A guide to the 2023 legislative health budget

A guide to the 2023 legislative health budget

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House Budget Proposal Senate Budget Proposal Moves $273M of funding from the Coronavirus Capital Projects Reserve to the Coronavirus Capital Projects Fund. Moves $273M of funding from the Coronavirus Capital Projects Reserve to the the Coronavirus Capital Projects Fund. Includes the entirety of the Medical Freedom bill which would prevent any political subdivision of the state to deny or refuse employment to someone based on their refusal of the COVID-19 vaccination. Includes the entirety of the Medical Freedom bill which would prevent any political subdivision of the state to deny or refuse employment to someone based on their refusal of the COVID-19 vaccination. Appropriates $1M in recurring funding to Surry Community College to enter into an MOU with Northern Regional hospital to train and employ as many as eight nurse educators. Also includes a provision that would prohibit publicly-funded school entities from requiring a student have a COVID-19 vaccine. Also includes a provision that would prohibit publicly-funded school entities from requiring a student have a COVID-19 vaccine. Appropriates up to $10M for nursing programs to community colleges in each of the FYs and sets forth matching requirements. Appropriates up to $15M for health care education programs, including nursing, to community colleges in each of the FYs and sets forth matching requirements. Inserts language from Senate Bill 743 which would give UNC Health leeway to expand, freed from antitrust considerations and with less oversight. The Senate also includes East Carolina University Health system (which goes by the name of Vidant Health), in a proposal to create the “NC Care Initiative” which would be an integrated network of clinics and hospitals with the intent of providing care to rural parts of the state where health care has been sparse.  Sets out new requirements for selecting health and safety materials to be used in schools, which includes local boards of education needing to notify the public at least 10 days in advance of discussing new health and safety materials in a public hearing. Creates a structure for establishing multidisciplinary “threat assessment teams” to be employed when someone at a public school displays threatening behavior. Inserts the language of SB 62 which would change the governance and structure of the state’s schools for the deaf and blind. Transfers oversight of the school from Dept. of Health and Human Services to Dept of Public Instruction, appropriates an additional $1.4M for maintenance of the school. Instructs DPI to contract with a third-party administrator in order to maximize any potential Medicaid reimbursement for students at the Governor Morehead School for the Blind, Eastern NC School of the Deaf and the NC School for the Deaf. If DHHS fails to establish such a contract before Jan, 2024, deducts those expenses from the DHHS budget. Appropriates net of $305M for school health personnel, including nurses, school counselors, school social workers and school psychologists. Provides enough funding for an additional 120 positions. Forbids the state board of education from requiring that school nurses have a four-year degree. Appropriates net appropriation of $305M for school health personnel, including nurses, school counselors, school social workers and school psychologists. Provides enough funding for an additional 120 positions. Orders the NC Area Health Education Centers program (NC AHEC) to create team opportunities for five rural health care teaching sites across the state. The sites will create opportunities for medical students, nurse practitioners and physician assistants to be trained in team-based care. Appropriates $750,000/ year. In addition the legislature appropriates $250K for AHEC to study the availability of community preceptors in NC and nearby states and provide an interim report to the General Assembly in April 2024. Aligns privilege exemptions for psychiatrists, licensed marriage and family therapists, social workers, clinical mental counselors and psychologists. Bill language creates a prohibition on passive income from supervision agreements between physicians and certified nurse-midwives and nurse practitioners. Sets fines for physicians who violate this prohibition and makes the practice grounds for discipline by the NC Medical Board. Bill language makes it a requirement for anesthesiologists to be present during admission of anesthesia, even if the anesthesia is being administered by a Certified Registered Nurse Anesthetist. Currently, anesthesiologists do not have to be physically present. Also requires that any insurers operating in the state shall require this for their patients/ providers. Bill language creates a requirement for hospitals and insurers to give advanced notice to patients when care is delivered by an anesthesiologist, pathologist, emergency medicine physician, radiologist or any of their affiliated practitioners who are contractors at the hospital AND are out of network. Patient notification should include estimated cost to the person who is receiving health care services. Division of Aging and Adult Services Division of Aging and Adult Services Orders DHHS to use funds remaining in the State-County special assistance budget to cover the balance of costs for adults living in the community. Orders adult care and at home payments to be at parity. Orders DHHS to use funds remaining in the State-County special assistance budget to cover the balance of costs for adults living in the community. Orders adult care and at home payments to be at parity. $250,000 in new recurring funds to the NC Senior Games. Appropriates $20M in funding for emergency shelter services, paid for by federal receipts Appropriates $20M in funding for emergency shelter services, paid for by federal receipts Allocates $1.35M in state funds for Access Outreach for aging North Carolinians Allocates $1.35M in state funds for Access Outreach for aging North Carolinians Appropriates $43,815 in state funds for Wellness and Health Promotion services quality improvement activity. Appropriates $43,815 in state funds for Wellness and health promotion services quality improvement activity Appropriates $37M in state funds to federal Home and Community Care Block Grant funding for a total of $102M in funding in each FY Appropriates $37M in state funds to federal Home and Community Care Block Grant funding for a total of $102M in funding in each FY Appropriates $2.3M of state funding to cover Alzheimer’s and dementia support services. Appropriates $2.3M of state funding to cover Alzheimer’s and dementia support services. Adds $64,191 in state funding to cover the cost of at-risk case management, for a total of $198K in the program in each FY of the biennium. Adds $64,191 in state funding to cover the cost of at-risk case management, for a total of $198K in the program in each FY of the biennium. Appropriates $$8.29M in state funding to support the Key Program which helps develop housing options for people with disabilities. Appropriates $$8.29M in state funding to support the Key Program which helps develop housing options for people with disabilities. Adds $11,223 in funding to the Senior Community Services Employment services program. Total funds $2.3M, mostly covered by receipts. Adds $11,223 in funding to the Senior Community Services Employment services program. Total funds $2.3M, mostly covered by receipts. Adds $568K in state funding for Adult Protective Services and Guardianship program, for a total of $7.8M in each year of the biennium. Adds $568K in state funding for Adult Protective Services and Guardianship program, for a total of $7.8M in each year of the biennium. Appropriates $923K in state funding to the Long-term care ombudsman services program. The rest of the programs $4.8M budget is paid for by billing for services. Appropriates $923K in state funding to the Long-term care ombudsman services program. The rest of the programs $4.8M budget is paid for by billing for services. Appropriates $535,670 for state/ county special assistance, which helps pay for Medicaid recipients in adult care/ family care homes. Appropriates $535,670 for state/ county special assistance, which helps pay for Medicaid recipients in adult care/ family care homes. Division of Central Management and Support Division of Central Management and Support Sets timing for reports from non-governmental entities that receive grant funds at Nov 1 following the end of the FY where the money was granted. Moves funding for maintenance for the Gov. Morehead School which serves blind people from the Department of Health and Human Services to the Department of Public Instruction, includes the maintenance funds and the positions. Allocates $1M in American Rescue Plan (ARPA) funding