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FINAL: The Health and Human Services Budgets Compared

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By Rose Hoban, Jasmin Singh & Hyun Namkoong

Voices of members of the North Carolina House were raised and filled with passion as they debated the final version of the budget. In a three-hour debate, members voiced their support for the bill, but many also raised their concerns.

The budget passed its final reading, 66-44, in the House on Aug. 2. Four Republicans voted against the bill, including two co-chairs of the House Finance Committee. No Democrats voted for the budget’s final version.

Rep. Nelson Dollar (R-Cary), the bill’s primary sponsor and lead fighter for Medicaid reform in the House, said the bill fulfilled their promises.

“You have to be able to stand on your beliefs,” Dollar said during debate on the bill.

Because of unsettled differences between the chambers, full-fledged Medicaid won’t happen until November. Rep. Bryan Holloway (R-King) said that’s a good thing.

The floor of the N.C. House of Representatives shortly after the budget vote Friday.

The floor of the N.C. House of Representatives shortly after the budget vote Friday. Photo credit: Jasmin Singh

“Medicaid reform is like a hundred thousand-piece puzzle,” Holloway said. “It’s not something we want to rush through.”

What’s it all mean?

Every year, we at N.C. Health News spend hours slogging through the text and the numbers to make the year’s budget more discernible to the lay reader.

This spreadsheet details how parts of the Department of Health and Human Services budget changed between passage of the Senate budget at the end of May and the House budget on June 13 and the final bill passed on Aug 2.

The table allows a reader to see how the budget evolved from the House to the Senate to its final form.

Changes made in the final budget are noted in blue. Yellow blocks denote parts of the budget that only appeared in the final version. And, of course, there are links to our stories about different parts of the budget sprinkled throughout.

