 to fund the settlement of a lawsuit filed by Disabilty Rights NC over the lack of capacity to serve children with dual mental health and intellectual/ developmental disabilities. The funding will provide comprehensive assessments and services, including home health care, rehab and personal care services. The money also goes to creating an outpatient clinic at the Murdoch Center, which currently serves this population on an inpatient basis.	Also takes $20,193,449 in recurring single-stream funding and redirects those dollars to other services, including: Local three-way crisis beds ($2.5M); Disability Rights Settlement ($6.2M); US DOJ/ Transitions to Community Living ($8.89M); Expanding DD/Innovations waiver slots ($2.5M). In the FY18-19 budget, the budget reduces single-stream funding by $30.98 million and redirects funds thusly: Local three-way crisis beds ($2.5M); Disability Rights Settlement ($6.28M); US DOJ/ Transitions to Community Living ($17M); Expanding DD/Innovations waiver slots ($5.2M). All told, it’s a $28.7 millioin reduction in total funds in FY 17-18 for DMHDDSAS, and an $8.7 million increase in FY18-19.
Orders reports from DHHS to include income and spending from the single-stream, I/DD and substance abuse services on the third Monday of each month.	Orders reports from DHHS to include income and spending from the single-stream, I/DD and substance abuse services on the third Monday of each month.
	Provides $10M over the biennium in supplemental funding for mental health group homes housing 6 or fewer people. Restricts who is eligible to receive these extra funds. (Continuation of “bridge” funding created in 2015).
	Orders LME-MCOs to submit plans for how they intend to spend their fund balances each year, and caps the amount of “unrestricted” funds in the balance to 15 percent.
	Orders Cardinal Innovations to use $800,000 in single stream dollars to fund a matching grant for a mental health clubhouse located in its catchment area to make capital investments.
Orders evaluation of the financial position of each LME-MCO. Stipulates that if the Secretary feels that the LME-MCO is at risk of failing in the coming biennium, DHHS officials need to meet with the LME-MCO, devise a remediation plan, and report to the JLOC on HHS. Also specifies what should be in an corrective action plan, schedules for reports, and sets out benchmarks for compliance.	Orders evaluation of the financial position of each LME-MCO. Stipulates that if the Secretary feels that the LME-MCO is at risk of failing in the coming biennium, DHHS officials need to meet with the LME-MCO, devise a remediation plan, and report to the JLOC on HHS. Also specifies what should be in an corrective action plan, schedules for reports, and sets out benchmarks for compliance.
Directs the use of funds appropriated in each year to increase the number of community hospital beds that can be used for mental health treatment (three-way beds), authorizes the use of funds for new and existing beds, and stipulates the use of the money (only buy bed time for indigent patients). Stipulates that 10 percent of total funds can be used for facility-based crisis services and hospital detox. It also sets the format for departmental reports to the legislature. Senate allocates $38.8 million in annual funds and $2.5 million in one-time funds in each year of the biennium.	Directs the use of funds appropriated in each year to increase the number of community hospital beds that can be used for mental health treatment (three-way beds), authorizes the use of funds for new and existing beds, and stipulates the use of the money (only buy bed time for indigent patients). Stipulates that 10 percent of total funds can be used for facility-based crisis services and hospital detox. It also sets the format for departmental reports to the legislature. House allocates $41.3 million in annual funds.
A 2015 plan began eliminating the state appropriation to the state Alcohol and Drug Abuse Treatment centers and changing them to only being supported by receipts. The plan phases down the state appropriation over a few years and order the LME-MCOs to use 80 percent of their money for drug treatment from the ADATCs. This sets the threshold at 86 percent of the allocation to purchase services from the ADATCs. The remaining 14 percent of the LME money for substance use treatment can be used to purchase services from “any qualified provider.”	A 2015 plan began eliminating the state appropriation to the state Alcohol and Drug Abuse Treatment centers and changing them to only being supported by receipts. The plan phases down the state appropriation over a few years and order the LME-MCOs to use 80 percent of their money for drug treatment from the ADATCs. This sets the threshold at 86 percent of the allocation to purchase services from the ADATCs. The remaining 14 percent of the LME money for substance use treatment can be used to purchase services from “any qualified provider.”
Moves $21 million to DHHS from the proceeds of the Dix sale for the purpose of creating hospital-based psychiatric beds: $1.8 million for the Dix Crisis Intervention Center in Onslow County. Sets aside $6.2 million for beds to be created in three state regions: East, Central and West during FY17-18. (Total of $8M)	Moves $21 million to DHHS from the proceeds of the Dix sale for the purpose of creating hospital-based psychiatric beds in rural counties: $4 million for Caldwell Hospital, $2.2 million at Mission Health, $4 million at Cape Fear Valley MC, $4 million at Vidant Health, $3 million at Good Hope Hospital and $1.8 million for the Dix Crisis Intervention Center in Onslow County. The total of the allocation for the beds is $19 million. Orders that all the beds be named in honor of Dorothea Dix. Sets aside $2 million in one-time funding to cover the start-up costs for new child facility-based crisis centers.
