NC General Assembly building
Lawmakers return to Jones St. this week for the short legislative session. Photo credit Rose Hoban

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The House of Representatives wants to spend $5.29 billion on  Health and Human Services in the upcoming fiscal year. We break down some of the main points in the House budget.

By Rose Hoban & Rachel Herzog

This week, the NC Senate will deliver it’s proposed budget, which is expected to look quite different from the budget created by the House of Representatives last month.

This table shows the main points of the House Health and Human Services budget as it stands now. Stay tuned for the comparison with the Senate budget in the coming week.

HOUSE

DHHS ADMINISTRATION

$7.7M for 2 percent salary incase for agency employees. (also funds will be added for teachers who are on DHHS payroll) Another $2M will fund health benefits, retirement, etc.
Reduces funds by $1.48M to eliminate 57 positions.
Designates Office of Program Evaluation Reporting and Accountability (OPERA) structure, funding, legal authority, where it falls in the DHHS organizational structure, and what it is supposed to accomplish.
Adds $500,000 in annual funding to create office of program evaluation and accountability (OPERA) within DHHS.

HEALTH INFORMATION TECHNOLOGY

Takes $2M for the Health Information Exchange (NC HIE, which shares patient records between hospitals) out of the recurring budget and makes the funds non-recurring, meaning DHHS will have to seek this funding each year as directed by S.L. 2015-7
Moves administration for the NCHIE to DHHS.
Provides $3.16M in funds to help implement the Health Information Exchange statewide.
$5.8M of one-time funds to cover a budget deficit in the Division of Information Resource Management
Additional funds of $5.8M and 37 positions for NC FAST, the computer system that will integrate applications for Medicaid and other social service programs. This will bring the total funding for the program to $77.7M
$2.3M in one-time funding plus $400,000 in recurring funding for NC Tracks, the Medicaid claims payment system. The money will be used to bring the system up to compliance with federal requirements for ICD-10, etc.
Allocates $500,000 in funding to program NC Tracks to reimburse pharmacists for providing immunizations.
Allocates $1M in one-time funding to create a data analytics center for DHHS.
The budget document outlines goals for DHHS’ Health Information Technology office, including responsibilties, data security, coordination of information among hospitals and providers and the development of a state plan.
Orders DHHS to create a methodology to determine how many hospice beds needed in North Carolina.
Provides a one-time $20M grant for the development of residential (in-patient) hospice facilities.
Provides for continued funding for State Loan Repayment Program for primary care providers who agree to work in rural areas; this includes physicians, surgeons and psychiatrists. The provision also expands the program to providers who use telemedicine in rural and underserved areas.

MEDICAID

Creates a new Legislative Oversight Committee on Medicaid and requires DHHS to submit quarterly reports and detailed spending forecasts. Reinstates the annual Medicaid report which was discontinued in 2008.
North Carolina is anticipated to receive an additional $33M in federal funds to cover the State Children’s Health Insurance Plan (SCHIP) because of changes to the federal match rate. Even though the program budget will remain about the same, the state will not have to spend that $33M.
Recalculation (rebase) of the Medicaid program increases the total budget by $287.5M to a total of $3,773B. The rebase takes into account increased enrollment, increased utilization and costs. Recalculates Medicaid eligibility to reflect inflation and the federal poverty guideline updates.
Raises eligiblity for Medicaid for children in low income families to families earning 211 percent of the federal poverty level (up from 200 percent FPL).
Gives DHHS the ability to control and spend total Medicaid funds as it sees fit – in conjunction with a Medicaid reform plan.
Providers who want to get reimbursed by Medicaid will have to pay an initial $100 credentialing fee and $100 every three years when they apply for recredentialing.
Orders Medicaid to cover all adoptive children with special or rehabilitative needs, regardless of family income; to cover independent foster children until they’re 20 and to women with breast or cervical cancer who lack insurance and who meet income guidelines. Raises threshold for paying annual enrollment fee.
Increases the state’s cost settlement with Vidant Medical Center to 100 percent of allowable costs. This will cost a total of about $3.4M in annual funds. Vidant is the former Pitt County Medical Center and is the teaching hospital for the medical school at ECU.
Recalculation (rebase) of the cost of Health Choice (the program that allows for children in families that do not qualify for Medicaid, but who also cannot afford health insurance). The rebase anticipates enrollment growth of about 2.3 percent, plus increased utilization and claims. This increases the total budget by 14.2 percent, or $5.52M to a total of $199.2M for FY 2015-16.
Under the Affordable Care Act, children who qualify for the State Children’s Health Insurance Plan (SCHIP) are being moved to Medicaid and SCHIP is phasing out. The budget realizes fewer receipts from the federal government for SCHIP to the tune of $20.5M. Not a cut so much as a recognition of lost program revenue. Some of this money will be seen in increased federal receipts for Medicaid.
Provides $2M recurring dollars for a new Traumatic Brain Injury Waiver program to cover people with TBI to get enhanced Medicaid services
Provides $2.5M in planning funds for a Medicaid reform program which will “shift risk from the State under a capitated model.” No other details of the reform plan are given.
Orders LME/MCOs to coordinate and collaborate with CCNC to improve the integration of mental health and physical health services. Orders a report on progress and performance by March, 2016.
Requires LME/MCOs to consolidate to create no more than five organizations.
Requires a joint study by DHHS and the Dept of Public Safety to measure impact of Justice Reinvestment Act on demand for mental health services, measure the impact of mental health needs on local law enforcement and look at how judicial rulings have impacted behavioral health system.
Uses $2.1M to create pilot program to study the effects of targeted case management, with a report due in Dec 2017.
Orders DHHS to study the fiscal effect of reinstating visual aid coverage. Orders a report by Oct, 2015.
Provides $1M in funding per year to the Office of Administrative Hearings for mediation services tor Medicaid patients in dispute with their providers.
DHHS will transfer $139M per year to the Dept of the Treasurer to be accounted for as “nontax revenue” from state owned hospitals and facilities.
Allows Health Choice to set a maximum lifetime limit for benefits.