Senate House Conference / Final Budget
No mention of Medicaid risk reserve. Adds $117.8M to Medicaid risk reserve. Creates $186M Medicaid Contingency Reserve.
Sets Medicaid rebase at $206M (had been projected to be $557M in original budget), provides $143M in additional non-recurring funds to cover Medicaid liabilities. No mention of Medicaid rebase; allocates $75M in additional non-recurring funds to cover Medicaid liabilities. No mention of Medicaid rebase. Provides $186M in additional non-recurring “contingency” funds to cover Medicaid liabilities. (Blend of the two proposals, see line 1.)
Eliminates $8M in vacant DHHS administrative positions and contracts. Allocates money for two actuary positions in the office of the secretary of DHHS Eliminates $16M in vacant DHHS administrative positions and contracts. Allocates money for two actuary positions in the office of the secretary of DHHS. Eliminates $16M in vacant DHHS administrative positions and contracts, money to be found via “flex” cuts. Allocates money for two actuary positions in the office of the Secretary of DHHS, CMS pays for those positions at rate of 50p.
Provides $1,000 annual salary increase for full-time employees of DHHS. Also comensurately increases state retirement contribution. Total cost: $8.98M
Creates $28,000/year worth of loan forgiveness for students from NC to study optometry and then return to the state to practice in a “health professional shortage area.” Creates a study to explore the feasibility of establishing an optometry school at a UNC institution; also invites private universities in NC to study the possibility. Both reports due by Dec 2014. Creates a study to explore the feasibility of establishing an optometry school at a UNC institution; also invites private universities in NC to study the possibility. Both reports due by Dec 2014. (Same as House proposal.)
Orders local boards of education to supply all schools with epinephrine pens to be used in case of emergency. (Legislation stipulating this passed the House in 2013; has been in Senate without action since.) Orders local boards of education to supply all schools with epinephrine pens to be used in case of emergency. (Legislation stipulating this passed the House in 2013; has been in Senate without action since.)
Funds nonprofit organizations and establishes a competitive process for non-governmental organizations that contract with the state to provide specific social services. Total: $9,303,911 in recurring funds. Funds nonprofit organizations and establishes a competitive process for non-governmental organizations that contract with the state to provide specific social services. Total: $9,303,911 in recurring funds. (Same as Senate.) Funds nonprofit organizations and establishes a competitive process for non-governmental organizations that contract with the state to provide specific social services. Total: $9,103,911 in recurring funds (reduction of $200,000/4.5 percent) plus $317,400 in non-recurring funds for FY 2014-15. Also moves $3,852,500 from Social Services Block Grant to nonprofit funding for both years of the biennium.
Removes Brain Injury Association from the competitive bidding process. Creates separate traumatic brain injury fund of $2,373,086. Removes Brain Injury Association from the competitive bidding process. Creates separate traumatic brain injury fund of $2,373,086. (Same as Senate.) Removes Brain Injury Association from the competitive bidding process. Creates separate traumatic brain injury fund of $2,373,086. (Same as House, Senate.)
Creates funding for St. Gerard House for autism services ($175,000) for the first time. But starting in FY 2015-16, the organization must go through competitive block grant application process.
$4M in funds for Statewide Health Information Exchange, a nonprofit corporation responsible for overseeing and administering a computer network among hospitals for patient medical and billing records. $4M in funds for Statewide Health Information Exchange, a nonprofit corporation responsible for overseeing and administering a computer network among hospitals for patient medical and billing records. (Same as Senate.) $2M in funds for Statewide Health Information Exchange, a nonprofit corporation responsible for overseeing and administering a computer network among hospitals for patient medical and billing records.
Orders all hospitals with electronic medical records to connect to the Health Information Exchange Network and provide individual patient, demographic and clinical data on services paid for with Medicaid funds. Data must be available in real time to state staff. Orders all hospitals with electronic medical records to connect to the Health Information Exchange Network and provide individual patient, demographic and clinical data on services paid for with Medicaid funds. Data must be available in real time to state staff. Orders all hospitals with electronic medical records to connect to the Health Information Exchange Network and provide individual patient, demographic and clinical data on services paid for with Medicaid funds. Data must be available in real time to state staff. (Same as House, Senate.)
Requires DHHS to plan and implement system changes to allow all providers under contract with DHHS to submit all Medicaid claims into NCTracks. Submit plan by May 1, 2015. Implement by July 1, 2017. Repeals plans to implement system modifications to enable contract entities to perform Medicaid Claim Adjudication in the replacement Medicaid management information system. Changes dates (to Dec. 1, 2014) for plans to create a claims adjudication system for all of the mental health LME/MCOs. Also permits DHHS to use revenue received by NCTracks during FY 2013-14 ($9.66M) to advance development of NCTracks.
Allocates $864,655 for FY 2014-15 along with prior year earned revenue of $4,138,002 and the cash balance in the budget toward NC FAST in order to draw federal matching funds. Money to be used to develop the next parts of NC FAST to determine eligibility for:
– Home Energy Assistance Program
– Child Care Subsidy Program
– Crisis Intervention Programs
– Child Service Program
CHILD CARE SUBSIDY/SERVICES
Adjusts eligibility for child care subsidy for families from qualifying at 75% of state median income ($50,975 for family of four) to new rates: for children 0-5 years old, qualifying income is 200% of federal poverty level ($47,700 for family of four), and for children 6-13 years old, qualifying family income is 133% of federal poverty level ($31,721 for family of four). For children with special needs, the qualifying family income will be 200% of federal poverty level. Adjustments go into effect Sept 1. Adjusts eligibility for child care subsidy for families from qualifying at 75% of state median income ($50,975 for family of four) to new rates: for children 0-5 years old, qualifying income is 200% of federal poverty level ($47,700 for family of four), and for children 6-13 years old, qualifying family income is 133% of federal poverty level ($31,721 for family of four). For children with special needs, the qualifying family income will be 200% of federal poverty level. Adjustments go into effect Oct 1. Child care subsidy eligibility will be determined based on federal poverty level for following ages:
– 0-5 years old, 200% of FPL
– 6-12 years old, 133% of FPL
– For children with special needs, the qualifying family income will be 200%.
– Any child receiving child care subsidy based on 75% of state median income (current standards) will continue to receive the subsidy until the next redetermination of eligibility.