	Orders an additional $2 million to go to a pilot case management system at WakeMed designed to reduce emergency room boarding of behavioral health patients.
States the NCGA’s intent to set aside up to $2 milllion in one-time funding to pay for up to two new facility-based crisis centers for children and adolescents. Orders DHHS to create a process for applying for those funds, criteria for winning the grants, and allocation. Orders a study by DHHS on how to support these new beds into the future, to be delivered by December 2020.	States the NCGA’s intent to set aside up to $2 milllion in one-time funding to pay for up to two new facility-based crisis centers for children and adolescents. Orders DHHS to create a process for applying for those funds, criteria for winning the grants, and allocation. Orders a study by DHHS on how to support these new beds into the future, to be delivered by December 2020.
Orders that any money left over from the Dix property sale not used to create new beds must remain in that fund.	Orders that any money left over from the Dix property sale not used to create new beds must remain in that fund.
Makes additions to the instructions given in the 2016 budget to DHHS around creating a statewide strategic plan for the improvement of behavioral health services. It requires DHHS to consider past studies and reports in the development of that strategic plan and orders the department to consider: why there is a growing waitlist for Innovations waiver slots and potential solutions to the growth of the waitlist; issues around single stream funding and how to use those dollars to support the I/DD population; any federal mandates that might impact services; coverage of services for people with autism.	Makes additions to the instructions given in the 2016 budget to DHHS around creating a statewide strategic plan for the improvement of behavioral health services. It requires DHHS to consider past studies and reports in the development of that strategic plan and orders the department to consider: why there is a growing waitlist for Innovations waiver slots and potential solutions to the growth of the waitlist; issues around single stream funding and how to use those dollars to support the I/DD population; any federal mandates that might impact services; coverage of services for people with autism.
Adds money to the budget to reflect the fact that more uninsured patients are using state-operated psychiatric hospitals. The funds cover inflationary increases in operations, including food, utilities and pharmaceuticals. Adds $5.6 million in annual funds.	Appropriates $4.4 million in annual funding for a receipt shortfall at state psychiatric hospitals, and also provides $1.2 million to account for inflationary increases on things such as drugs, food and utilities.
Appropriates $3.5 million in non-recurring funding each year to pay for possible litigation on the defaulted contract from the contractor building Broughton Hospital. It also provides money for administrative costs, costs related to having to redesign some of the problematic parts of the construction site, continued use of the old hospital, IT and other technology dollars, and one-time money for equipment for the new hospital (once it’s finished).	Appropriates $2.5 million in funding each year to pay for litigating the defaulted contract by the contractor building Broughton Hospital. It also provides $180,000 for a study around the future use of the old Broughton Hospital facilities and allows for the balance to be used for purchasing equipment and administrative costs incurred by the construction delays on the new hospital.
	Appropriates $100,000 in annual funding to purchase the opioid antagonist Naloxone.
Sets aside $150,000 in one-time funding in FY17-18 and $300,000 in one-time funding in FY18-19 to create a pilot program managed by the Division of Mental Health in DHHS to assist providers in creating a quality assessment and assurance support tool to be used for Traumatic Brain Injury patients/care. Orders a report on the pilot due by January 2019.	Sets aside $2.9 million each year to be used to fund services for people with Traumatic Brain Injury, to be distributed as followed: $359,218/year to fund contracts with specific providers, $796,934 to support residential programs that are specific to people with TBI, and $2.01 million/year to support requests from TBI patients in the community who need things such as home modifications, transportation, etc.
Orders the renaming of the Prescription Drug Abuse Advisory Committee to the Opioid and Prescription Drug Abuse Advisory Committee, adds a seat for someone from the Department of Public Safety.
Orders a study of provider prescribing practices and whether a continuing education class on best practices for controlled substance prescribing is changing practice. To be completed December 2017.
Orders the closure of the Wright School, a facility in Durham County which serves children with severe mental and behavioral health problems.
	Eliminates a semiannual report DHHS sent to the NCGA on mental health integration activities between Community Care of North Carolina and Medicaid providers. Community Care is being de-emphasized as the state prepares to move Medicaid to commercial managed care.
