This past weekend, the House of Representatives presented it’s biennial budget. NC Health News has put the House’s plan next to the Senate plan for convenient comparison.
By Rose Hoban
It can be a challenge to understand the differences between the budgets presented by the Senate (414 pages) and by the House of Representatives (305 pages). So we’ve done what we can to put the two Health and Human Services proposals side-by-side.
Tomorrow, we’ll present Medicaid and NC Pre-K side-by-side, plus more analysis of what the budget proposals mean.
| House | Senate |
| Funds 32 positions to increase Department of Health and Human Services internal audit capacity | Funds 32 positions to increase DHHS internal audit capacity |
| Changes the process for providing funds to not-for-profit agencies that provide health and human services; new competitive bidding process starts in Fiscal Year 2014, allocates $12.5 million/year for 2013-15; details allocations to each agency for this FY | Changes the process for providing funds to not-for-profit agencies that provide health and human services; new competitive bidding process starts in Fiscal Year 2013; allocates $14.8 million/year for 2013-14 only |
| Medication Assistance Program that assists low-income, uninsured to get free prescriptions, at rate of $1,704,033/year | No allocation for Medication Assistance Program |
| Provides $8 million for FY 2013-14 to cover mental health group homes personal care assistance, at rate of $15.26/day | No mention of group homes for mentally ill |
| $400,000/year to NC MedAssist Program to expand capacity of statewide pharmacy program | No mention of NC MedAssist |
| Medicaid Management Information System: replace money and report due dates; similar language to Senate | Medicaid Management Information System: replace money and report due dates; also provides funds for integration of fraud-detection system |
| Provides for additional $864,000 to complete NC FAST implementation in FY 2014-15. Computerized system will be used to determine eligibility for Medicaid, Work First and other entitlement programs. | Provides for additional $864,000 to complete NC FAST implementation in FY 2014-15. Computerized system will be used to determine eligibility for Medicaid, Work First and other entitlement programs. |
| Allows for $1 million in medical liability insurance for doctors and dentists practicing under DHHS aegis, including faculty and residents at UNC School of Medicine | Allows for $1 million in medical liability insurance for doctors and dentists practicing under DHHS aegis, including faculty and residents at UNC School of Medicine |
| Eliminates agency/DHHS reports | Eliminates agency/DHHS reports, also adds clause about forgiveness of late reports |
| Makes DHHS lapsed-salary report annual rather than quarterly | Repeals the DHHS lapsed-salary report |
| Reduces Justus Warren Stroke Prevention Task Force to semi-annual rather than quarterly; eliminates subcommittees | Reduces Justus Warren Stroke Prevention Task Force to semi-annual rather than quarterly; eliminates subcommittees |
| No mention of Commission for the Blind | Modifications to Commission for the Blind |
| Use of Foster Care budget for guardianship assistance program; similar language to Senate | Use of Foster Care budget for guardianship assistance program |
| Sets eligibility and payment standards for Work First Program. | Requires drug testing in order to receive Work First (welfare) benefits; payment for drug test is responsibility of recipient, to be reimbursed once comes back negative. |
| Repeals Child Fatality Task Force starting July 2014 | No mention of Child Fatality Task Force |
| No mention of child-abuse reporting issues | Creates DSS study on procedures for reporting child abuse |
| Creates promotion fund to encourage adoption of kids in foster care: allocates $1.5 million/year, 2013-15; creates foster care “permanency” initiative, allocating $3.75 million over two years to Children’s Home Society; creates legislative oversight committee for permanency initiative | No mention of foster care issues |
| Keeps Project CARE (Caregiver Alternatives to Running on Empty) at current funding level of $500,000 | Statewide implementation of Project CARE at cost of $2.9 million/year. Does this by reducing Home and Community Services Block Grant by the same amount. |
| Reduces the Home and Community Block Grant by $500,000 to support Project CARE; $27 million remains to provide home and community-based services to seniors and disabled adults. | Reduces the Home and Community Block Grant by $2,900,000 to support Project CARE; $24.6 million remains to provide home and community-based services to seniors and disabled adults. |
| Creates six-county special-assistance pilot program to test two-tiered rates to provide personal care services for people in group homes and assisted living residences and for Medicaid-eligible people living at home. Sets rates for County “Special Assistance” payments at $1182 for adult care home residents and $1515 for those in Alzheimer’s/ dementia special-care units (rates same as last year). | Creates six-county special assistance pilot program to test two-tiered rates to provide personal care services for people in group homes and assisted living residences and for Medicaid-eligible people living at home. Does not set rates for county “special assistance” payments. |
| Sets inspection rates for “temporary food establishments” at $95, $75 of which goes to local health departments | Sets inspection rates for “temporary food establishments” at $120, $75 of which goes to local health departments |
| No mention of Oral Health program. | Eliminates 39 dental hygiensts, two dental techs and seven administrative positions from statewide program under the Oral Health Section of the Division of Public Health, removing $6.5 million; moves $3.65 million of that money to local health departments. |