Beginning September 1, 2014, the family share in the cost of care shall be based on 10% of gross family income. Replaces the old calculation that had a graduated payment scale. Saves about $1.8 M. Also eliminates the “part-day” child care payment; now parents will pay a full-day fee for for after-school care. Beginning October 1, 2014, the family share in the cost of care shall be based on 10% of gross family income. Replaces the old calculation that had a graduated payment scale. Saves about $1.8 M. Also eliminates the “part-day” child care payment; now parents will pay a full-day fee for for after-school care. – Beginning October 1, 2014, the family share in the cost of care shall be based on 10% of gross family income. Replaces the old calculation that had a graduated payment scale from 6-9%.
Saves about $1.8 M.
– Also eliminates the “part-day” child care payment; now parents will pay a full-day fee for after-school care.
Saves additional $2.1M.
Extra funds that combined with the above reduces the child care subsidy waiting list by 3,200. Extra funds that combined with the above reduces the child care subsidy waiting list by 2,250. Extra funds that combined with the above reduces the child care subsidy waiting list by approximately 4,000.
Requires local partnerships to spend for subsidies to provide at least $52M for federal maintenance of effort requirement for Temporary Assistance to Needy Families, Child Care Development Fund and Block Grant match requirement. Requires DHHS Division of Child Development and Early Education to study child care subsidy for 11- and 12-year-olds and report findings and recommendations to the lawmakers by November 30, 2014. Requires local partnerships to spend for subsidies to provide at least $52M for federal maintenance of effort requirement for Temporary Assistance to Needy Families, Child Care Development Fund and Block Grant match requirement. Requires DHHS Division of Child Development and Early Education to study child care subsidy for 11- and 12-year-olds and report findings and recommendations to the lawmakers by November 30, 2014. (Same as Senate.) – Requires local partnerships to spend for subsidies to provide at least $52M for federal maintenance of effort requirement for Temporary Assistance to Needy Families, Child Care Development Fund and Block Grant match requirement.
– Requires NC Partnership for Children to create plan for increasing fundraising by local partnerships.
– Also directs DHHS to study child care subsidy for 11- and 12-year-olds and report findings and recommendations to the lawmakers by November 30, 2014.
Moves $7.2M out of Temporary Assistance for Needy Families block grant into PreK funding. Moves 15.8M out of Temporary Assistance for Needy Families block grant into PreK program. Increases lottery funding of PreK program by $49M. Moves $19.8M out of Temporary Assistance for Needy Families block grant into PreK funding. No mention of increases to lottery funding for PreK program.
General Assembly findings and intent on Child Protective Services:
– finds county DSSs have lost federal TANF and other funding, even as investigations have grown by 20% from 2002-12
– state lacks data on performance of county DSSs on child protective services
– conflicts of interest arise when county DSS employees also act as guardians or foster parents
– recommends average caseload be no more than 10 families per caseworker. Caseloads in many counties are 50-100% higher
Give $8,326,627 to DHHS to provide additional CPS workers at county departments of social services to reduce caseloads. Give $4,500,000 to DHHS for Child Welfare in-home services to focus on child safety and protection, family preservation and prevention of further abuse or neglect. Give $750,000 to DHHS to fund nine positions to the Division of Social Services to enhance oversight of child welfare services in county departments of social services. These employees will monitor, train and provide technical assistance to county DSSs to ensure children and families are provided services that address the safety, permanency and well-being of children. Give $300,000 to DHHS to establish and implement a Child Protection Services pilot program and to enhance coordination of services and information amount county DSSs, local law enforcement agencies, the court system, guardian ad litem programs and other agencies. Give $700,000 to DHHS to provide for comprehensive statewide evaluation of State’s CPS system. Require DHHS Division of Social Services to study the issue of conflicts of interest in child welfare cases as related to public guardianship. This is in response to the case in Union County where a DSS supervisor was found to be abusing a foster child. Provides $5M in foster care assistance payments. Give $8,326,627 to DHHS to provide additional CPS workers at county departments of social services to reduce caseloads. Give $4,500,000 to DHHS for Child Welfare in-home services to focus on child safety and protection, family preservation and prevention of further abuse or neglect. Give $750,000 to DHHS to fund nine positions to the Division of Social Services to enhance oversight of child welfare services in county departments of social services. These employees will monitor, train and provide technical assistance to county DSSs to ensure children and families are provided services that address the safety, permanency and well-being of children. Give $300,000 to DHHS to establish and implement a Child Protection Services pilot program and to enhance coordination of services and information amount county DSSs, local law enforcement agencies, the court system, guardian ad litem programs and other agencies. Give $700,000 to DHHS to provide for comprehensive statewide evaluation of State’s CPS system. Require DHHS Division of Social Services to study the issue of conflicts of interest in child welfare cases as related to public guardianship. This is in response to the case in Union County where a DSS supervisor was found to be abusing a foster child. Provides $5M in foster care assistance payments. (Same as Senate.) – Gives $7,369,970 to DHHS to provide additional CPS workers at county departments at social services to reduce case loads.
– Gives $4,500,000 for Child Welfare in-home services to focus on child safety and protection, family preservation and prevention of further abuse or neglect.
– Gives $750,000 to DHHS to fund nine positions to the Division of Social Services to enhance oversight of child welfare services in county departments of social services. These employees will monitor, train and provide technical assistance to county DSSs to ensure children and families are provided services that address the safety, permanency and well-being of children.
– Gives $300,000 to DHHS to establish and implement a Child Protection Services pilot program and to enhance coordination of services and information among county departments of social services, local law enforcement agencies, the court system, guardian ad litem programs and other agencies.
– Gives $700,000 to DHHS to provide for comprehensive statewide evaluation of the State’s CPS system.
– Requires study of performance, caseload sizes, administrative structure of CPS system in the state, adequacy of funding, CPS worker turnover and monitoring and oversight of county departments of social services.
– Requires DHHS Division of Social Services to study the conflicts of interest in child welfare cases are related to public guardianship. This is in response to the case in Union County where a DSS supervisor was found to be abusing a foster child.
Payment level for Work First Family Assistance shall be 50% of standard of need. Payment level for Work First Family Assistance shall be 50% of standard of need. (Same as Senate.) Payment level for Work First Family Assistance shall be 50% of standard of need (Same as House, Senate.)