to pay for software services provided by MediSked, which provides care management for Medicaid patients. Appropriates various amounts for information technology to support Medicaid and other DHHS/ Division of Social Services programs. Total appropriation of $79 million in state dollars. Differs from Senate budget by using ARPA dollars to pay $1M for services provided by MediSked. Appropriates various amounts for information technology to support Medicaid and other DHHS/ Division of Social Services programs. Total appropriation of $83 million in state dollars. Differs from House budget by adding $997K for cyber/ info security, allowing for ‘backbone’ equipment and boosting IT rates by $2.8M Appropriates $5.5M to the NC Association of Free and Charitable Clinics in each FY. Appropriates $15M in non-recurring dollars to the NC Association of Free and Charitable Clinics in each FY. Allocates $850,000 for Community Health Center apprenticeships in FY 23-24. No single grant is to exceed $150K, and the Office of Rural Health is order to report to the General Assembly in Feb. 2024. Bill sets out parameters for using the funds, including allowing $200K of funds for administration. Each September, Office of Rural Health is to submit a report to JLOC on grants and grantees. Allocates $1.7M for Community Health Center apprenticeships in FY 23-24. sets out parameters for using the funds and at which clinics/ health centers the apprenticeships should occur. Provides $600K in each year of the biennium to the Mt. Cavalry Center for Leadership Development for development and implementation of a Community Health Workers Outreach program, administered through the Office of Rural Health. Appropriates $600,000 in one-time funding for NC MedAssist, which helps indigent and uninsured people get access to medications. Allocates $200,000 in one-time funding to the NC Dental Society for clinics serving indigent patients in each year. No funds to be used for administrative purposes. Allocates $200,000 in one-time funding to the NC Dental Society for clinics serving indigent patients in each year. No funds to be used for administrative purposes, administered through the Office of Rural Health. Uses $3M in ARPA money to provide one time funding in each FY to support residency programs affiliated with Campbell University School of Medicine. Uses $3M in ARPA money to provide one time funding in each FY to support residency programs affiliated with Campbell University School of Medicine. Spends $25M in ARPA money in each FY to provide loan repayment/ practice incentives for health providers in rural and underserved areas. Annual allocations: $22M to support the current program, $2M to support a sub-program targeting recruitment, retention of additional pediatricians, psychiatrists and family docs to rural/ medically underserved areas, $1M for nurses/ clinical nurse specialists in those same areas. Orders an annual report. Provides $40M the ARPA Temporary Savings Fund in each FY for loan repayment, recruitment and practice incentives for primary care providers, psychiatrists, nurse practitioners and physician assistants who agree to practice in rural areas, administered through the Office of Rural Health. Provides $10M from the ARPA Temporary Savings Fund in each FY to provide grants to rural health care providers for start-up equipment for telehealth. The competitive grant program will prioritize independent primary care practices and obstetrics and gynecology practices, administered through the Office of Rural Health. Bill sets out the maximum grant amount ot $250K/ grantee. Orders ORH to submit a report to JLOC and Fiscal Research Division by April. Uses $25M of ARPA money over the biennium to provide stabilization grants for rural hospitals. Bill sets out parameters for the program. Uses $125M from the ARPA Temporary Savings Fund in each FY to create a Rural Health Care Stabilization Program which provides loans to rural hospitals in distress/ crisis. Transfers positions and funding that support the Gov. Morehead School for the Blind from DHHS to DPI. Sets up the competitive grants process for non-profits delivering state services, spending a total of $10.6M in recurring and $4.77M in non recurring funds in each FY of the biennium. Programs include providing services to autistic people, people with substance use issues, a program to support with I/DD, food distribution, homeless services, services for people aging out of foster care, programs promoting wellness, physical activity and health education, after school services for at-risk youth, services for people with ALS, smoking prevention and cessation for pregnant people, providing residential substance use services and sports / training programs for adults and children with disabilities. Competitive grant process has been in place since 2011. Eliminates the competitive/ application process for funding non-profits that provide various services. Provides $3M of one-time state money to the Boys and Girls Clubs, in particular for initiatives to reduce gang participation, school dropout and teen pregnancy rates. Provides $750,000 in one-time funding to the Boys Club of Wake County for workforce development grants for the 23-24 FY Pulls down $293K in one-time funding to pay for legislative increases and fringe benefits in the FY 23-24. Division of Child and Family Well-Being Division of Child and Family Well-Being Provides a $5M grant in the 23-24FY to Reinvestment Partners to support its Prescription Produce Program, which, for up to 3 months, provides a monthly $40 per household benefit for each eligible Food and Nutrition Service recipient enrolled by the recipient’s health care provider. Appropriates $75K in recurring funding in each FY to the NC Association of People Supporting Employment to develop and implement training programs on the best way to create supported employment services for people with I/DD and serious mental illness. Bill sets out parameters for use, eligibility. Provides $1.8M in one-time funding to Wake County’s Transitions Life Care to support hospice and palliative care services to children and their families. Transfers $5.2M in recurring Mental Health Block Grant funding from the Division of Mental Health, Developmental Disabilities and Substance Abuse Services to cover the cost of children’s mental health services and $140,000 in recurring administration funds. Transfers $5.2M in recurring Mental Health Block Grant funding from the Division of Mental Health, Developmental Disabilities and Substance Abuse Services to cover the cost of children’s mental health services and $140,000 in recurring administration funds. Allocates $12.5M in annual receipts from the Maternal Child Health Block Grant to support work that’s no longer housed in the Division of Public Health and now are part of the Division of Child and Family Well Being. Allocates $11.2M in annual receipts from the Maternal Child Health Block Grant to support work that’s no longer housed in the Division of Public Health and now are part of the Division of Child and Family Well Being. Division of Child Development and Early Education Division of Child Development and Early Education Allocates an additional $5M in recurring funding for Smart Start for each FY. Appropriates $795,640 of annual funding for DHHS criminal records background checks. Appropriates $795K to conduct criminal records checks for DHHS employees to meet a total cost of $3.25M Sets out standards for the 4- and 5-star rated NC PreK facilities. Sets out standards for the 4- and 5-star rated NC PreK facilities. Sets out standards for eligibility for child care subsidy. Sets out standards for eligibility for child care subsidy. Bill has language to increase the capacity of child care facilities from nine to 10 children in a residence. Allows for maximum group sizes for different age groups. Appropriates a total of between $206M and $215M to reduce the wait list for subsidized child care. Also allows for increasing the child care subsidy rates to those set in the 2021 Child Care Market Rate Study. Sets out allocation formula. Appropriates a total of between $206M and $215M to reduce the wait list for subsidized child care. Also allows for increasing the child care subsidy rates to those set in the 2021 Child Care Market Rate Study. Sets out allocation formula. Uses $289M in federal Child Care and Development Fund block grant funding to support subsidized child care. Uses $289M in federal Child Care and Development Fund block grant funding to support subsidized child care. Directs $1M in new federal TANF funds to the child care subsidy program in FY 23-24. That amount goes up to $2M in FY 24-25. Directs $1M in new federal TANF funds to the child care subsidy program in FY 23-24. That amount goes up to $2M in FY 24-25. Funds an increase in the child care subsidy reimbursement with $11.5M of recurring funding in the second year of the biennium (FY 24-25). The rate increase goes into effect Oct. 1, 2023. (There’s no funding in the first year because there are still one-time ARPA funds covering that cost in FY 23-24) Sets aside $10M in one-time funding for FY 24-25 to create a pilot child care program that provides automatic eligibility for the young children of full-time child care teachers. Total state appropriation for NC PreK: $47.4M, out of a total requirement of $200M Total state appropriation for NC PreK: $47.4M, out of a total requirement of $200M Total state appropriation for Smart Start: $162M, including an additional $5M in recurring dollars in each FY. Total Smart Start appropriation: $158M Sets out parameters for Smart Start. Orders NC Partnership for Children and local partnerships to match 100% of the amount budgeted for the program, stipulates amounts and record keeping procedures. Sets out parameters for Smart Start. Orders NC Partnership for Children and local partnerships to match 100% of the amount budgeted for the program, stipulates amounts and record keeping procedures, also contract bidding procedures, evaluation, expenditure restrictions. Increases the child care subsidy portion of the Child Care Block Grant to $48M in recurring funding in each year of the biennium, will go towards rate increases for providers. Total Child care subsidy budget: $514M, with $43.8M in state dollars. Total Child care subsidy budget: $514M, with $43.8M in state dollars. Orders Smart Start to use a portion of its funding to increase access to the Dolly Parton Imagination Library program. Provides an additional $1.5M to support the statewide administration of Dolly Parton’s Imagination Library. Net appropriation is $8.5M in each FY. Also orders that $1.05M of SmartStart money to be used in FY 24-25 to establish a pilot program in partnership with Wonderschool. Also orders that $1.8M of SmartStart money to be used in FY 24-25 to establish a pilot program for the Tri-Share Child Care pilot project, which creates a three-way partnership between employers, employees and the state. Moves $10.7M from the federal Child Care Development Fund Block Grant for quality activities in each FY. Moves $10.7M from the federal Child Care Development Fund Block Grant for quality activities in each FY. Division of Health Benefits Division of Health Benefits *will include new and increased funds related to Medicaid expansion Orders an annual report on Medicaid to be submitted by Dec 31 of each year, orders volume purchase plans and single source procurement to contain costs. Orders an annual report on Medicaid to be submitted by Dec 31 of each year, orders volume purchase plans and single source procurement to contain costs. Impact of Medicaid expansion, contracts and IT needs for supporting expansion. About $54.4M coming in via hospital assessments. Orders $1M in each FY to be transferred to the Office of Administrative Hearings to hear Medicaid appeals, etc. Orders $1M in each FY to be transferred to the Office of Administrative Hearings to hear Medicaid appeals, etc. Provides funds to support contracts and IT needed to administer Medicaid expansion . Requires $56.4M in FY 23-24 and $42M in FY 24-25, all federal dollars. Non-federal share of costs of $12.7 million in FY 2023-24 and $16.0 million in FY 2024-25, to be transferred from the Health Advancement Receipts Special Fund. Provides funds to support contracts and IT needed to administer Medicaid expansion . Requires $56.4M in FY 23-24 and $42M in FY 24-25, all federal dollars. Non-federal share of costs of $12.7 million in FY 2023-24 and $16.0 million in FY 2024-25, to be transferred from the Health Advancement Receipts Special Fund. Impact of Medicaid expansion, costs of reimbursing county departments of social services for additional admin costs associated with determinations for the new NC Health Works program, $48M in costs will be covered by new receipts, mostly hospital assessments, which will flow into a new Health Advancement Receipts Special Fund. Impact of Medicaid expansion, costs of reimbursing county departments of social services for additional admin costs associated with determinations for the new NC Health Works program, $48M in costs will be covered by new receipts, mostly hospital assessments, which will flow into a new Health Advancement Receipts Special Fund. Appropriates $110M in recurring funds to increase the Medicaid reimbursement rates for behavioral health providers. Changes implementation date for LMEs to pay new rates for behavioral health services for patients waiting discharge from psychiatric hospitals, with a proposed start date of March 2023. Makes the policy retroactive to Dec 2022. Orders that $43M in disproportionate share funds from the federal government be deposited into DHHS to be used to administer the Medicaid program in each FY. Orders that $43M in DSH funds from the federal government be deposited into DHHS to be used to administer the Medicaid program in each FY. Sets out a schedule and requirements for reporting on program progress to the Joint Legislative Oversight Committee on Medicaid and Fiscal Research Division on Medicaid enrollment, how many people are dis-enrolled in the wake of the pandemic emergency, Medicaid-related budget challenges for the upcoming biennium, any unanticipated costs, etc. Sets out a schedule and requirements for reporting on program progress to the Joint Legislative Oversight Committee on Medicaid and Fiscal Research Division on Medicaid enrollment, how many people are disenrolled in the wake of the pandemic emergency, Medicaid-related budget challenges for the upcoming biennium, any unanticipated costs, etc. Instructs DHHS how to calculate hospital assessments for all acute care hospitals in the state, these assessments will pay for the state share of Medicaid expansion. Allows for these assessments to be levied starting in July (if the budget passes before July 1) in order to fund start up costs for NC Health Works (the new Med Ex program). Orders transfer of $150M in FY 23-24 and $125M in FY 24-25 to be moved from the Medicaid Transformation Fund to Division of Health Benefits to provide the state share of needs related to Medicaid transformation. Defines “qualifying needs.” Orders transfer of $120M in FY 23-24 and $120M in FY 24-25 to be moved from the Medicaid Transformation Fund to Division of Health Benefits to provide the state share of needs related to Medicaid transformation. Defines “qualifying needs.” Provides $15M in additional funds to support new and enhanced Medicaid services for children receiving foster care services. Provides $1.85M in FY 23-24 and $1.95M in FY 24-25 to maintain the North Carolina – Psychiatry Access Line (NC-PAL), a telephone consultation service that connects providers with psychiatrists to advise on the behavioral health needs of patients. $100.8M appropriated to maintain the increased rates paid to skilled nursing facilities. Those rates were bumped up during the COVID pandemic. Appropriates $50M in funds to permanently retain at least half of the COVID-19 add-on amount in the Medicaid reimbursement rates for skilled nursing facilities. Funds 250 additional slots for the Medicaid Innovations waiver with a $6.1M appropriation in each year of the biennium. In addition, appropriates $60M for increasing the wages of direct care workers who provide services to Innovations recipients. Bill creates a program to increase wages for “Innovations direct care workers” to $6.50 above the average rate cited in a report to the Joint Legislative Oversight Committee. Requires that agencies receiving enhanced payments pass 85% of the increase on to workers. Funds 350 additional slots for the Medicaid Innovations waiver with a $10M appropriation in each year of the biennium. In addition, appropriates $60M for increasing the wages of direct care workers who provide services to Innovations recipients. Bill creates a program to increase wages for “Innovations direct care workers” to $6.50 above the average rate cited in a report to the Joint Legislative Oversight Committee. Requires that agencies receiving enhanced payments pass the increase on to workers. Increases the rate paid to private duty nurses who care for people on Medicaid requiring home care nursing from $45/ hour to $52/ hour. Appropriates $10M to cover extra costs. Funds an increase in the Medicaid reimbursement rate for personal care services up to $25/ hour, with an appropriation of $75.7M. This rate is an increase over the enhanced rate paid during the pandemic. Applies to personal care for Medicaid beneficiaries, CAP/C, CAP/DA, CAP/CO recipients. Eliminates $10M in group home stabilization/ transition dollars. No longer necessary now that the state reimburses in-community care rates with the group homes. Appropriates $3.5M to increase the monthly Medicaid personal needs allowance from $30 to $70 for individual residents of nursing homes and from $60 to $140 for married couples residing in nursing homes. Medicaid reimbursements to nursing homes will adjust to cover the reduction in payments from residents. Adjusts the reimbursement methodology used for services provided to senior dual eligible patients. Goals include making a formal request to federal regulators, establishing a new adult care home payment methodology. Determine what amendments to the 1115 waiver for Medicaid transformation could provide more appropriate reimbursement for services for Medicaid recipients in adult care homes and other congregate living settings. Orders report to the JLOC by March 2024. Orders DHHS to seek approval from CMS for some Community Living and Support services for Innovations waiver recipients who are minors to be provided by a relative. Codifies the delay of the Behavioral Health/ I/DD tailored plans required under the Medicaid MCO transformation, delaying the go-live date to Oct, 2023. Sets the length of the first contract to expire in 2027. Accounts for the delay of the implementation of Behavioral Health / IDD “Tailored Plans” to October 1, 2023. Orders a report by March 1, 2024 about conclusion of the first contract year. Orders DHHS to adjust the Medicaid State Plan to take into account tailored plans, and apply to federal authorities for new rates, etc, ASAP. Effective retroactively to Dec 2022. Orders DHHS to adjust the Medicaid State Plan to take into account tailored plans, and apply to federal authorities for new rates, etc, ASAP. Effective retroactively to March 2023. Also defines some outpatient services that differ from what’s covered in standard benefit plans. Lays out language for a proposed Medicaid 1115 waiver focused on adults with serious mental illness and children with serious emotional disturbance or both. This will include federal reimbursement for stays in Institutions of Mental Disease and goals of treatment and the goals of the proposed 1115 waiver. One goal includes increased availability of crisis stabilization services and community-based services. Appropriates $1.85M in FY 23-24 and $1.95M in FY 24-25 to establish a psychiatry access line, which is a partnership between DHHS and the Dept of Psychiatry and Behavioral Sciences at Duke University. Lays out information in a report to be submitted to the JLOC by Sept 2024 on the service. Appropriates $5M to community health clinics and rural health clinics to help with administration, cash flow. Creates a comprehensive reimbursement structure for Federally Qualified Health Centers and Rural Health clinics, as outlined in a report to the JLOC from March 8, 2023. That report estimated the cost of implementation at $5.2M Makes permanent the rate paid for durable medical equipment under the Medicaid MCO system. Sets the rate at 100% of the supplier’s usual and customary rate OR the maximum allowable Medicaid fee-for-service rates. Orders the state’s Medicaid program to review and update preferred drug list for prescription medications to treat serious mental illness. Sets out parameters for adding new medications to the list. Orders DHB to create performance standards (including claims payment data) and report to the JLOC on performance standards for each prepaid health plan managing the state’s Medicaid program. Orders DHHS / DHB to convene a work group to identify “innovative Medicaid service options” to address gaps in care for foster youth. This includes identifying models of community evidence based practices that support a foster child returning to the child’s family timely, diverting higher level foster care placements, identifying short-term residential treatment options to serve children with high needs that could divert a child from psychiatric facility placement. Sets out details for the desired provider health plans. Orders DHHS to issue request for proposals for a single statewide children and families specialty plan for children in the foster care system and their families. Sets out parameters, gives guidance for establishing provider networks. Creates a Medicaid beneficiary “lock-in” program for patients receiving some controlled substances. Beneficiary will be permitted to select a single prescriber and a single pharmacy from the provider network (to be used only for the controlled substance). If beneficiary is overusing Medicaid services, creates restrictions. Sets up procedure for Medicaid disputes. Sets up procedures for adjusting federal poverty guidelines which will dictate who is covered by Medicaid expansion. Sets up data sharing requirements with prepaid health plans along with payment deadlines and prior authorization guidelines. Orders DHHS to come up with a proposal to allow freestanding psych hospitals to receive reimbursements through the HASP programs. Orders a report to the JLOC by March 2024. Because of the savings created in the Medicaid expansion bill, requirements for post-partum Medicaid coverage and coverage for parents of children in the foster care system passed in the last biennium are no longer needed. Reduces the overall need by $14M Orders adherence to Medicaid state plan / reimbursements for ambulatory surgical centers, which are to be reimbursed at 95% of Medicare rate. Increased funding to Medicaid via the Healthcare Access and Stabilization Program will bring in an additional $3.2B which will be paid out as increased reimbursements to hospitals. This is a result of HB 76, the Medicaid expansion bill, which included the HASP program. Increased funding to Medicaid via the Healthcare Access and Stabilization Program will bring in an additional $3.2B which will be paid out as increased reimbursements to hospitals. This is a result of HB 76, the Medicaid expansion bill, which included the HASP program. Also orders the creation of a Task Force on Primary Payment Reform. Sets out who should be appointed/ Some of the tasks of the body are: establish a definition of primary care, Conduct actuarial evaluation of current health care spend on primary care in Medicaid, the commercial market and Medicare advantage programs, determine primary care practitioner supply statewide, compare NC to other states, Report due April, 2024. Increases the net appropriation for Medicaid (rebase) by $440M in the first year and $620M in FY 24-25. Increases the net appropriation for Medicaid (rebase) by $540M in the first year and $720M in FY 24-25. Medicaid Managed Care and the Healthy Opportunities program requires $375M in funding for FY 23-24 and $315M for FY 24-25, all these monies are paid for by federal dollars. A provision in the American Rescue Plan Act gives states that choose to expand Medicaid an additional 5 percent bump in reimbursement for two years, which translates into $817M in FY 23-24 and $818M in FY 24-25 coming to NC from the federal government because NC chose to expand Medicaid. Those dollars will be moved into a temporary savings fund. The overall cost for expansion Medicaid recipients will bump up to $4.3M in FY 23-24 and $4.9M in 24-25. The federal government pays 90% of that cost, with the balance coming from the Health Advancement Receipts Special Fund for a total cost of $435M in FY 23-24 and $499M in FY 24-25. The overall cost for expansion Medicaid recipients will bump up to $4.3M in FY 23-24 and $4.9M in 24-25. The federal government pays 90% of that cost, with the balance coming from the Health Advancement Receipts Special Fund for a total cost of $435M in FY 23-24 and $499M in FY 24-25. Overall, because NC expanded Medicaid, and with additional assessments, Medicaid will have an excess of $78.5M after paying those Health Advancement Receipts Special Funds pay for the 10 percent cost for the new beneficiaries, the cost for NC Health Works and the program’s administration. Reduces the Medicaid budget by $14M in recurring dollars in FY 23-24 and $17M in FY 24-25 because of new dollars flowing from Medicaid expansion funds. Medicaid expansion will reduce the costs of postpartum coverage (enacted in 2021), and also eliminates the need for another 2021 initiative that allows for the parents of children placed in the child welfare system to retain Medicaid coverage. * The House takes a different approach to spending the ARPA Temporary Savings Funds, appropriating them in a standalone bill, HB 855. Recognizes savings from the temporary 5% additional Medicaid match from the federal government given to NC for expanding Medicaid. State deposits $833M in FY 23-24 and $834M in FY 24-25. Transfers that money into an “ARPA Temporary Savings Fund” Uses $75M in each FY from the ARPA Temporary Savings Fund for capital investments in community-owned hospitals as part of an “NC Care Initiative” Uses $70M in FY 23-24 and $140M in FY 24-25 from the ARPA Temporary Savings Fund for construction of 3 rural care centers as part of an “NC Care Initiative” Uses $10M in FY 23-24 to go to UNC Board of Governors to use to form a clinically integrated network with ECU