SOCIAL SERVICES

Reduces funds for State-County Special Assistance by $4M, leaving $125.8M, leaves rates the same: $1,182 for adult care home residents, $1,515 for residents in special care/ dementia units.
Reduces funding for personal services contracts by $9,540
Extends the moratorium on creating new licenses for in-home aide services to June 2017. Orders a study on the state-wide demand and supply by March, 2016
Extends moratorium on special care unit (dementia care) licenses to June 2017, orders a study on the state-wide demand and supply due March, 2016.
Increases funding for foster care by $4.5M. Also provides $50,000 in funding to raise age to 19 for youth in foster care, adding one new position and $1.3M in funding to support a demonstration project to improve outcomes for youth transitioning out of foster care (this is all contingent on the passage of legislation making its way through the General Assembly).
Provides $400K in funding for child advocacy centers
Allocates $75,000 annually to pay for the National Federation of the Blind Newsline, an electronic reading service for the blind.
Funds Intensive Family Preservation Services funding and provides money to do enhance performance fo the program by adding provisions for six month follow-up, cost-benefit data, data on long term benefits and info on the interventions used.
Mandates that some foster care budget dollars go to guardianship assistance program, to reimburse legal guardians for room and board a the same rate as in the foster care program. .
Provides funding to administer the NC REACH program that targets foster children who wish to attend post-secondary school.
Creates a Foster Care Transitional Living Initiative Fund that will provide transitional living services for kids aging out of the foster care system. The Fund is ordered to raise matching funds from private entities, measure the impact and evaluate the effectiveness of the services provided.
Creates a Permanency Innovation Initiative Oversight Committee with 12 members to oversee changes and administration of foster care and adoption programs.
Allows the Division of Social Services to retain 15 percent of federal dollars for administration and to improve effectiveness of services to children supported by the state. Also orders the department to report findins of a statewide evaluation to the General Assembly by March 2016.