Allocates $218,538 in recurring funding and $125,700 in one-time funding for implementing drug testing for Work First participants as ordered in law passed during 2013 session. Allocates $218,538 in recurring funding and $125,700 in one-time funding for implementing drug testing for Work First participants as ordered in law passed during 2013 session.
Beginning October 1, 2014, have Eastern Band of Cherokee Indians assume responsibility for some social services, health care benefit programs and ancillary services, including parts of Medicaid. Also assume responsibility of SNAP. By October 1, 2015, Eastern Band of Cherokee Indians assumes responsibility for other programs. This relieves the county of legal responsibility to those services and non-federal matching funds will be allocated directly to Eastern Band. Beginning October 1, 2014, have Eastern Band of Cherokee Indians assume responsibility for some social services, health care benefit programs and ancillary services, including parts of Medicaid. Also assume responsibility of SNAP. (Same as Senate.) By October 1, 2015, Eastern Band of Cherokee Indians assumes responsibility for other programs. (Same as Senate.) This relieves the county of legal responsibility to those services and non-federal matching funds will be allocated directly to Eastern Band. Also includes NC Health Choice health care benefits, along with Medicaid. Beginning October 1, 2014, the Eastern Band of Cherokee Indians may assume responsibility for SNAP. This relieves the county of legal responsibility of those services and nonfederal matching funds will be allocated directly to the Eastern Band. The tribe may assume responsibility for some social services, health care benefit programs and ancillary services, including parts of Medicaid and NC Health Choice health care benefits.
SPECIAL ASSISTANCE
Changes eligibility for state-county special assistance programs. People on the program before Nov 1, 2014 will remain; afterwards, special assistance will only kick in if an applicant has income at or below 100% of federal guidelines and insufficient other resources. Retains one of the requirements of the person coming to North Carolina to join a close relative who has resided in North Carolina for at least 180 consecutive days immediately prior to the person’s application. Doesn’t include the Nov 1, 2014 deadline or the below 100% requirement Changes eligibility for state /county special assistance. Now it may only be provided if applicants meet all of the eligibility requirements for state-county special assistance:
– 65 years or older
– between ages 18 and 65 and is permanently and totally disabled or legally blind.
Income levels must be at or below 100% of federal guidelines and insufficient other resources.
New eligibility requirements don’t affect people who were approved prior to November 1, 2014 who currently can earn more than 100 percent of the FPL and still get special assistance and Medicaid (see next line).
DHHS must submit to federal Centers for Medicare and Medicaid Services to grandfather people in so they may retain their eligibility.
Eliminates funding for any additional Medicaid Special Assistance recipients; current SA recipients grandfathered in. Also sets SA threshold at 100% of federal poverty level. Changes eligibility for county special assistance: limits income eligibility to 100% of the federal poverty level ($11760/year, $980/month). Saves $378,000 this FY. Also reduces funding for Special Assistance by $4.2M.
DHSS and county departments of social services are no longer required to maintain state’s appropriation to state and county Special Assistance program at 100% of the 2012-13 budget level. DHSS and county departments of social services are no longer required to maintain state’s appropriation to state and county special assistance program at 100% of the 2012-13 budget level. (Same as Senate.) State funds for DHHS shall pay 50% of special assistance and counties pay the other 50% of authorized rates for care in adult care homes, including mental health agency-operated or contracted-group homes.
– DHHS will use these funds for state-county special assistance program for the state-county in-home program and for rental assistance.
– County funds budgeted for the state-county assistance program will be used for group homes, the state-county special assistance in-home program and for rental assistance.
Eliminates automatic Medicaid eligibility for those receiving state-county special Assistance and who are medically needy as of January, saving $28.7M. The intent is to reduce optional coverage for certain aged, blind and disabled persons to minimum federal requirements, effective July 1, 2015, and move these people onto the ACA health exchanges for their insurance needs. Also saves $4.2M by reducing county case management caseloads for these recipients. Maintains current Medicaid eligibility. Eliminates automatic Medicaid eligibility for those receiving state-county special assistance and who are medically needy, as of Nov 1. Grandfathers in all recipients of state-county special assistance who currently receive Medicaid; but after Nov, 2014, new applicants will not receive approval for special assistance. Also requires DHHS to submit state plan amendments to federal government for approval of these changes by Oct 31, 2014.
$2M in one-time funding to provide temporary, short-term assistance in monthly payments to group homes that have residents who meet following criteria: (1) was eligible for Medicaid-covered personal care services before Jan 1, 2013, (2) has continously resided in group home since Dec. 31, 2012. (This is second half of $4.7M in funding provided in original budget).
Orders DHHS to come up with a long-term solution for people living in group homes and come up with a list of funding sources for each group home that gets state assistance. To be done by April 1, 2015.
DHHS and the Division on Aging and Adult Services will examine ways to improve the public guardianship system and tighten reporting requirements for corporate guardians. DHHS and the Division on Aging and Adult Services will examine ways to improve the public guardianship system and tighten reporting requirements for corporate guardians. (Same as Senate.) DHHS and the Division on Aging and Adult Services will examine ways to improve the public guardianship system and tightening reporting requirements for guardians of incompetent person.
Reduces the Home Care and Community Block Grant by $969,549 Reduces the Home Care and Community Block Grant by $969,549 (3%); reinstates Volunteer Development Program to help provide services to older adults. (See block grant section.)
DHHS shall close four state-operated Child Development Service Areas, effective January 1, 2015, and submit a report to lawmakers by March 1, 2015. (Carry forth from 2013-14 budget; reduces total budget by $10M) Won’t close the four state-operated Child Development Service Areas. Requires DHHS to submit a report to lawmakers by March 1, 2015. Won’t close the four state-operated Child Development Service Areas … yet. Requires DHHS to submit a report to lawmakers.
Reduces funding for school nurses by $3.48M and directs funding for any additional school nurses to local health departments in Tier 1 (mostly rural) counties. Eliminates 70 school nurses overall, while adding more school nurses to rural counties. Maintains full funding for school nurses. Maintains funding for school nurses.