as part of an “NC Care Initiative” Uses $100M in FY 23-24 and $400M in FY 24-25 from the ARPA Temporary Savings Fund for the construction of a new UNC Children’s hospital in the Triangle area, which will include a behavioral health hospital. Uses $50M in FY 24-25 from the ARPA Temporary Savings Fund to create a regional children’s behavioral health facility in Greenville Uses $35M from the ARPA Temporary Savings Fund to create a new regional medical examiner’s office at ECU Uses $10M from the ARPA Temporary Savings Fund in each FY to provide support for new health care-oriented programs at UNC Pembroke. Uses $8M from the ARPA Temporary Savings Fund in each FY to create a new loan forgiveness program for medical students who go on to practice primary care or psychiatry in health care worker shortage areas. Uses $ 3M from the ARPA Temporary Savings Fund in each FY to support residency programs at UNC Health Southeastern that are affiliated with Campbell U. School of Medicine. Uses $225K from the ARPA Temporary Savings Fund to App State University to purchase equipment for Beaver College of Health Sciences. Uses $39M from the ARPA Temporary Savings Fund to assist with construction costs for a new health sciences building at Caldwell Community College. Uses $30M from the ARPA Temporary Savings Fund to fund a new health sciences building at Isothermal Community College. Uses $25.5M from the ARPA Temporary Savings Fund to fund a new health sciences and public safety complex at McDowell Technical Community College. Uses $20M from the ARPA Temporary Savings Fund to fund construction of an allied health center at Pamlico Community College. Uses $15M from the ARPA Temporary Savings Fund in each FY to fund health program capital improvements at Cape Fear Community College. Uses $15M from the ARPA Temporary Savings Fund to fund health career center improvements at Roanoke Chowan Community College. Uses $10.5M in each FY from the ARPA Temporary Savings Fund in each FY to provide a grant for capital improvements at the health career center at Robeson Community College. Uses $7.5M the ARPA Temporary Savings Fund in each FY to provide a grant for allied health care capital improvements at Sampson Community College. Uses $3M in the ARPA Temporary Savings Fund for South Piedmont Community College for capital needs for the aseptic training facility. Uses $750K the ARPA Temporary Savings Fund in each FY to provide a grant to Montgomery Community College for capital improvements related to its new dental hygienist program. Uses $15M from the ARPA Temporary Savings Fund in each FY to the NC Community College system to help colleges develop and expand courses that lead to a degree/ credential in health care related fields. Uses $15M from the ARPA Temporary Savings Fund in each FY to assist comm colleges to start programs in high-demand health care fields that require “significant startup funds.” Uses $1M from the ARPA Temporary Savings Fund in each FY to create a competitive grant program for public schools to promote health careers to HS students. Uses $40M from the ARPA Temporary Savings Fund in each FY to provide loan repayment assistance to providers who agree to practice in rural/ underserved communities. Uses $10M from the ARPA Temporary Savings Fund in each FY to give the DHHS Division of Mental Health (etc) the ability to expand its centralized bed registry, Behavioral Health Statewide Central Availability Navigator (BH SCAN). Uses $3M from the ARPA Temporary Savings Fund to purchase 12 automated medication carts for use at state-operated facilities. Uses $20M from the ARPA Temporary Savings Fund in FY 24-25 to implement electronic medical records at State-operated health care facilities. Uses $6M from the ARPA Temporary Savings Fund in FY 23-24 to complete the new warehouse/ maintenance facility and relocation of all operations to the new Broughton Hospital. Uses $5.4M from the ARPA Temporary Savings Fund in FY 23-24 to complete the new warehouse/ maintenance facility and relocation of all operations to the new Cherry Hospital. Uses $1.3M from the ARPA Temporary Savings Fund in FY 23-24 for permanent facilities at the Walter B Jones Center to provide medical services and support. Uses $1.5M from the ARPA Temporary Savings Fund in FY 23-24 as a grant to Campbell U. School of Medicine for a mobile clinic medical shelter. Uses $15.7M from the ARPA Temporary Savings Fund in FY 23-24 to provide a grant to the Mountain Community Health Partnership for the construction of the Spruce Pine Integrated Healthcare Clinic and HQ project. Uses $7.5M from the ARPA Temporary Savings Fund in FY 23-24 for capital improvements to the Tammy Lynn Center that provides services to people with intellectual and developmental disabilities. Uses $6.5M from the ARPA Temporary Savings Fund in FY 23-24 to provide grant money to Good Hope Hospital in Harnett County for capital improvements. Uses $6M from the ARPA Temporary Savings Fund in FY 23-24 to provide grant funding to Appalachian Regional Healthcare System for capital improvements at Watauga Medical Center. Uses $6M from the ARPA Temporary Savings Fund in FY 23-24 to construct a substance use services facility at Tree House Recovery, Inc. Uses $2M from the ARPA Temporary Savings Fund in FY 23-24 to help TROSA with increased facility expansion costs in the Triad. Uses $1.5M from the ARPA Temporary Savings Fund in FY 23-24 to complete a new Duplin County Department of Aging Senior Resource Center and Veteran’s Services building. Uses $1.4M from the ARPA Temporary Savings Fund in FY 23-24 to provide a grant to Johnston Health Enterprises to finish construction of mental health treatment beds. Provides $12M from the ARPA Temporary Savings Fund in FY 24-25 to Coastal Horizons for capital improvements. Division of Health Services Regulation Division of Health Services Regulation Uses $258K in Social Services Block Grant funding in each FY to support administrative positions. Uses $125K in Social Services Block Grant funding in each FY to support administrative positions. Adds $279K in recurring funding to add two full time jail inspectors to the unit. Adds $165K in recurring funding and 13K in one-time funding to add two full time jail inspectors to the unit. Extends the temporary Certificate of Need exemptions passed in 2021 out to 2027. This applies to facilities that have closed and would not require them to reapply for CON certification if they were to be re-opened. Extends the temporary Certificate of Need exemptions passed in 2021 out to 2027. This applies to facilities that have closed and would not require them to reapply for CON certification if they were to be re-opened. When you need dialysis, a physician has to do minor vascular surgery to create a “fistula” that then is accessed for the purposes of dialysis. Senate budget creates an exemption to certificate of need for this vascular surgery that’s usually done in a hospital to be done in a physician’s office once that physician has obtained a license to do it. Application needs to be made by Dec 31, 2023. Budget bill eliminates the certificate of need review for new linear accelerators, machines used to do targeted cancer radiation treatment. Budget bill eliminates the certificate of need review for dialysis centers within a hospital or a freestanding dialysis clinic. Budget bill exempts certificate of need review for facilities that are moving locations within their own county. Budget bill removes the certificate of need requirement for diagnostic facilities wanting to place a new magnetic resonance imaging (radiology equipment) machine if the county’s population is more than 125,000 people OR if the county is smaller and lacks a hospital. Provides $349K in FY 23-24 and $323K in FY 24-25 to the Mental Health Licensure and Certification Section to add 4 Facility Compliance Consultant positions and their operating costs. These positions will monitor substance use disorder treatment facilities. Positions will also oversee licensure of child residential facilities for youth with complex needs who currently reside in emergency departments and Division of Social Services offices. Eliminates the certificate of need requirement for specialty ambulatory surgery programs that want to convert to multi-specialty programs or to add another specialty (e.g. for an orthopedic ASC to add eye surgery to it’s suite of services). Eliminates certificate of need review for ambulatory surgical clinics that want to locate in counties with fewer than 125,000 people and do not have a hospital operating in the county already. Expands the charity care requirement to all ambulatory surgical facilities, not just those that are in urban counties. Eliminates the territorial restrictions on hospital authorities. These authorities are currently limited to establishing hospitals only within the counties in which they are authorities and 10 miles beyond the county