	Establishes interim policies around cash reserves and reinvestments to be in place until more comprehensive solvency standards that are being developed as part of the behavioral health statewide plan are incorporated into the LME-MCO contracts in Jan, 2018. The provision outlines requirements around cash reserves and reinvestments made by the LME-MCOs. Stipulates that LME-MCOs must define the state of cash and reserve accounts, defines where the funds in restricted reserves must go, and states that reinvestment plans must be approved by DHHS and include measurable outcomes and long term goals.
	Requires DHHS to notify each LME-MCO of approved and not approved cash reserve plans and thresholds for the coming year, submitting copies to the JLOC of HHS, the JLOC of Medicaid and Health Choice and the Fiscal Research Division. Outlines a process that will take place if an LME-MCO’s unrestricted cash reserve is more than the threshold set by DHHS, this may include withholding future single stream funding, a required transfer of funds to the Medicaid risk reserve or a requirement that the fund balance be spent on behavioral health services. Expire in June 2019, or when solvency standards are incorporated into state contracts with LME-MCOs. Also lays out requirements for maintenance of effort.
DIVISION OF HEALTH SERVICE REGULATION	DIVISION OF HEALTH SERVICE REGULATION
Provides money for additional staff for adult care home and acute care setting inspections, this will improve the timeliness of the inspections for many kinds of facilities, including hospitals, home care agencies, adult and family care homes and dialysis centers. The positions will help the state meet federal requirements for the number of staff to inspect facilities that are paid by Medicare and Medicaid. Amounts are for $372,380 of annual funds in FY17-18, bumped up to $729,667 in FY18-19, with $10,000 each year to set up the positions. By the end of the biennium, 14 new positions will have been added.	Provides money for additional staff for adult care home and acute care setting inspections, this will improve the timeliness of the inspections for many kinds of facilities, including hospitals, home care agencies, adult and family care homes and dialysis centers. The positions will help the state meet federal requirements for the number of staff to inspect facilities that are paid by Medicare and Medicaid. Amounts are for $372,380 of annual funds in FY17-18, bumped up to $729,667 in FY18-19, with $10,000 each year to set up the positions. By the end of the biennium, 14 new positions will have been added.
Designates continued $250,000 in funding each year for a pilot program at New Hanover Hospital to expand the roles of paramedics and train them to appropriately divert behavioral health patients from emergency departments to community-based services, helping them “navigate” through the mental health system to find the services they need.
Designates continued $210,000 in funding each year for pilot programs to expand the roles of paramedics and train them to appropriately divert behavioral health patients from emergency departments to community-based services. This pilot would be based at New Hanover Regional Medical Center.	Designates continued $350,000 in funding each year for pilot programs to expand the roles of paramedics and train them to appropriately divert behavioral health patients from emergency departments to community-based services.
	Appropriates $248,000 over the two-year budget to automate the background check system used by providers of long-term care services. It’s used check backgrounds of non-licensed staff (because licensed staff such as nurses, etc. go through background checks as part of their licensure) who provide hands-on care for patients/residents. The system was actually developed using federal funds and this money provides ongoing support.
Allows for hospitals to roll a shuttered hospital in a neighboring county into one license, so long as the closed hospital has been closed for fewer than three years and was the only hospital in operation.	Allows for hospitals to roll a shuttered hospital in a neighboring county into one license, so long as the closed hospital has been closed for fewer than three years and was the only hospital in operation.
Extends a moratorium on licensing “special care units” in adult care homes targeted toward people with Alzheimer’s disease until 2019. The moratorium does not restrict DHHS from moving the license from an existing facility to a new owner. It also allows for the HHS Secretary to issue a license for a unit in a county that’s been deemed to be a shortage area. Requires DHHS to submit a report on special care units to be delivered to the JLOC on HHS by March 2019.
Makes exemptions to North Carolina’s Certificate of Need laws to include: 1) allowing eye surgeons to obtain licenses to do create surgery centers outside of hospitals to perform eye procedures and redefines what constitutes an eye surgery beginning in 2018, 2) exempts psychiatric beds from the beds required to get approval from the state, and 3) removes hospital hospice-unit beds from CON review.
Removes ambulatory surgery centers from CON review so long as the surgery group creating the center makes “every effort to enter into a joint venture” with the nearest hospital. If they are not able to reach agreement, the physician group needs to notify DHHS of this failure before starting construction. Also requires that any ambulatory surgery center must have an agreement with a hospital at a “reasonable distance” to address medical complications that might arise and must be able to perform emergency transfer of that patient.
Also exempts new construction, new services, purchases of major medical equipment, etc., from additional CON review for community hospitals with more than 200 beds starting in October 2017.
Repeals any remaining CON laws by January 2025.