Charge a fee of $74 (up from $55 ) for analyzing private well-water samples sent to State Laboratory of Public Health, effective July 1, 2014. Charge a fee of $74 (up from $55 ) for analyzing private well-water samples sent to State Laboratory of Public Health, effective July 1, 2014. (Same as Senate.) – Charge a fee of $74 (up from $55) for analyzing private well-water samples sent to State Laboratory of Public Health. Fee is for analyzing samples from newly constructed and existing wells. Effective when budget passes.
DHHS and Division of Public Health will consult with local health departments and the Department of Environment and Natural Resources to study options for reducing or waiving the fee for households with incomes at or below 300% of federal poverty level. The department will report their findings by December 1, 2014.
Changes oversight for waste-water systems from the Division of Public Health to the Environmental Management Commission. No mention of waste-water systems or Environmental Management Commission. instructs DHHS Division of Public Health to study options for well-water testing payment options for low-income people. No mention of waste-water systems or Environmental Management Commission.
Authorizes a legislative committee to study ways to improve medical examiner system. Provides $1M in extra money to chief medical examiner’s office. Chief medical examiner shall appoint one or more county medical examiners for each county for a three-year term. Opens possibility for NPs, PAs, RNs, coroners or EMTs to serve as examiner in the absence of an available or willing MD. Provides $1M in extra money to chief medical examiner’s office. DHHS shall study and report to lawmakers on the adequacy of the current fee paid by the state and counties by Dec 1, 2014. – Instructs Program Evaluation Division to consider studying ways to improve the state’s medical examiner system.
– Instructs chief medical examiner to give preference to appointing physicians as county medical examiners, but may also appoint licensed PAs, NPs, RNs, EMTs or coroners to serve in the absence of an available or willing MD.
– Instructs DHHS to study and report to the legislature on the adequacy of the current medical examiner fee, recommended categories of professionals and recommended qualifications and training requirements for medical examiners.
– Provides $1M in extra funds to chief medical examiner’s office.
– A portion of 2014-15 funds for the chief medical examiner’s office to be used to establish an oversight system to develop and implement uniform protocols.
MENTAL HEALTH
Eliminates reserve funds provided to purchase equipment, furniture and information technology infrastructure for the new Broughton Hospital. Opening of the facility delayed until May 2016 due to construction delays. Trims $16.6M in non-recurring funds. Eliminates reserve funds provided to purchase equipment, furniture and information technology infrastructure for the new Broughton Hospital. Opening of the facility delayed until May 2016 due to construction delays. Trims $16.6M in non-recurring funds. (Same as Senate.) Eliminates reserve funds provided to purchase equipment, furniture and information technology infrastructure for the new Broughton Hospital. Opening of the facility delayed until May 2016 due to construction delays. Trims $16.6M in non-recurring funds. (Same as House, Senate.)
Allocates a total of $2.37M to help people with brain injury: $359,218 goes to the Brain Injury Association of North Carolina and Carolinas Rehabilitation, $796,934 to support residential programs serving individuals with TBI and $1,216,934 to support requests submitted by individuals for assistance with residential support services, home modifications, transportation, etc. Allocates a total of $2.37M to help people with brain injury: $359,218 goes to the Brain Injury Association of North Carolina and Carolinas Rehabilitation, $796,934 to support residential programs serving individuals with TBI and $1,216,934 to support requests submitted by individuals for assistance with residential support services, home modifications, transportation, etc. (Same as Senate.) Allocates a total of $2.37M to help people with brain injury: $359,218 goes to Brain Injury Association of North Carolina, Carolinas Rehabilitation and other providers. $796,934 to support residential programs serving individuals with TBI and $1,216,934 to support requests submitted by individuals for assistance with residential support services, home modifications, transportation, etc.
No mention of diabetes-coordination reports. Orders biennial reporting on diabetes-coordination reports that include fiscal impact of diabetes, assessment of state and county activities, coordination among entities, action plans and budgets. Requires a report to Joint Legislative Oversight Committee on Health and Human Services and the Fiscal Research Department on or before Jan. 1 of each odd-numbered year detailing an assessment of fiscal impact of diabetes, effectiveness of state and county activities, coordination among entities, action plans and budgets.
No mention of food-protection activities. Moves $400,000 for county food-protection activities written into last year’s budget back to DHHS to pay for departmental operations on food protection. Moves $400,000 for county food-protection activities back to DHHS to pay for departmental operations on food protection. (Same as House.)
Closes the Wright School by September 30, 2014, saving $2.7M No mention or Wright School closure. Wright School remains open.
Requires DHHS to report to lawmakers how they plan to improve mental health, developmental disabilities and substance-abuse services by November 1, 2014. Gives instructions for detailed reporting. Requires DHHS to report to lawmakers how they plan to improve mental health, developmental disabilities and substance-abuse services by November 1, 2014. Gives instructions for detailed reporting. (Same as Senate.) Requires DHHS to report to lawmakers how they plan to improve mental health, developmental disabilities and substance-abuse services by November 1, 2014. Gives detailed instructions for reporting on range of areas including strategy to improve communications, findings and recommendations for increasing inventory of inpatient psychiatry and substance-abuse services.
Requires planning and reporting on budget shortfalls within the Division of Mental Health, Developmental Disabilities and Substance Abuse Services to be delivered December 2014. Requires planning and reporting on budget shortfalls within Division of Mental Health, Developmental Disabilities and Substance Abuse Services to be delivered December 2014. (Same as House.)
Creates prior-authorization requirements for drugs to treat mental illness, resulting in $6M in annual savings to General Fund appropriations to Medicaid. Orders $12M in annual savings to appropriations to Medicaid for mental health drugs starting in January 2015. Of that, $6M should come from controls that can include prior authorization, utilization-review criteria changes and other restrictions. (Same as Senate.) Orders a report by October 2015 on changes
Requires report on improving mental health crisis intervention services, due March 2015.
Total of $5M new money for community-based crisis services. Allocates new dollars for mental health critical time intervention ($750,000) and moves some money out of adult/child services and into crisis intervention, ($700,000) and walk-in crisis centers, plus dollars for peer-support respite, group home skills training, mental health first aid, etc. Total of $2.2M new money for community-based crisis services as recommended by NCGA.
Total of $5M new money for community-based crisis services. Allocates new dollars for mental health critical time intervention ($750,000) and moves some money out of adult/child services and into crisis intervention, ($700,000). Walk-in crisis centers receive $420,000, collegiate wellness/ addiction recovery $1,085,000, mobile crisis management $60,000, veterans crisis $250,000, peer-support respite, group home skills training, mental health first aid, etc.
