Lawmakers propose regulatory relief during pandemic, advocates worry it goes too far - North Carolina Health News
By Rose Hoban
Lawmakers returned to Raleigh this week to appropriate more money for COVID-19 relief. The intention was to allocate close to a billion dollars of federal money sent to North Carolina to address issues created by the pandemic that’s been upending lives for more than half a year.
Tucked into the 54-page spending bill were pages of policy provisions meant to ease the way for organizations to address the many needs generated by the pandemic. Included among them were provisions to make it easier to license facilities serving both children and seniors.
One set of provisions made it easier for community organizations to create temporary child care centers where kids can come together to participate in online learning while their parents work. Another set of provisions smoothed the process for relicensing some of the state’s 1,200 adult care homes that may have had poor track records and had lost permission to operate.
Both those sets of provisions set off alarm bells for advocates, who worried publicly and privately that easing standards would set dangerous precedents that could extend beyond the confines of the COVID emergency.
“A lot of these changes, people don’t know what they are,” said Bill Lamb, a longtime advocate for seniors living in congregate facilities. “It’s kind of in the weeds and regulations.”
But Lamb said that these small tweaks can make a big difference.
Gut and amend
This week’s bill moved quickly, and that’s by design.
House Bill 1105 made its debut at a press conference Tuesday and was released online in a post on Medium. But it wasn’t officially on the General Assembly website until Wednesday morning when it was introduced and passed in a legislative committee. Legislators used the mechanism of taking an older bill, in this case a six-page bill addressing broadband coverage and then dropping in new statutory language, adding another 48 pages. It’s a procedure known around Jones Street as “gut and amend.”
Because the bill moved fast, and was negotiated and drafted behind closed doors, interested parties did not know what provisions might be contained in it.
“This always happens when you have bills that have got to be passed,” Lamb said. “They start looking at opportunities to stick stuff in and that’s what’s happened here.”
In the case of adult care homes, what got tucked into the bill was the ability to allow operators with patterns of abuse or noncompliance to be quickly relicensed. An offending adult care home operator could simply file an appeal, and then once a provisional license was issued, drop the appeal.
The provision could potentially tie the hands of the Division of Health Services Regulation, the state agency that oversees health and safety in facilities to restrict bad actors.
Agency officials expressed concern. Some lawmakers also objected to the idea. When a reporter pointed out the language to Rep. Donna White (R-Clayton), who worked for the state Division of Aging before coming to the legislature, her eyes grew wide.
Lamb and others swung into action, calling legislators, while some headed to the General Assembly building to buttonhole others. They knew there wasn’t much time, because the gut-and-amend process circumvents the usual, multiday lawmaking routine of a bill being introduced, making its way through multiple committees, with many people weighing in and finally landing in legislative chambers for three separate votes.
Instead, with gut-and-amend, the bill can be amended in one chamber, in this case the Senate, and then go to the House for an up or down vote.
Changes on the floor
When HB 1105 was introduced Wednesday afternoon for debate in the Senate, lawmakers had teed up at least a half dozen amendments, among them one to address the adult care home licensure provision.
Sen. Mike Woodard (D-Durham) argued that operators who would benefit could have been those that had serious deficiencies, “such as death, the deflection of prescription drugs, the taking of a patient’s drugs, and quite a few others that are very, very serious,” he said on the floor.
“There are current provisions in law now that would allow for appeal of that denial of licensure. And there’s so there’s already checks and balances in place,” he said. “This is actually an unnecessary provision.”
“We need not rush what we’re doing when we think about the language that’s concerned here,” said Sen. Joyce Waddell (D-Charlotte) as she offered an amendment that removed the language.
“I think many of us have had some concerns about this,” responded Senate majority leader Harry Brown (R-Jacksonville). “It probably is something that needs a little more vetting.”
With the support of such a powerful member of the majority, the language was stricken from the bill.
The child care conundrum
The other regulatory issue that raised concerns was a provision that would make it easier for community organizations to provide gathering spaces for children to engage in remote learning. While many families are struggling to work as their children attempt to learn remotely, community organizations are providing an outlet.
“Frankly, I don’t understand how a single parent can really do this,” said Senate leader Phil Berger during a press conference during Wednesday’s noontime hour. “How a single mother handles that working, parenting and teaching all at the same time is amazing to me. I don’t know where she finds the time. I don’t know when she sleeps.”
For some families where the breadwinner cannot work remotely, it’s an impossible situation and an agonizing decision, to leave a child alone or perhaps even miss work.
Many families have turned to community organizations such as the YMCA or Boys and Girls Clubs. The problem is not the larger, well-established organizations, which often have professionalized staff members, but smaller organizations such as parks and recreation departments or churches.
“It means that community-based organizations could be allowed to operate with no oversight, no background checks, no CPR or first aid training, no required COVID health and safety standards, and no required reporting of communicable disease outbreaks which is going to happen in new sites,” said Michele Rivest, who heads the NC Child Care Coalition. “It already has happened in parks and rec departments for example.”
She worried about the lack of accountability.
“We think at a minimum, we need to ensure that these programs adhere to CDC health and safety standards,” Rivest said, “and that these programs meet the minimum health and safety standards that all child care programs in our state need to meet.
“There really isn’t a need for an exception. And we don’t understand why this has been put in place.”
Rivest also worried that the temporary provisions would eventually become permanent, once the COVID pandemic resolved.
When the bill hit the Senate floor and Asheville Democrat Sen. Terry Van Duyn proposed an amendment to add these requirements, it met forceful pushback.
Sen. Jim Perry, a Republican representing Lenoir and Wayne counties, gave the example of a constituent, a sheriff’s deputy and single parent, who had called him about his need for child care.
“He had child care through a local church for about four hours a day, and he was notified that he would no longer be able to have that child care,” Perry said. “His child knew the providers, they were there in his community, actually went to church there, and he felt very safe about the care. The child was very comfortable, but it was going to be taken from him.”
With that, the amendment was tabled without a vote.
“We must never lose sight of the importance of health and safety and the Department’s important role to ensure that programs are following the regulations that we know allow parents to go to work,” said Amy Cubbage, head of the North Carolina Partnership for Children.
“It’s a conundrum that families and the General Assembly and the Department [of Health and Human Services] face at this point.”