DIVISION OF VOCATIONAL REHABILITATION	DIVISION OF VOCATIONAL REHABILITATION

DIVISION OF MEDICAL ASSISTANCE	DIVISION OF MEDICAL ASSISTANCE
Instructs DHHS to reduce the overall spending on Medicaid by $20M by finding reductions that can include contractual changes, rate reductions, different reimbursement methodologies, clinical policies, etc. These are called “flexibility” cuts, in that the Department has the flexibility to take the cuts where it can, but there is no flexibility on the amount.	Instructs DHHS to reduce the overall spending on Medicaid by $20M by finding reductions that can include contractual changes, rate reductions, different reimbursement methodologies, clinical policies, etc. These are called “flexibility” cuts, in that the Department has the flexibility to take the cuts where it can, but there is no flexibility on the amount.
Outlines Medicaid eligibility, which is adjusted to meet federal poverty level guidelines and stipulates the delivery of the annual Medicaid report. Codifies the provider application and recredentialing fee required every five years for providers who can accept Medicaid. Provides for the transfer of money to the N.C. Office of Administrative Hearings for remediation and other services related to the Medicaid appeals process. Patients who appeal decisions about their care made by Medicaid have recourse to the OAH for appeal. Sets out language for accounting for federal Medicaid receipts, volume purchasing and procurement policies.	Outlines Medicaid eligibility, which is adjusted to meet federal poverty level guidelines and stipulates the delivery of the annual Medicaid report. Codifies the provider application and recredentialing fee required every five years for providers who can accept Medicaid. Provides for the transfer of money to the N.C. Office of Administrative Hearings for remediation and other services related to the Medicaid appeals process. Patients who appeal decisions about their care made by Medicaid have recourse to the OAH for appeal. Sets out language for accounting for federal Medicaid receipts, volume purchasing and procurement policies.
Each year, legislators work with the Office of State Budget and Management to “rebase” Medicaid, that is, revise what the estimate is for the upcoming year’s spending. This year’s rebase adds $66.1M of recurring expenses in FY17-18 and $174.9M in recuring expenses in FY18-19, this allows for a 5.6 percent enrollment in the first year and 5 percent in the second year, plus anticipated changes in utilization of services. There’s also a $62.3M reduction in one-time expenses in each year. These reductions represent federal payments the state receives as part of the ACA which provided additional funding for the State Child Health Insurance Plan (called NC Health Choice). That continues until Sept 2019. So, those funds are credited to Medicaid for each year of the biennium.	Each year, legislators work with the Office of State Budget and Management to “rebase” Medicaid, that is, revise what the estimate is for the upcoming year’s spending. This year’s rebase adds $66.7 million of recurring expenses in FY17-18 and $177.4 million in recuring expenses in FY18-19, this allows for a 5.6 percent enrollment in the first year and 5 percent in the second year, plus anticipated changes in use of services. There’s also a $62.9 million reduction in one-time expenses in the first year, and a $64.8 million reductioon in FY18-19. These reductions represent federal payments the state receives as part of the ACA which provided additional funding for the State Child Health Insurance Plan (called NC Health Choice). That continues until September 2019. So, those funds are credited to Medicaid for each year of the biennium.
	Transfers $17.7 million in FY 17-18 and $18 million in FY 18-19 of funds back to the state from the LME-MCO system to cover risk reserve moneys paid on behalf of Medicaid patients who get their behavioral health care from the LME-MCOs. That care is paid for in a “capitated” flat rate. Some of that money is placed in a reserve to cover unexpected large expenditures.
Reduces the rebase for NC Health Choice (the State Children’s Health Insurance Program) by $42.9 million in FY17-18 and by $43 million in FY18-19, both in one-time savings to the program. This reflects federal receipts that came as a result of the Affordable Care Act and the fact that most Medicaid eligible children have been moved off of Health Choice and onto Medicaid to take advantage of better reimbursements. At the same time, the rebase does increase by $1.5 million in FY17-18 and by $3.9 million in FY18-19 in recurring funds. In sum, the expected total appropriatioon for Health Choice will be $4589,077 (??) in FY17-18 and $396,238 in FY18-19 because almost all of the children will be off of the program (these moves account for much of the increased Medicaid rebase).	Reduces the rebase for NC Health Choice (the State Children’s Health Insurance Program) by $44.4 million in FY17-18 and by $46.9 million in FY18-19, both in one-time savings to the program. This reflects federal receipts that came as a result of the Affordable Care Act and the fact that most Medicaid eligible children have been moved off of Health Choice and onto Medicaid to take advantage of better reimbursements. At the same time, the rebase does increase by $1.5 million in FY17-18 and by $3.9 million in FY18-19 in recurring funds. In sum, the expected total appropriatioon for Health Choice will be $458,280 in FY17-18 and $394,925 in FY18-19 because almost all of the children will be off of the program (these moves account for much of the increased Medicaid rebase).