$5M in one time funding to pay off liabilities incurred by mental health LME/ MCOs. Reduces funds to LME/MCOs for unpaid liabilities by $2M.
Orders study of allowing ambulances to deliver mental health patients directly to mental health crisis centers, reimbursement and creating statewide contract for non-emergency medical transport. Orders study of allowing ambulances to deliver mental health patients directly to mental health crisis centers, reimbursement and creating statewide contract for non-emergency medical transport. (Same as House.)
Sets ratio for intensive in-home service to one team per 12 families by October 1, 2014. Sets ratio for intensive in-home service to one team per 12 families by October 1, 2014. (Same as Senate.) Sets ratio for intensive in-home service to one team per 12 families by October 1, 2014. (Same as Senate, House.)
HOSPITALS/FACILITIES
Requires hospitals, ambulatory surgical facilities and insurance payers to report patient charges, Medicaid and Medicare payments to DHHS. No mention of hospitals, ambulatory surgical facilities and insurance payers reporting patient charges, Medicaid and Medicare payments to DHHS. DHHS will study and submit a written report to lawmakers summarizing its recommendations for extending North Carolina’s Health Care Cost Reduction and Transparency Act of 2013 to additional health care providers by December 1, 2014. Requires hospitals to give information about 100 most frequently reported admissions by DRG for inpatients and the amount of Medicaid and Medicare reimbursement. Beginning September 30,2014, hospitals and ambulatory surgical facilities are required to submit information on total costs for 20 most common procedures and 20 most common imaging procedures.
Exempts from Certificate of Need review any purchases of equipment costing more than $2 million for hospitals replacing equipment on their main campuses only if the equipment passed CON review originally and if the health facility gives notice to DHHS. Exempts from Certificate of Need review any purchases of equipment costing more than $2 million for hospitals replacing equipment on their main campuses only if the equipment passed CON review originally and if the health facility gives notice to DHHS. (Same as Senate.) Exempts from Certificate of Need review any purchases of equipment costing more than $2 million for hospitals replacing equipment on their main campuses only if the equipment passed CON review originally and if the health facility gives notice to DHHS. (Same as House, Senate.)
Starting September 30, 2014, more hospital, ambulatory surgical facilities and insurers (including the State Health Plan) shall provide more health care cost data to DHHS each quarter. Expands the Health Care Cost Reduction and Transparency Act passed in 2013. This information would include cost data, negotiated settlements and Medicaid and Medicare reimbursement levels. Also recommends a study of more cost reporting. Only asks for study of more cost reporting. No extra requirements. Starting September 30, 2014, more hospital, ambulatory surgical facilities and insurers (including the State Health Plan) shall provide more health care cost data to DHHS each quarter. Expands the Health Care Cost Reduction and Transparency Act passed in 2013. This information would include cost data, negotiated settlements and Medicaid and Medicare reimbursement levels. Also recommends a study of more cost reporting. (Combines House and Senate.)
Creates single statewide base rate for hospital inpatient services equal to $2,788 or the statewide median rate (whichever is less) on June 30, 2014. Does not apply to UNC Health Care System or Vidant Medical Center. Orders a study of regional base rates for hospitals. Creates single statewide base rate for hospital inpatient services equal to $2,788 or the statewide median rate (whichever is less) on June 30, 2014. Does not apply to UNC Health Care System or Vidant Medical Center. (Same as Senate.)
Limits the number of medical professional providers eligible for supplemental payments at UNC and Vidant/ECU effective July 1, 2014. Beginning December 31, 2014, UNC and ECU shall submit yearly report to legislature on information for each individual provider who receives supplemental payment. Limits the number of medical professional providers eligible for supplemental payments at UNC and Vidant/ECU effective July 1, 2014. Allows for 43 extra providers at ECU to receive the payments. Beginning December 31, 2014, UNC and ECU shall submit yearly report to legislature on information for each individual provider who receives supplemental payment. Gives supplemental payment to medical providers at UNC and Vidant/ECU effective July 1, 2014. Allows for more providers at ECU to receive the payments. Beginning December 31, 2014, UNC and ECU shall submit yearly report to legislature on information for each individual provider who receives supplemental payment. (Same as House.)
Repeals “shared savings” program that assessed health care providers at 3% per annum in exchange for promise those providers could share in savings. Repeals “shared savings” program that assessed health care providers at 3% per annum in exchange for promise those providers could share in savings. (Same as Senate.) Repeals “shared savings” program that assessed health care providers at 3% per annum in exchange for promise those providers could share in savings. (Same as House, Senate.)
UNC system is ordered to report to the Health and Human Services Committee how UNC and ECU medical schools are funded, with detailed information of all income in current and historical context. UNC system is ordered to report to the Health and Human Services Committee how UNC and ECU medical schools are funded, with detailed information of all income in current and historical context. (In Education portion of House budget.) UNC system is ordered to report to the Health and Human Services Committee how UNC and ECU medical schools are funded, with detailed information of all income in current and historical context. (In Education portion of budget.) Report due Oct, 2014.
Eliminates the favorable Medicaid payment (100%) for outpatient services to UNC and ECU hospitals. Those hospitals will now be paid at 70% of Medicaid rate; some of those savings will go into supplementing Disproportionate Share Hospital payments. Saves the state $6.1M. Eliminates the favorable Medicaid payment (100%) for outpatient services to UNC and ECU hospitals. Those hospitals will now be paid at 70% of Medicaid rate; some of those savings will go into supplementing Disproportionate Share Hospital payments. Saves the state $6.1M (Same as Senate) Eliminates the favorable Medicaid payment (100%) for outpatient services to UNC and ECU hospitals. Those hospitals will now be paid at 70% of Medicaid rate; some of those savings will go into supplementing Disproportionate Share Hospital payments.
Creates a moratorium on issuing licenses for in-home aide services, to be lifted only when General Assembly gives approval. Creates a moratorium on issuing licenses for in-home aide services, to be lifted July 2016. Creates a moratorium on issuing licenses for in-home aide services, to be lifted June 30, 2016.
Removes the end of 2016 date for a moratorium on licenses for special care units. Now the moratorium will only be lifted when the General Assembly gives approval. Changes to 2015 the end date (from original 2016 end date) for a moratorium on licenses for special care units Creates June 30, 2016 end date for a moratorium on licenses for special care units for patients with Alzheimer’s.