border. The most prominent system this would affect is Charlotte’s Atrium Health, which operates at the Charlotte-Mecklenburg Hospital Authority. Orders the Division of Health Services Regulation to provide a semi-annual report to the NCGA on facility inspections, number of complaints, comp time/ OT used by DHSR staff, lapsed funds, salary bonuses and supplements, and recruitment problems experienced by DHSR. Provides funds to the Complaint Intake Program for 3 Nurse Consultant positions and their operating costs. These positions are intended to enhance the section’s ability to process and refer complaints and facility reported incidents. Division of Mental Health, Developmental Disabilities and Substance Abuse Services Division of Mental Health, Developmental Disabilities and Substance Abuse Services Provides a $6.1M grant to Coastal Horizons Center (New Hanover County) in each FY. $2M to support Certified Community Behavioral Health Clinic model and $4.1M to support Treatment Accountability for Safer Communities program. Appropriates $3.75M in one-time dollars in each FY to the NC Alliance of YMCAs for a program to “expand character development” and for mental health services and programs for youth. Appropriates $550K in grant dollars in each FY to the SAIL initiative (Robeson County) to support Breeches Buoy Addiction Medicine Service. Uses $977K in recurring funding in each FY from the federal Substance Use Prevention, Treatment and Recovery Block Grant (SUBG) to add 6 contract specialists, 1 program manager, 1 business service coordinator and 1 business officer. Uses $241K in funding in each FY from the Substance Use Prevention, Treatment and Recovery Block Grant for operations and maintenance of the Controlled Substance Reporting System that’s used by physicians to check on patient’s access to opioid drugs. Appropriates $261M total to the state’s LME-MCOs for single stream funding, a reduction of $15M from 2022. Sets out single stream funding levels for LME-MCOs as follows (same amounts in each FY): Alliance: $4.9M; Eastpointe: $1.6M; Partners: $3.36M; Sandhills: $2.67M; Trillium: $2.59M; Vaya: $2.86M Sets out single stream funding levels for LME-MCOs as follows (same amounts in each FY): Alliance: $4.9M; Eastpointe: $1.6M; Partners: $3.36M; Sandhills: $2.67M; Trillium: $2.59M; Vaya: $2.86M Sets out timing for distribution of single stream funding to LME/MCOs so they do not experience cash flow issues. Orders that LMEs are not permitted to reduce funding for home and community-based services or any services paid for by single stream funding to fulfill the 2012 US DOJ/ Transitions to Community Living Initiative settlement. Sets out timing for distribution of single stream funding to LME/MCOs so they do not experience cash flow issues. Orders that LMEs are not permitted to reduce funding for home and community-based services or any services paid for by single stream funding to fulfill the 2012 US DOJ/ Transitions to Community Living Initiative settlement. Allows for $30M in additional Single Stream funding to go to LME/MCOs at the end of the fiscal year, if there is surplus in the Medicaid budget. Reduces $550K funding in each FY from the federal Substance Use Prevention, Treatment and Recovery Block Grant (SUBG) going to IV Drug Treatment services. Now, the total of SUBG monies going for this purpose is $2M. Uses $1.6M in funding from the federal Substance Use Prevention, Treatment and Recovery Block Grant (SUBG) to go to TROSA. This replaces General Fund monies going to the program, for a total of $3.2M in annual funding going to TROSA. Provides $5M in recurring funding in each FY to support competitive integrated employment through vocational rehabilitation services, day supports, and community services for individuals with intellectual and developmental disabilities. Sets out parameters for use of funding for three-way psychiatric beds. Sets out parameters for LME reserves to pay for the beds, and sets out mechanism for clawing back funds. Sets report dates for December of each FY, with specifics of what should be in the reports. Sets out parameters for use of funding for three-way psychiatric beds. Sets out parameters for LME reserves to pay for the beds, and sets out mechanism for clawing back funds. Sets report dates for December of each FY, with specifics of what should be in the reports. Appropriates $250K in recurring donations to Special Olympics NC in each FY Appropriates $250K in recurring donations to Special Olympics NC in each FY Provides $$1.7M in FY 23-24 and $3.9M in 24-25 to fund increases in the number of child crisis stabilization beds throughout the state. Funding is enough to manage emergency, short-term shelter and therapeutic services for up to 50 people at a time. Adds one FT position to manage the expansion. Budget bill details a plan for improving the assessment and placement of juveniles presenting to the hospital for mental health treatment, including the need for creating “rapid response teams” that have representatives from all pertinent DHHS divisions. Specifies that when a juvenile reports to the emergency department for mental health care, that the hospital needs to contact the county health director’s office within 24 hours. Hospital also is ordered to cooperate with the local LME/ MCO to bring treatment into the hospital while the child waits. The bill also sets a deadline of five business days for placing the child bed, and stipulates criteria for discharging the child from an ED. Finally, the bill requires LME/MCOs to report monthly to DHHS on number of assessments, placements and time to placement, etc. for all juveniles in the LME catchment area. Budget bill sets forth rules/ procedures for any county that wants to change LME/MCOs and sets forth criteria that need to be met for this to happen. Gives the DHHS secretary the ability to assume total control over an LME/MCO (as it did with Cardinal Innovations), and gives more detail to the powers and requirements of dissolving an LME/MCO and sets up processes for what happens to that LME’s fund balances, etc. if it is dissolved or if a county withdraws from it’s catchment area. (The section repeals old language around the Secretary’s powers and replaces it) This is language requested by DHHS. Bill rewrites the statutory language around LME/ MCO solvency and corrective action plans and repeals old statutory language around this. Bill also creates a process for providing approval of salary ranges for LME/ MCO directors and employees. Provides a $1M one-time grant to the Community Foundation of NC East (Pitt County) for a hyperbaric oxygen therapy program for veterans. Provides a $4.1M one-time grant to Hope Center Ministries, a faith-based recovery program in Johnston, Wayne and Harnett counties to build or expand facilities. The organization’s website does not indicate that they use an abstinence and 12 Steps-based treatment regimen that does not use medication assisted therapy. Provides a total of $10M in recurring funds to purchase opioid antagonists for local government entities. Appropriates another $4M in funding for the NC Harm Reduction Coalition to support current programs and provide naloxone for EMS and reentry programs. Eliminates $100K in funding to the NC Harm Reduction Coalition that was previously used for purchasing overdose medications (e.g. naloxone) Provides start up funding of $2.7M for Wilkes Recovery Revolution to build, remodel or renovate a new building in order to expand. Exempts the peer-run non-profit from certificate of need requirements. Budgets receipts from ARPA funds to provide a $15M grant for the Katie Blessing Foundation, a Mecklenburg County organization, to build a new StarMed adolescent health facility. The organization usually provides discounted primary and urgent care services to un- and under-insured people. Uses $15M from the ARPA Temporary Savings Fund in FY 23-24 to provide a grant to the Katie Blessing Fdn to build a new StarMed adolescent behavioral health facility in Mecklenburg County Budgets receipts from ARPA funds to provide a one-time $750K grant for Charlotte-based UMAR Services that provides services for people with I/DD. At least half to be set aside to create workforce development opportunities and vocational services. Appropriates $5M in FY 24-25 for implementation, operations and maintenance of electronic health records in state run facilities. Orders a report on implementation status of new electronic health records at the state’s psychiatric hospitals. Reports due in Dec of each year. Orders a report on implementation status of new electronic health records at the state’s psychiatric hospitals. Reports due in Dec of each year. Provides close to $1M in money from the Substance Use Block Grant to add administrative FTEs, including 6 contract specialists, a program manager, business service coordinator and a business officer. Provides a total of $5.9M ($3.2 