Rquires DHHS to issue annual Medicaid cards and then requires DHHS to update rules to reflect that. One of the rules that will be changing in the coming year is the replacement of social security numbers on Medicaid cards with a unique ID number, which is a federal requirement.	Requires DHHS to issue annual Medicaid cards and then requires DHHS to update rules to reflect that. One of the rules that will change in the coming year is the replacement of social security numbers on Medicaid cards with a unique ID number, which is a federal requirement.
Provides language to allow a person who receives services from an LME-MCO outside of his or her home county to have that service billed to their home LME-MCO without difficulty. Prior to this language, patients had to travel “home” in order to receive services.	Provides language to allow a person who receives services from an LME-MCO outside of his or her home county to easily have that service billed to their home LME-MCO. Prior to this language, patients had to travel “home” to receive services.
Adds 250 slots to the Medicaid Innovations waivers that support adults with intellectual and developmental disabilities, costing $2.58 million in FY17-18 and $5.1 million in FY18-19.	Adds 250 slots to the Medicaid Innovations waivers that support adults with intellectual and developmental disabilities, costing $2.58 million in FY17-18 and $5.1 million in FY18-19.
Adds to the Medicaid Transformation Fund by $75,000,000 per year in one-time funds ($150 million over two years) from the General Fund. Limits use of Medicaid Contingency fund to covering Medicaid shortfalls and only upon appropriation by the NCGA. Outlines procedure for using the contingency funds for the shortfalls.	Moves $186,372,673 from Medicaid Contingency Reserve to the Medicaid Transformation Fund.
Provides $1.5 million in one-time funding in FY 17-18 and $2.24 million in FY 18-19 for programming changes in NC Tracks, which is the Medicaid claims support and payment system. This will enable DHHS to make changes to the computer system such as clinical policy changes, and to make claims payment more efficient.	Provides $1.5 million in one-time funding in FY 17-18 and $2.24 million in FY 18-19 for programming changes in NC Tracks, which is the Medicaid claims support and payment system. This will enable DHHS to make changes to the computer system such as clinical policy changes, and to make claims payment more efficient.
Orders enhancements to NC Tracks to prevent and detect fraud, waste and abuse. Any new capability for fraud detection should be made in the computer program within four months after the budget passes.	Orders enhancements to NC Tracks to prevent and detect fraud, waste and abuse. Any new capability for fraud detection should be made in the computer program within seven months after the budget passes.
Designates a rate increase for workers providing personal care services for people eligible for Medicaid services. (This increase was included in the rebase, above.) The services include things such as help with bathing, dressing, eating, toileting, etc. The rate will go from $15.52/hour to $15.76/hour, costing an additional $2.6 million in FY17-18 and $5.5 million in FY18-19. Also in the rebase is an assumption of an increase in the number of hours between 7-10 percent. This increase is effective January 2018.	Designates a rate increase for workers providing personal care services for people eligible for Medicaid services. (This increase was included in the rebase, above.) The services include things such as help with bathing, dressing, eating, toileting, etc. The rate will go from $15.52/hour to $15.76/hour, costing an additional $2.6 million in FY17-18 and $5.5 million in FY18-19. Also in the rebase is an assumption of an increase in the number of hours between 7-10 percent. This increase is effective January 2018.
	Orders DHHS to report to the JLOC of Medicaid and Health Choice on a plan for adding Medicaid coverage for ambulance transports of behavioral health crisis patients who are eligible for Medicaid away from emergency rooms and to more appropriate clinics or facilities. Plan is due by December 2017.
The budget reinstates $30 million in annual funding to maintain or continue graduate medical education payments, which are added to inpatient hospital Medicaid payments. Medical interns and residents provide care to Medicaid patients even as they are being trained to become physicians and while it costs money to support them, they cost less than fully qualified and credentialed doctors. Stipulates that if the state expenditure (less receipts) exceeds $10 million, DHHS has to find the funds from elsewhere to cover the costs.	The budget reinstates $30 million in annual funding to maintain or continue graduate medical education payments, which are added onto inpatient hospital Medicaid payments. Medical interns and residents provide care to Medicaid patients even as they are being trained to become physicians and while it costs money to support them, they cost less than fully qualified and credentialed doctors.
	Orders DHHS to submit an amendment to the Medicaid plan for North Carolina allowing for professional supplemental payment for doctors and other practitioners who work at state-operated schools of medicine, heatlh systems, hospitals and the Duke University practice plan. The extra payment will be the difference between the commercial rate and the Medicaid rate. State share will be covered by moving money within the Medicaid program or by assessing private hospitals, which is an expansion of existing assessments on hospitals. This needs to be approved by federal regulators.