MEDICAID
Orders DHHS to cease activities relating to implementing Medicaid reform based on the accountable care organization model. Orders Medicaid to move toward a managed care system. No mention of moving Medicaid to a managed care system. Orders $1M appropriated for Medicaid reform activities to be used only for that purpose. – Notes that the intention of lawmakers is to return in November to have a special session on Medicaid reform.
– Instructs DHHS to continue work with stakeholder groups until then and restricts the department from committing to “any particular course” on Medicaid reform.
– Emphasis in final budget language is on “budget predictability.”
Creates new process for selection and approval of Medicaid director, requiring approval by the governor and the General Assembly. Sets term of Medicaid director at five years Not mentioned in final budget. Lawmakers intend to return in November to have a special session on Medicaid reform.
Reduces funding for Health Choice by $14.5M due to about 20,000 children being moved off of Health Choice and onto Medicaid as permitted in the Affordable Care Act.
Reinstates Medicaid annual report, which was discontinued in 2008 (same as House). Reinstates Medicaid annual report, which was discontinued in 2008. (Same as Senate.) Reinstates Medicaid annual report, which was discontinued in 2008. (Same as House, Senate.)
Instructs DHHS to draft a waiver that would create 1,000 new slots a year for three years to serve adults with developmental disabilities. Budget for each slot capped at $20,000 per plan year per beneficiary. Instructs DHHS to draft a waiver that would create 1,000 new slots a year for three years to serve adults with developmental disabilities. Budget for each slot capped at $20,000 per plan year per beneficiary. (Same as Senate.)
Requires DHHS to draft waiver adding service package for Medicaid eligibles with traumatic brain injury. Requires DHHS to draft waiver adding service package for Medicaid eligibles with traumatic brain injury. (Same as Senate.) Requires DHHS to draft waiver adding service package for Medicaid eligibles with trajamatic brain injury. (Same as House, Senate.)
Creates Joint Legislative Study Commission on Traumatic Brain Injury to study and make recommendations about service needs of people with TBI. Report is due by May 2016 No mention of study commission. Creates Joint Legislative Study Commission on Traumatic Brain Injury to study and make recommendations about service needs of people with TBI. Report is due by December 2014
Freezes rate for nursing home direct care services as of Dec. 31, 2014. No mention Freezes rate for nursing home direct care services as of Dec. 31, 2014. (Same as Senate.)
Requires DHHS to raise dispensing fees so average acquisition cost ingredient pricing plus dispensing fees, net of drug rebates, generates $975,000 in savings in General Fund and requires DHHS to maintain distinction between fees for preferred and brand drugs. Requires DHHS to raise dispensing fees so average acquisition cost ingredient pricing plus dispensing fees, net of drug rebates, to be budget neutral and requires DHHS to maintain distinction between fees for preferred and brand drugs. – Requires DHHS to raise dispensing fees so average acquisition cost ingredient pricing plus dispensing fees, net of drug rebates, to generate $975,000 in savings in General Fund.
– Requires DHHS to maintain distinction between fees for preferred and brand drugs.
– Adds that DHHS will ensure ingredient prices are updated at least monthly. (Same as Senate except last line)
Raises annual state assessment on hospitals to 28.85 percent of total amount collected under Medicaid. Saves the state $15.1M. This assessment is essentially a fee (percentage) hospitals give back to the state in order to participate in treating Medicaid patients. Keeps hospital assessment at last year’s rate of 25.9 percent. Raises annual state assessment on hospitals to 28.85 percent of total amount collected under Medicaid. Saves the state $15.1M. This assessment is essentially a fee (percentage) hospitals give back to the state in order to participate in treating Medicaid patients. (Same as Senate.)
Implements 3% rate reduction for personal care services, retroactive to Oct, 2014. Starting July 1, 2014, an additional reduction in personal care rates so that extra hours approved by CMS are “budget neutral.” Legislature authorizes study of issues around reforming and redesigning personal care services. Orders a contractor-performed study of personal care services pay rate and how the state can comply with the Supreme Court ruling Olmstead v L.C. Report by December 2015. Implements 3% rate reduction for personal care services, retroactive to Oct, 2014.
Starting July 1, 2014, an additional reduction in personal care rates so that extra hours approved by CMS are “budget neutral.”
Orders study of issues around reforming and redesigning personal care services.
Orders a contractor-performed study of personal care services pay rate and how the state can comply with the Supreme Court ruling Olmstead v L.C. Report by December 2015. (Combines both proposals.)
Requires DHHS to require compliance with adult care home cost reporting requirements and shall make available data collected from cost reporting. Requires DHHS to require compliance with adult care home cost reporting requirements and shall make available data collected from cost reporting. (Same as Senate.) Requires DHHS to require compliance with adult care home cost reporting requirements and shall make available data collected from cost reporting. (Same as House, Senate.)
Inserts language to allow Medicaid recipients to move from county to county with their Medicaid benefits following them for the purposes of coverage in mental health local entities. Orders development of a plan to allow Medicaid recipients to move from county to county with their Medicaid benefits following them for mental health/DSS benefits.
Eliminates any payments to Community Care of North Carolina. Terminates CCNC’s contract without cause, given 30 days notice. Terminates CCNC’s contract permanently as of December 2015. Implements payment of per-member per-month payment for Medicaid recipients to Community Care of North Carolina. Retains the organization’s contract. Structure of per-member per-month payments or other payments to providers participating in Community Care of North Carolina programs now considered as a part of any Medicaid reform plan for the state. A proposed pilot program to pay PMPM payments directly to providers will not move forward.
Reduces Medicaid reimbursement by 3% to inpatient hospital, physicians (excluding primary care until Jan. 1, 2015), dental, personal care services, nursing homes, adult care homes and dispensing drugs on or after January 1, 2014. Rate cut does not apply to optical services and supplies, podiatry, chiropractors and hearing aids. Reduces Medicaid reimbursement by 3% to inpatient hospital, physicians (excluding primary care until Jan. 1, 2015), dental, personal care services, adult care homes, optical services and supplies, podiatry, chiropractors, hearing aids and dispensing drugs on or after January 1, 2014. Rate cut does not apply to nursing homes. Reduces Medicaid reimbursement by 3 percent to inpatient hospital, physicians (excluding primary care until Jan. 1, 2015), dental, personal care services, adult care homes, optical services and supplies, podiatry, chiropractors, hearing aids and dispensing drugs on or after January 1, 2014. Rate cut does not apply to nursing homes. (Same as House.)
Rate cut of 1 percent for fee-for-service paid services, such as adult care homes, assisted living, hospital outpatient.