recurring and $2.7M in one-time funding in FY 23-24 $2.7M) to cover the costs for start-up and operating costs for a new substance use treatment center. Appropriates $241K for operations and maintenance of the Controlled Substance Reporting System, using Substance Use Block Grant funds. Paid for by receipts. Allocates $8M for the Transitions to Community Living Initiative which addresses requirement for the state to address housing shortage for people with mental health/ I/DD issues as ordered by the US DOJ in 2012. Allocates $30M over the biennium for the Transitions to Community Living Initiative which addresses requirement for the state to address housing shortage for people with mental health/ I/DD issues as ordered by the US DOJ in 2012. Also adds 4 positions to monitor performance and provide training. Reduces funding for the Community Paramedic Mobile Crisis Management program by $40K due to reduced funding. DSOHF residential programs for children and adolescents: net requirement: $9.94M and appropriation of $5.07M DSOHF residential programs for children and adolescents: net requirement: $9.94M and appropriation of $5.07M DSOHF psychiatric hospitals: net requirement: $600M, net appropriation $361.4M DSOHF psychiatric hospitals: net requirement: $600M, net appropriation $361.4M DSOHF Developmental centers: net requirement: $314.6M, net appropriation $6M DSOHF Developmental centers: net requirement: $314.6M, net appropriation $6M DSOHF Neuro-Medical Treatment Centers: net requirement: $138.8M, new appropriation: $1.6M DSOHF Neuro-Medical Treatment Centers: net requirement: $138.8M, new appropriation: $1.6M DSOHF Alcohol and Drug Abuse Treatment Centers: net requirement: $55M, net appropriation: $0 DSOHF Alcohol and Drug Abuse Treatment Centers: net requirement: $55M, net appropriation: $0 Appropriates $9.1M in FY 23-24 and $9.9M in FY 24-25 of opioid settlement funds that come from the opioid abatement reserve. Appropriates $9.1M from opioid abatement funds that are held in reserve. Uses $5M from opioid settlements for DHHS to award competitive grants to non-profits to provide evidence-based opioid use disorder treatment to people who are under- and uninsured. Appropriates $300K in one time funding in FY 23-24 from the above reserve to the Administrative office of the Courts to study the potential implementation of statewide judicially-run recovery court programs. Transfers $4.1M to the NC Collaboratory in FY 23-24 and $4.9M in FY24-25. $3.89M to be used in 23-24 and the entire sum in FY 24-25 for grants for opioid abatement research and development projects, and $300K in FY 23-24 to study potential implementation of statewide drug / recovery courts. Division of Public Health Division of Public Health Appropriates funds for competitive grants to local health departments for the improvement of child and maternal health. Sets out parameters and process for applying for grants. Sets out dates for reports and evaluations to be conducted annually. Appropriates funds for competitive grants to local health departments for the improvement of child and maternal health. Sets out parameters and process for applying for grants. Sets out dates for reports and evaluations to be conducted annually. Orders report on premium assistance program for AIDS Drug Assistance Program. Orders report on premium assistance program for AIDS Drug Assistance Program. Appropriates $5M in recurring funding in each FY to the Human Coalition for a statewide program. Human Coalition is a Texas-based anti-abortion organization. Inserts recurring language restricting the use of state funding for provision of abortion. Adds new language restricting any state funding for family planning, pregnancy prevention, adolescent parenting programs, etc going to any agency that also provides abortions. However allows for these organizations to be paid for reproductive care (that’s not abortion) by Medicaid, the State Health Plan. Inserts recurring language restricting the use of state funding for provision of abortion. Adds new language restricting any state funding for family planning, pregnancy prevention, adolescent parenting programs, etc going to any agency that also provides abortions. However allows for these organizations to be paid for reproductive care (that’s not abortion) by Medicaid, the State Health Plan. Appropriates $6.25M in recurring funding in each FY to the Carolina Pregnancy Care Fellowship, a crisis pregnancy center, to support grants for services, equipment, training and instruction materials. Uses $6M from the ARPA Temporary Savings Fund for the Carolina Pregnancy Care Fellowship to support grants for services, equipment, training and instructional materials. Sets out parameters for reports to be submitted by the organization to the NCGA. Bill allows for the expansion of allowable uses for the Newborn Screening Equipment Replacement and Acquisition Fund. $31 of each fee collected at births goes to the fund and these dollars can be applied to “purchase, replace, maintaini or support” lab instruments, equipment and IT systems used in the state’s Newborn Screening program. Allocates $293K in recurring funds to create a water protection training team to support and train local health departments by creating three positions for Environmental Health Regional Specialists. No change in environmental health funding. Appropriates $14.7M in recurring funds to go to local health departments to expand communicable disease testing, surveillance, detection, control and prevention. No change in funding for epidemiology/ communicable disease. Appropriates $714K ($550K in one time funding and $164K in recurring) funding for activities and a chemist and a chemistry tech to enable comprehensive toxicology testing in all child deaths examined by the Medical Examiner. No change in state lab funding. Increases autopsy fees from $2800 to $5800 as of Jan 1, 2025. Will require $7.3M in recurring funding with a total state appropriation of $3M. Increases autopsy fees from $2800 to $5800 as of Jan 1, 2025. Will require $7.3M in recurring funding with a total state appropriation of $3M. Orders the Office of the Chief Medical Examiner to conduct autopsies/ investigations on all cases in suspected “death by distribution” cases. Appropriates $2M in funding for a new county operated regional autopsy center to serve the South Piedmont region, including: Anson, Cabarrus, Montgomery, Richmond, Stanly and Union Counties. Uses $15M in FY 23-24 and $5M in FY 24-25 from the ARPA Temporary Savings Fund to give a grant to Union County for a regional autopsy center to serve the southern Piedmont region. Orders Office of Vital Records and all local register of deeds offices to process all amendments to birth/ death certificates within 10 business days of the application for change. Allows for unused funds from the OVR to hire temp staff to amend birth/ death certs, operate technical support for NC DAVE and pay bonuses to those staff. No change in funding for Vital Records Appropriates $1M in one-time funds in each FY to scan and digitize the state’s vital records so they can be searchable. The budget contains a provision requiring timely amendment of birth and death certificates, and prohibits the Office of Vital Records from using lab salary funds to address the issue of timeliness and processing of vital records. Appropriates $2M in one-time funding for an infection prevention pilot program Creates $600K in non-recurring funding in each FY for support of medication therapy management to replace expiring federal receipts. Provides $35K in recurring funding from the Community Mental Health Services Block Grant to data collection around behavioral health in emergency departments. Deposits $22.5M over the biennium in receipts from the Juul settlement to the Youth Electronic Nicotine Dependence Abatement Fund. Deposits $22.5M over the biennium in receipts from the Juul settlement to the Youth Electronic Nicotine Dependence Abatement Fund. From those Juul receipts, appropriates $5.5M in one-time funding in each year to target elementary school children with prevention and cessation activities. From those Juul receipts, appropriates $750K in one-time funding in each year to support data monitoring to track tobacco/ nicotine use and exposure among youth and to measure outcomes from the state’s prevention programs.The remainder of annual funds to target children in grades 4-12 with nicotine dependence prevention and cessation activities. Appropriates $5.5M in one-time funding each year to continue nicotine/ e-cigarette/ tobacco prevention and mitigation activities for those exposed as youth. Appropriates $250K in one-time funds in each of the FYs to perform lung cancer screening and surveillance for people exposed to e-cigarettes and support research. Appropriates $14.7M in recurring funds to local health departments to address ongoing needs stemming from the COVID-19 pandemic, to