	Orders DHHS to do a feasibility study of creating a chiropractic medicine, a physician assistant and other programs at Winston-Salem State U.
Adds language to the Medicaid rules to add additional eligiblity monitoring for Medicaid recipients, requiring them to present qualifying information every quarter. This kind of documentation includes earned and unearned income, employment records, residency status, enrollment status in other state programs, death records, lottery winnings, etc.
Adds language from SB 629 which does several things including: eliminates the practice of “surprise billing,” where patients receive a hospital bill for services provided by an “out of network” provider; sets limits on the ability of hospitals to bill patients for the balance of their charges not paid by insurance companies; requires hospitals and insurers to make notice of who will be billing a patient for services; and requires hospitals to set benchmark amounts that they can bill for services and make these publicly known.
Orders DHHS to issue a report every March that details whether eligibliity determinations by counties are being done in a timely manner. This is in response to a state audit last year showing that many counties were not complying with federal guidelines for how quickly applicants were receiving their Medicaid and other social service benefit eligibility determinations. Originally, it was only a two-year report, but now will be ongoing.	Orders DHHS to issue a report every November that details whether eligiblity determinations by counties is being done in a timely manner. This is in response to a state audit last year showing that many counties were not complying with federal guidelines for how quickly applicants were receiving their Medicaid and other social service benefit eligibility determinations. Originally, it was only a two-year report, but now will be ongoing.
Adds language from SB 546, which sets out a process for taking over a county social service department where Medicaid and other benefits eligibility determinations are too slow and not meeting state and federal timeliness guidelines. The Act would allow for DHHS to take over a county social service agency, implement a corrective action plan, and assume Medicaid eligibility administration until the county department can resume the services.
	The budget orders DHHS to manage their budget, within its authority, and make changes to Medicaid rates and policy to find $30 million in savings annually.
	Appropriates money from Medicaid to pay for increases in the rate paid for state-county special assistance, which goes to support people living in adult care and family care homes and other long term care facilities. In sum, SA rates will go up $34/month, $1.9 million will come out of Medicaid dollars in FY17-18 and $4.9 million in FY18-19.
	Sometimes, when a resident enters long term care, they are not yet eligible for state-county special assistance. This extends the retroactive authorization period for SA from 10 days to 30 days, increasing the annual expenditure by $1.4 million in annual funds in FY17-18 and by $1.45 million in annual funds in FY18-19.
	Requires DHHS to study the PACE program, similar to the study ordered in 2014, and requires an update to that info. Also orders an assessment of the state’s long-term needs for addressing the aging population and an evaluation on state regulations on PACE providers. The programs have been restricted in their ability to expand, and there’s been a moratorium on the development of new PACE programs.
Makes technical amendments to the new rules that will apply to new Medicaid “prepaid health plans.”	Makes technical amendments to the new rules that will apply to new Medicaid “prepaid health plans.”
	Requires any Prepaid Health Plans bidding for contracts under Medicaid transformation to reveal any litigation that has to do with overbilling or Medicaid fraud.
Sets forth language permitting the suspension of payment to Medicaid providers who may have been overpaid. Also allows the state Medicaid program to recoup overpayment by withholding further payment and makes technical changes to make this happen. Also makes changes to the review process for prepaying Medicaid claims.	Makes changes to the review process for prepaying Medicaid claims.
Allows the new Division of Health Benefits to receive federal matching funds and prevents them from being moved to any other division of DHHS. The DHB will manage the Medicaid program once it is run by outside managed care companies after approval by federal regulators.	Allows the new Division of Health Benefits to receive federal matching funds and prevents them from being moved to any other division of DHHS. The DHB will manage the Medicaid program once it is run by outside managed care companies after approval by federal regulators.
	MISCELLANEOUS
	Creates subcommittees of the JLOC of HHS and the Joint Education Oversight Committee to develop statewide plan to develop medical education and residency programs in the state in a way to maximize the state’s investment and addresses future provider needs. DHHS and UNC need to provide the subcommitteed with information by Feb, 2018, with focus on shortage areas of practice, with final plan due March, 2018.