Requires DHHS to publish comprehensive information on Medicaid payments made to its providers on its website and to update it yearly within three months of end of fiscal year. Requires DHHS to work with UNC School of Public Health or other appropriate party to perform analytics on this information or generate interactive website. No mention of publishing provider Medicaid payments. Requires DHHS to publish comprehensive information on Medicaid payments made to its providers on its website and to update it yearly within three months of end of fiscal year.
Requires DHHS to work with UNC School of Public Health or other appropriate party to perform analytics on this information or generate interactive website.
(Same as Senate.)
Requires DHHS to work with North Carolina Medical Society to study imposition of an assessment on physicians by Dec. 1, 2014. (There’s already an assessment on hospitals for participating in Medicaid but not on individual doctors.) Not in final budget.
Allocates funds for reorganization of the Division of Medical Assistance, the part of DHHS that manages Medicaid $4.9M Notes that the intention of lawmakers is to return in November to have a special session on Medicaid reform.
No money allocated for Medicaid reform or reorganization of DMA between now and then.
Secretary of Health and Human Services shall implement a Medicaid assessment program for local management entities/managed care organizations at a rate of 3.5%, saving $59M. (Federal regulators have subsequently told state this will not be acceptable to them.) Orders DHHS to impose assessment on “Innovations” waiver that serves people with developmental disabilities if federal regulations allow and use proceeds to help pay for increased rates for services provided under the waiver Eliminated in the final budget, as federal regulators indicated in June this would not be approved.
No mention of dual-eligible patients. Orders DHHS to submit a waiver to allow patients dually eligible for both Medicaid and Medicare to have primary care case management and submit a report on what it will cost. Orders DHHS to submit a waiver to allow patients dually eligible for both Medicaid and Medicare to have primary care case management and submit a report on what it will cost. For people with mental health, intellectual or developmental disabilities, this case management can be done by LME/MCOs
Requires additional notice from DHHS on any requests to federal regulators for state plan amendments or waivers to the Medicaid state plan. Requires additional notice from DHHS on any requests to federal regulators for state plan amendments or waivers to the Medicaid state plan. (Same as Senate.) Requires additional notice from DHHS on any requests to federal regulators for state plan amendments or waivers to the Medicaid state plan. (Same as Senate, House.)
Effective March 1 2015, the new Medicaid entity will create a contract for the following “program integrity” services to root out fraud and abuse. Those activities include: (1) post-payment reviews, (2) data analytics, (3) Medical necessity reviews, (4) Investigation, (5) Recovery Audit Contracts and (6) Prepayment review. Effective March 1 2015, the new Medicaid entity will create a contract for the following “program integrity” services to root out fraud and abuse. Those activities include: (1) post-payment reviews, (2) data analytics, (3) Medical necessity reviews, (4) Investigation, (5) Recovery Audit Contracts and (6) Prepayment review (Same as Senate.) Effective June 30, 2015, the new Medicaid entity will create a contract for the following “program integrity” services to root out fraud and abuse. Those activities include: (1) post-payment reviews, (2) data analytics, (3) Medical necessity reviews, (4) Investigation, (5) Recovery Audit Contracts and (6) Prepayment review. (Same as prior proposals, but gives later date.)
The department shall suspend payments to providers for whom the Department of Medical Assistance has identified an overpayment. Creates a process for recouping overpayment, with penalties. The department shall suspend payments to providers for whom the Department of Medical Assistance has identified an overpayment. Creates a process for recouping overpayment, with penalties. (Same as Senate.) The Department shall suspend payments to providers for whom the Department of Medical Assistance has identified an overpayment. Creates a process for recouping overpayment, with penalties. (Same as Senate, House.)
Changes the process for appeals to the Office of Administrative Hearings; compels petitioner to engage in mediation before an appeal can be heard by a judge. Shifts the burden of proof onto the recipient for all issues before the OAH. Changes the process for appeals to the Office of Administrative Hearings; compels petitioner to engage in mediation before an appeal can be heard by a judge. Changes the process for appeals to the Office of Administrative Hearings; compels petitioner to engage in mediation before an appeal can be heard by a judge. Shifts the burden of proof onto the recipient for all issues before the OAH. (Same as Senate.)
Orders DHHS to renegotiate contract for imaging utilization-management services to achieve savings of $5.5M. Requires applying companies to submit an RFP that meets the savings guidelines. Orders DHHS to renegotiate contract for imaging utilization management services to achieve savings of $5.5M. Requires applying companies to submit an RFP that meets the savings guidelines. (Same as Senate.) Orders creation of a contract request proposal for imaging (Xrays, CT scans, etc) services to achieve savings of $5M. (Changes number; otherwise similar to both.)
Orders DHHS to develop an RFP for a statewide contract for non-emergency transportation. Not in final budget.
Orders study on Medicaid reimbursement for Botox. Sets reimbursement for Botox at the same rate as pharmacy reimbursement.
Orders Medicaid to pay for Paragard, a form of birth control, at the same reimbursement level as similar devices Orders Medicaid to pay for Paragard, a form of birth control, at the same reimbursement level as similar devices.
Orders study on the PACE program including how many patients served, funding and state-to-state comparison of programs. No mention of the current PACE enrollment cap. Orders study on the PACE program including how many patients served, funding and state-to-state comparison of programs. Report due Oct 1, 2014. No mention of the current PACE enrollment cap.
Creates prohibition on tanning bed use for youth under 18 years of age. (House passed bill to this effect in March 2013. Has been in Senate without movement since.) Not addressed in final budget.
Program Evaluation Oversight Committee will study the pros and cons to the state requirement that local ABC boards cease payments to DHHS for alcoholism, substance-abuse research and treatment/education, and redirect these payments to NC Alcoholic Beverage Commission for an alcohol and substance-abuse education and prevention initiative. No mention of ABC board study. Program Evaluation Oversight Committee will study the pros and cons to the state requirement that local ABC boards cease payments to DHHS for alcoholism, substance-abuse research and treatment/education, and redirect these payments to NC Alcoholic Beverage Control Commission for an alcohol and substance-abuse education and prevention initiative. (Same as Senate.)
Development of Strategic State Plan to Address Alzheimer’s Disease to address topics such as: care coordination, quality of care, health care system capacity, training for health care professionals, access to treatment, home- and community-based services, long-term care and caregiver assistance.