prepare for other public health threats and to hire/ retain other communicable disease staff. Lays out how to distribute the funds across the state. Orders a report to be delivered to the JLOC of HHS by Oct 24 on the distribution of funds and activities. Appropriates $2M in one-time funds to run an infection prevention pilot program centered around hand sanitizers to provide hand hygiene for health care workers. Moves $10.9M from the Maternal Child Health Block Grant that supports children’s health services activities to the Division of Child and Family Welfare. About $4M remains in t he MCHBG for local programs in each FY. Uses $35K from the Community Mental Health Services Block Grant for data collection on behavioral health treatment in hospital emergency departments in each FY. Services for the Blind/ Deaf/ Hard of Hearing Services for the Blind/ Deaf/ Hard of Hearing Most programs unchanged, except for moving $276K in funding from the Social Services Block Grant for the Independent Living program and oversight of that program. Most programs unchanged, except for moving $276K in funding in each FY from the Social Services Block Grant for increases for receipt-supported positions. Division of Social Services Division of Social Services Approves the DHHS’ annual TANF plan with Electing Counties of Beaufort, Caldwell, Catawba, Lenior, Lincoln, Macon and Wilson Counties Approves the DHHS’ annual TANF plan with Electing Counties of Beaufort, Caldwell, Catawba, Lenior, Lincoln, Macon and Wilson Counties Orders the Intensive Family Preservation Services program to provide intensive services to children and families in cases of abuse, neglect, risk. Orders data collection, reporting Orders the Intensive Family Preservation Services program to provide intensive services to children and families in cases of abuse, neglect, risk. Orders data collection, reporting Allows for foster care funds to provide for financial support of kids who are in a permanent family placement, who are eligible for legal guardianship or who are otherwise unlikely to achieve permanency. Sets legal guardian rates for room/ board at the same rate as foster care rates. Allows for foster care funds to provide for financial support of kids who are in a permanent family placement, who are eligible for legal guardianship or who are otherwise unlikely to achieve permanency. Sets legal guardian rates for room/ board at the same rate as foster care rates. Sets maximum reimbursement for child caring institutions to rate set by DHHS Controller. Sets maximum reimbursement for child caring institutions to rate set by DHHS Controller. Continues post-secondary support program (NC REACH) for foster children who continue in school. Sets aside $389K for administration. Continues post-secondary support program (NC REACH) for foster children who continue in school. Sets aside $389K for administration. Total budget for Child Support/ Enforcement in each FY $166M with all but $870K coming from receipts. Provides $750K in state funding in each FY to replace the current Child Support Services IT system with a cloud-based platform with “modern coding language, advanced analytics and future State enhancements.” $680K of the state funding will come from the IT Reserve, rest comes from federal funds. Increases total child support/ enforcement budget to $176M, with a total state appropriation of $1.6M in each FY. Budget document orders a transfers of $1.6M in one-time funding in each year from the IT Reserve for replacing the County Reimbursing System. Provides $620K in state funding in each FY to support 6 regional director positions to implement the State’s Regional Support Model for child welfare, insuring compliance with Rylan’s Law. Provides $11.4M in FY 23-24 and $2.4M (all receipt supported save for $1.6M in FY 24-25) for replacing the County Reimbursement System. $7.5M will be transferred from the Information Technology Reserve to support this work, rest will be sourced from federal funds. Orders NC Child Support Services Section to retain up to 15% of the annual federal incentive payments it receives from the federal government to enhance centralized child support services. Rest of funding to go to County Child Support Services Programs. Orders NC Child Support Services Section to retain up to 15% of the annual federal incentive payments it receives from the federal government to enhance centralized child support services. Rest of funding to go to County Child Support Services Programs. Continues funding for Foster Care Transitional Living Initiative Fund. Supports a continuing demonstration project with services provided by Youth Villages to improve outcomes for kids who transition from foster care. Continues funding for Foster Care Transitional Living Initiative Fund. Supports a continuing demonstration project with services provided by Youth Villages to improve outcomes for kids who transition from foster care. Bill orders that state dollars appropriated to the Permanency Innovation Initiative can only be used to supplement, not supplant, federal matching funds. Bill orders that state dollars appropriated to the Permanency Innovation Initiative can only be used to supplement, not supplant, federal matching funds. Appropriates $2M in recurring funding for foster care permanency initiative. Appropriates $3M in recurring funds for Child Advocacy Centers. Total appropriation becomes $54M Moves funding for Child Advocacy Centers from the General Fund with federal Social Services Block Grant funding, but leaves total appropriation unchanged at $51M. LIHEAP total requirements: $117M, net appropriation: $5,000; Increases federal BG funding for the crisis intervention program. paid for by federal receipts at a rate of $10.5M LIHEAP total requirements: $117M, net appropriation: $5,000; Increases federal BG funding for the crisis intervention program. paid for by federal receipts at a rate of $10.5M Decreases federal TANF block grant funding for Work First Family Cash Assistance by $4.2M. Document states there’s a decreasing trend in program spending. Decreases federal TANF block grant funding for Work First Family Cash Assistance by $4.2M. Document states there’s a decreasing trend in program spending. Orders reports on SNAP and TANF expenditures, sets up parameters for reporting. Reports due June 30 and Dec 31. Orders reports on SNAP and TANF expenditures, sets up parameters for reporting. Reports due June 30 and Dec 31. Adds $5.1M in recurring funding in FY 23-24 and $10.2M in recurring funding in FY 24-25 to support increased payments to relatives caring for a child in foster care. Part of this appropriation ($200K in 23-24 and $400K in 24-25) for staffing/ administrative costs. Provides $750K in FY 23-24 to fund the development and implementation of a trauma-informed, standardized assessment for every child entering the foster care system. This assessment will address the trauma experienced by children and youth served by the child welfare system. Orders assessment to be completed within 10 working days of the referral for children 4-17 yo, done face to face or via telehealth. Currently, there is no standard assessment for kids entering foster care. Bill creates new language around the transport of high-risk juveniles who are under the age of 18 and have serious mental, emotional or behavioral disturbances. Designates agencies to manage the transportation. Allows for “reasonable force” to detain the juvenile and gives discretion around the use of restraints. Waives criminal/ civil liability for the reasonable measures “provided the high-risk juvenile transporter was acting in good faith.” Allows county Social Service departments to contract for transportation. Creates process for evaluating kinship care program. Training to be completed by Jan 2023. Sets monthly rates for reimbursement ($257/ child/ month for kids 0-5 yo, $327/ child/ month for kids 6-12 yo and $349/ child/ month for remaining kids up to 18). Appropriates additional funding to the tune of $250K in recurring funds and a one-time grant of $250K in FY 23-24 for Youth Villages to provide services to improve outcomes for foster youth. Total budget for State and County Special Assistance that goes to pay for care for residents who are Medicaid eligible in adult care homes, in the community. Total requirement: $123M, total state appropriation $63M. Total budget for State and County Special Assistance that goes to pay for care for residents who are Medicaid eligible in adult care homes, in the community. Total requirement: $123M, total state appropriation $63M. Division of Vocational Rehabilitation Services Division of Vocational Rehabilitation Services Appropriates $400K in one time funding in each year to purchase equipment to maintain a statewide inventory of assistive technology to be used for assessment, training, and loans. No change.

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