DIVISION OF PUBLIC HEALTH

Keeps AIDS drug assistance program budget at $47.8M. Recurring extra drug rebate money of $6.3M goes back to state coffers
Instructs Department of Public Safety to work with DHHS to buy AIDS drugs for prisoners in a way that allows for federal matching funds for the drugs
Reduces recurring funding for university and personal services contracts by $70,072
Keeps Quitline’s budget at $1.2M. $100K of recurring extra Medicaid receipt money goes back to the state
Earmarks $2.2M of future money, nonrecurring, to replace and upgrade the Medical Examiner information system
Provides $100K in recurring training money to implement mandatory annual training for county medical examiners and nonrecurring funds of $400K to replace the Office of the CME’s outdated and obsolete equipment, increasing the total budget of Office of CME to $8.7M. The training will include instruction regarding sudden unexplained death from epilepsy.
Increases the fee paid to county medical examiners to $200 per case.
Creates funding for 12 grants to be used in projects aimed at reducing health disparities in non-white communities, mandates the grants be geographically dispersed, and sets a limit for the amount of overhead funds a program can spend. The department will submit a status report to the NCGA in Oct 2017.
Provides $106,587 in annual funds and $368,000 in one-time funding to develop and implement an Electronic Death Records system (currently, all death certificates are processed by hand). Much, if not all, of the costs of this system will be covered by receipts.
Provides $175K in nonrecurring funds for time-limited Vital Records Section customer service staff during the development and implementation of the Electronic Death Records System, increasing the Section’s budget by 4% to $4,552,729
Budgets $110K in recurring funds to provide rabies drugs at the State Public Health Laboratory to indigent persons who have been exposed to rabid animals, increasing the funds available for drug supplies to $280,466
Allots $250K in recurring funds to support one Forensic Pathologist Fellowship each year at East Carolina and Wake Forest Universities, who will perform autopsies at the State’s regional autopsy centers. This increases the funds available for purchased services to $3,651,250. Also increases the fee for an autopsy from $1,250 to $1,750.
Provides $2.5M in recurring funds and $2.5M in nonrecurring funds for a competitive block grant process for county health departments to apply for funds to use to increase access to prenatal care and improve birth outcomes
Allots $900K in annual funds for home visiting services provided by the Nurse Family Partnership Program, making the total funds available for the program $1.4M
Provides $465K in one-time funding to sustain the Perinatal Quality Collaborative of North Carolina (PQCNC) while it transitions between 2015 and 2017 to become fully receipt-suppported effective July 1, 2017
Orders that funds allocated for school nurses not be used for other purposes and that school nurses not be used to teach any academic classes
Provides a raise for school nurses paid for by state dollars, gives DHHS flexibility to adjust health care worker salaries in state facilities closer to private market rates.

MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND SUBSTANCE ABUSE SERVICES

Takes away $243,886 in annual funding personal service contracts, leaving $535,015 available for miscellaneous contractual services
Provides $225K in nonrecurring funds to pilot the use of EMS departments to assess and trasnport persons with a mental health or substance abuse crisis to non-hospital settings, which will expand the existing pilot from 1 to 14 sites and complete a study after one year. This funding increases the pilot budget from $60K to $285K
$10.6M in nonrecurring funds will be allotted for the new Broughton Hospital replacement facility scheduled to open in December 2016. These funds will cover technology infrastructure, furniture and equipment
Allots $2.8M in recurring -but increasing in 2016-17 – funds to offset inflationary increases in utilities, food and other costs at State-operated healthcare facilities, increasing the total funds available for the facilties to $897,841,574
Provides $5M in recurring funds to offset the loss of Medicaid receipts, increased indigent caseloads and other factors that have contributed to chronic budget shortfalls at Central Regional Hospital, increasing the facility’s total available funds to $223.9M
Provides $4.9M in annually recurring funds in a three-way contract to increase the number of community hospital beds that may be purchased to provide psychiatric inpatient treatment services from 165 to 180, increasing funding by 14% to $43,047,144. Distributes these beds across the state’s geographic regions.
Allows state health officials to move management of these community hospital beds from one LME to another if the first LME is not effectively managing them.
Orders that as much as $25M from Trust Fund for Mental Health (which comes from money from the sale of Dorothea Dix property) go to creation of a three-year pilot program to convert unused beds in rural hospitals into shsort-term psychiatric beds, restricts that funding to this purpose only. Orders DHHS to inspect each facility at least every six months and orders an annual status report to the Legislature.
$7.8M in recurring funding to cover the US Department of Justice settlement that provides for the development housing options for people with mental health disabilities
Provides $2.3M in recurring funds to add a fourth NC START (Systematic, Therapeutic, Assessment, Resrouces and Treatment) Team to provide services to children and adolescents with intellectual or development disabilities, increasing the total funds available for child and adult NC START services from $2,437,207 to $4,753,207
Allots $1.86M in annual funds to increase the number of TASC (Treatment Alternatives for Safer Communities) case managers who provide substance abuse assessment and referral services to criminal offenders who are maintained in the community instead of sentened to prison or those who have been released form prison and are under a probation officer’s supervision, incrasing the TASC budget by 35% from $5.362M to $7.222M
Allots $2M in one-time funds to establish additional behavioral health urgent care centers and facility-based crisis centers around the State
Gives $350K in one-time funding and establishes $134K in annually recurring funding to develop and operate a psychiatric bed registry to provide real-time information on the number of child, adolescent and adult beds available at each licensed inpatient facility in the State
In the case that the state budget is not completed by the first day of the fiscal year, LMEs will receive 1/12th of their budget to keep them whole. That amount will be subtracted from their total state appropriation at year’s end.
Creates new services for people with traumatic brain injury (different from waiver services above). $359,218 goes to the Brain Injury Association to provide services, another $796,934 to residential programs for people with TBI and $1,216,934 in individual services, such as home modifications or transportation, etc.