Read all of our joint coverage with The Charlotte Ledger here.

2017 – Senate vs. House Health & Human Services Budgets

By Rose Hoban

SENATE

HOUSE

CENTRAL MANAGEMENT AND SUPPORT

CENTRAL MANAGEMENT AND SUPPORT

DIVISION OF CHILD DEVELOPMENT AND EARLY EDUCATION

DIVISION OF CHILD DEVELOPMENT AND EARLY EDUCATION

DIVISION OF SOCIAL SERVICES

DIVISION OF SOCIAL SERVICES

DIVISION OF AGING AND ADULT SERVICES

DIVISION OF AGING AND ADULT SERVICES

DIVISION OF PUBLIC HEALTH

DIVISION OF PUBLIC HEALTH

DIVISION OF MENTAL HEALTH/ DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES & DIVISION OF STATE OPERATED HEALTHCARE FACILITIES

DIVISION OF MENTAL HEALTH/ DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES & DIVISION OF STATE OPERATED HEALTHCARE FACILITIES

DIVISION OF HEALTH SERVICE REGULATION

DIVISION OF HEALTH SERVICE REGULATION

DIVISION OF VOCATIONAL REHABILITATION

DIVISION OF VOCATIONAL REHABILITATION

DIVISION OF MEDICAL ASSISTANCE

DIVISION OF MEDICAL ASSISTANCE

MISCELLANEOUS

Rose Hoban