| Sets standards and duties for school nurses; same language as Senate. | Sets standards and duties for school nurses |
| Orders Division of Public Health to cut four of the state’s Child Developmental Service Agencies; reduces personnel by $8 million of non-recurring funds in the first year of the biennium and by $10 million of recurring funds in the second year, reducing the workforce by 160 staff (out of approximately 800 staff). | Orders Division of Public Health to cut four of the state’s Child Developmental Service Agencies; reduces personnel by $8 million of non-recurring funds in the first year of the biennium and by $10 million of recurring funds in the second year, reducing the workforce by 160 staff (out of approximately 800 staff). |
| NC Reach Program to help pay for college tuition for former foster youth increased by $551,690 to cover 10% annual growth in the program; covers items such as books, supplies, transportation and room and board not covered by other funding sources. | NC Reach Program to help pay for college tuition for former foster youth, increased by $1,158,062 over two years to increase the program by an additional 100 students; covers items such as books, supplies, transportation and room and board not covered by other funding sources. |
| Cuts AIDS Drug Assistance Program by $8 million in recurring funds in both years; directs Division of Public Health to explore options for covering people with HIV/ AIDS on new federal health benefit exchanges. | Cuts AIDS Drug Assistance Program in both years by $8 million in recurring funds and adds $6 million in non-recurring (one-time) funds; directs Division of Public Health to explore options for covering people with HIV/AIDS on new federal health benefit exchanges |
| Eliminating Health Disparities Initiative: provides grants up to $300,000 to 12 entities to focus on eliminating health disparities among African-Americans, Latinos and Native Americans. | Eliminating Health Disparities Initiative: provides grants up to $300,000 to 12 entities to focus on eliminating health disparities among African-Americans, Latinos and Native Americans. |
| Provides no funding for teen tobacco prevention; provides $1 million for the Tobacco Quitline | Provides no funding for teen tobacco prevention: provides $1.4 million for the Tobacco Quitline |
| Directs Division of Public Health to develop strategic plan to improve health services, increase awareness and develop initiatives to improve men’s health. | Directs Division of Public Health to develop strategic plan to improve health services, increase awareness and develop initiatives to improve men’s health. |
| Increases Medical Examiner autopsy fees to $1250 from $1000 | Increases Medical Examiner autopsy fees to $1250 from $1000 |
| Establishes statewide telepsychiatry program; places program under the Office of Rural Health. | Establishes statewide telepsychiatry program; places program under the Division of Mental Health |
| Allocates $38 million/year to pay for mental health beds in local hospitals | Allocates $38 million/year to pay for mental health beds in local hospitals |
| Creates recurring funds for Child Maltreatment Program of $1.8 million and non-recurring funds of $250,000 annually to provide clinical training to Medicaid-certified physicians and child-trauma treatment services and develop an online database. | Creates recurring funds for Child Maltreatment Program of $1.8 million and non-recurring funds of $250,000 annually to provide clinical training to Medicaid-certified physicians and child trauma treatment services and develop an online database. |
| Directs DHHS to have mental health local management entities/managed care organizations create clinical “integration” program for Community Care of North Carolina to work with mental health agencies to cover physical health needs of people with mental health issues | No mention of clinical-integration program. |
| Preserves Wright School | Closes the Wright School, a residential school for children with mental health and behavioral disorders, saving $2.7 million/year. |
| Provides additional $250,000 to adult developmental vocational program to reduce waiting list for services | No allocation mentioned |
| No mention of Mental Health information systems project. | Directs Division of Mental Health to halt current work on information system project and submit a detailed report on how such a system would integrate with mental health agencies around the state, costs and operational needs |
| Directs mental health local management entities/managed care organizations to put some part of their funds to substance-abuse prevention and education activities; mandates $300,000 to increase treatment and services for people serving time in the criminal justice system | Directs mental health local management entities/managed care organizations to put some part of their funds to substance-abuse prevention and education activities; mandates $300,000 to increase treatment and services for people serving time in the criminal justice system |
| Maintains state-operated alcohol and drug-abuse treatment centers. | Closes state-operated alcohol and drug-abuse treatment centers; appropriates $30 million of that funding to LME/MCOs to provide community-based and residential substance-abuse treatment services. |
| No mention | Allows mental health LME/MCOs to offer higher benefits to candidates for director positions, including severance, relocation and funds not currently allowable under state personnel act |
| Eliminates comprehensive report on medication-related errors in nursing homes | Eliminates comprehensive report on medication-related errors in nursing homes |