CHILDREN’S SERVICES

Total availability for NC Pre-K is $144.2M
Increases the funding from the NC Education Lottery for NC Pre-K to $2.7M
Children’s Health Initiative: To improve children’s health by investing in programs with a strong evidence-base that provide good return on investment and improved outcomes for infants and children. Establishes DHHS as the lead agency, mandates the School of Public Health at UNC-Chapel Hill to statewide comprehensive plan, perform a review of all programs as they get implemented. To do this, the budget allocates:
– Maternal and Child Health Contracts: $2,847,094 one time funds
– Healthy Beginnings: $170,779 one time funds
– Pregnancy Care Case Management: $300,901 in one time funds
– Maternal, Infant and Early Childhood Home Visiting: $425,643 one-time funds
– Positive Parenting Program (Triple P): $828,233 one time funding
– NC Perinatal and Maternal Substance Abuse Initiative: $2,729,316 in one-time funding
– Perinatal Substance Abuse Specialist: $45,000 one time funding
– Residential Maternity Homes: $375,000 one time funding
– Baby Love Plus: $1,156,915 in federal funds
– Young Families Connect: $1,027,528 in federal funds
Provides funding for Child Treatment Program training and allocates funding to create a database of program graduates
Sets goals for the NC Partnership for Children that the statewide partnerships focus more on evidence-basaed programs to increase child literacy, improve child health, assist parents and improve and maintain the quality in 4- and 5-star rated facilities. Sets cap for administration spending at 8 percent and requires local partnerships to raise 100 percent matching funds to state dollars.
Creates a new legislative oversight subcommittee on early childhood and family support programs.

BLOCK GRANTS

Makes a one-time restoration of money in the Home and Community Care Block Grant, increasing the total by 2 percent [$969,549] to $55M (Division of Aging)
Creates $82,606 in funding to pay salaries for an engineer and a nursing consultant to inspect adult care homes and adult day health facilities which want to be certified to provide overnight respite care. Some of the funds for that program will come from receipts, certification fees and construction fees. Pays for these technical needs in the new progam that comes out of Home and Community Care Block Grant funds
With $2.5M allotted in recurring funds (2015-17) and $2.5M in onetime funding, DHHS shall implement a competitive process for local health departments to apply for grants. Selection shall be based on a county’s current health status and their proposal to invest in evidence-based programs. Requires the Secretary to prioritize grant awards to those local health departments that are able to leverage non-State funds in addition to the grant award. Funds to implement this plan will supplement – not replace – existing funds for health and wellness programs and initiatives.
Adds $2.25M of Health Net dollars to the Community Health Grant Program, bringing total up to $7.6M. Money goes to safety-net agencies for this fiscal year, but starting in FY 16-17, agencies must compete for grants.
Creates new rules for reporting by not for profit contractors for DHHS. Allocates $10.3M in general DHHS funding, plus $3.85 M in funding for not-for-profits to provide human services support for:
– autism advocacy, support, education and residental services
– residental treatment for people with substance abuse disorders
– program support for people with severe intellectual and developmental disabilities, mental illness, substance abuse problems or the elderly
– food distribution for low income people
– services for homeless people
– services for people aging out of foster care
– programs to support wellness, physical activity, and health education
– enhanced vision screening for school children
– providing after-school services for apprenticeships or mentoring for at-risk youth
– $400,000 for services for people with Amyotrophic lateral sclerosis (ALS)
– comprehensive smoking prevention and cessation program that screens and treats tobacco use in pregnant women and postpartum
mothers
– providing long-term (12 month minimum) residential substance abuse services
– $500,000 for a program providing short-term residential substance abuse services
– for the upcoming 2 years only, provide $1.3M to support Triangle Residential Options for Substance Abusers (TROSA)
DHHS shall work with the UNC GIllings School of Global Public Health to establish an evaluation protocol for determining program effectiveness and future funding requirements for local programs. By April 1, 2016, DHHS and the school shall submit a report to the HHS committee on a competitive process for local health departments to apply for State funds.

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