| No mention | Creates a three-year moratorium on new licenses for Alzheimer’s/dementia special-care units |
| No mention | Creates exemption in the state’s Certificate of Need law for replacement of equipment and facilities on the main campus of a hospital; exempts facilities from having to file paperwork with the state to replace equipment that costs more than $2 million threshold. |
| Similar language that passed the House in the form of House Bill 492 was incorporated into Senate budget | Sets criteria for Medicaid patients in their own homes or in adult care homes with disabilities to receive personal care services for up to 80 hours. Patients must:
Patients are eligible for an additional 50 hours of personal care services if:
Personal care cannot include babysitting, coaching, prompting, guiding, coaching, babysitting, transportation or financial management A doctor must attest to the above |
| House passed this language May 15 in HB 982; was incorporated into the Senate budget | Addresses U.S. Supreme Court decision in the Wos v. E.M.A. case that allows for patients suing Medicaid for malpractice to collect damages and repeals the state’s prior presumption that 1/3 of any recovery by a Medicaid beneficiary is attributable to medical expenses. The ruling protects the rights of Medicaid claimants from states hoping to recoup budget dollars by taking a large share of the tort recoveries claimants gain by suing. |
| Modifies funding for the Office of Administrative Hearings and changes procedures for contesting care and payment decisions made by Medicaid officials; ssets out procedure for withholding payment to a Medicaid provider that has an identified overpayment | Modifies funding for the Office of Administrative Hearings and changes procedures for contesting care and payment decisions made by Medicaid officials; sets out procedure for withholding payment to a Medicaid provider that has an identified overpayment |
| Sets out procedure for withholding payment around a Medicaid provider that is being audited; specifies that Medicaid will not pay the contractor performing the audit until all of the appeals have been exhausted | Sets out procedure for withholding payment around a Medicaid provider that is being audited; specifies that Medicaid will not pay the contractor performing the audit until all of the appeals have been exhausted |
| Sets forth procedures for appeals to the Office of Administrative Hearings; uses language created in the Senate budget bill. | Sets forth procedures for appeals to the Office of Administrative hearings |
| Sets out a requirement that Medicaid service providers purchase a performance bond of no more than $100,000 (depending on level of billing). The bond may be called if the provider has a financial failure or is found participating in fraud or abuse. The bond requirement can be waived for providers in good standing, with low billings and showing good record keeping, or if the service provided is essential for access to care for local Medicaid recipients. | Sets out a requirement that Medicaid service providers purchase a performance bond of no more than $100,000 (depending on level of billing). The bond may be called if the provider has a financial failure or is found participating in fraud or abuse. The bond requirement can be waived for providers in good standing, with low billings and showing good record keeping, or if the service provided is essential for access to care for local Medicaid recipients. |
| Creates a shared savings program, wherein DHHS will withhold 2% of Medicaid payments to doctors, hospitals, dentists, drugs, personal care services, chiropractors, podiatrists, nursing homes, adult care homes, opticians and optical suppliers and hearing-aid providers, with payments being paid back to the providers starting June 2014 if those providers save Medicaid dollars. | Creates a shared savings program, wherein DHHS will withhold 4% of Medicaid payments to doctors, hospitals, dentists, drugs, personal care services, chiropractors, podiatrists, nursing homes, adult care homes, opticians and optical suppliers and hearing-aid providers, with payments being paid back to the providers starting Jan, 2015 if those providers save Medicaid dollars. |
| Changes assessment levied on hospitals that care for Medicaid payments from a set statewide fee of $43 million to a statewide fee of $95 million | Changes assessment levied on hospitals that care for Medicaid payments from a set statewide fee of $43 million to 15.6% of Medicaid revenue |
| Changes the way the state Medicaid program pays for hospital care, setting three regional rates to be adhered to by all hospitals in a region | Changes the way the state Medicaid program pays for hospital care, setting three regional rates to be adhered to by all hospitals in a region |
| For hospitals newly acquired by another hospital system after Dec 2011, rates remain at the purchased hospital’s old rate | For hospitals newly acquired by another hospital system after Dec 2011, rates remain at the purchased hospital’s old rate |
| Requires a cost-effectiveness and outcomes study done on Community Care of North Carolina, the state’s medicaid care management organization | Requires a cost-effectiveness and outcomes study done on Community Care of North Carolina, the state’s medicaid care management organization |
| Sets a monthly incentive payment to CCNC for good performance | Sets a monthly incentive payment to CCNC for good performance |
| Study allowing certified nurse midwives greater flexibility in their practice, to consider whether CNMs should be allowed to practice midwifery in collaboration rather than under supervision of physicians | No mention of midwives |
| No mention of NC Institute of Medicine | Changes make-up of NC Institute of Medicine board of directors |
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