North Carolina News Roundup

Although the North Carolina General Assembly is formally out of session, it was still a busy week in state government and politics:

This week Senate President Pro Tempore Phil Berger (R-Rockingham) and House Speaker Tim Moore (R-Cleveland) asked a federal judge to reinstate a 20-week abortion ban that he blocked with a 2019 ruling. The Republican leaders assert Democrat Attorney General Josh Stein will not defend a 1973 state law that created the 20-week ban, even after the Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization. The judge has asked all parties in the case to submit briefs by August 7 to outline their position, ahead of his consideration to reverse his 2019 ruling.

Dozens of business and education leaders from across the state signed an amicus brief filing with the North Carolina Supreme Court on Wednesday. The friend-of-the-court filing argues the court should order the appropriation of the remaining $785 million of the total $1.75 billion ordered by the Leandro Plan to state public schools. The plan stems from a 1994 court ruling that sided with low-wealth school boards and families who sued the state to obtain more funding for adequate schools and materials. The Supreme Court will hear arguments from parties involved in the appeal during the week before Labor Day.

The State Board of Elections announced Tuesday that people who are not incarcerated while serving a felony sentence can register to vote and be allowed to vote in North Carolina, as long as they meet standard voter qualifications. The North Carolina Court of Appeals ordered this week that the decision by a Superior Court judge to allow voting rights to people serving their felony sentences outside of jail or prison go into effect on July 27.

General Assembly leaders acknowledged this week that a compromise to expand Medicaid will not come quickly. Both Senate leader Phil Berger and Speaker Tim Moore signaled this week during no-vote sessions that while conversations are still taking place, there are major differences on how to effectively expand Medicaid. The Senate prefers to include a host of other “supply side” changes that affect medical facilities, including reforming the certificate of need requirements in the state. The House, however, wants more stakeholder input from hospitals and providers before committing to the host of healthcare reforms.

Legislative Session Review: Healthcare

The North Carolina General Assembly adjourned July 1 with many of the legislature’s top healthcare issues unresolved. However, lawmakers did pass an updated budget for FY 2022-23, the main priority of this summer’s short session. A biennial budget for 2021-2023 passed during the long session, so this updated budget makes policy modifications and appropriates additional funds throughout state government initiatives to account for higher-than-anticipated revenue. Governor Roy Cooper signed the budget into law July 11.

The Health and Human Services section of the updated FY 2022-2023 budget, HB 103: 2022 Appropriations Act, includes:

- Requires the North Carolina Health Information Exchange Advisory Board to submit a report on the overall state of the health information exchange network, NC HealthConnex, to the legislature by March 31, 2023, and temporarily suspends the requirement for providers to connect and submit data through the NC HealthConnex network in order to receive Medicaid funds until legislation is passed in the future to designate a lead agency responsible for enforcement of the Statewide Health Information Exchange Act.

- Continues the enhanced COVID rates for skilled nursing and personal care services. The rates will remain in place until the funding runs out. At that time, the authority to set reimbursement rates will be returned to the Division of Health Benefits.

- Eliminates the NC Health Choice program and moves all beneficiaries to the state’s Medicaid program.

- Allows for nursing facilities to hire health care personnel who are not listed on the Nurse Aide Registry to perform nurse aide duties for up to four months.

- Provides DHHS with emergency flexibilities for certain services and facilities to temporarily waive rules and increase bed capacity during a state of emergency.

- Directs DHHS to develop and administer a two-year pilot program to gauge the effectiveness of FDA-authorized prescription digital therapeutics for the treatment of opioid use disorder.

- Allows prepaid health plans and primary care case management entities to access the North Carolina Immunization Registry.

- Modifies the quarantine and isolation authority of state and local health directors, stating that a statewide order may be issued for a period of no longer than seven days and a less than statewide order may be issued for no more than 30 days.

- Provides additional funding for Medicaid Transformation contracts, projects, and programs that support the transition to Medicaid managed care, including increases for the Healthy Opportunities pilot, care management initiatives, the enrollment broker contract, and actuarial rate setting.

Makes the following appropriations:

- $3 million in recurring funds to the Rural Health Loan Assistance Repayment Program for the recruitment and retention of primary care providers in rural areas, bringing the total for the program to $4.8 million.

- $6 million to increase rates paid to Medicaid PACE providers in North Carolina. PACE provides comprehensive care to seniors who are eligible for nursing home levels of care.

- $4.4 million to increase payments to federally qualified health centers to recognize pharmacy reimbursement challenges at the centers.

- $1 million to Cabarrus County to operate and expand the Substance Use Network (SUN) project. The SUN project is a collaborative system of care for pregnant mothers with a substance use disorder and their infants and families.

- $1.3 million for 9-8-8 Crisis Helpline call center to help staff the center to meet the anticipated call volume when implemented in July 2022.

- $1 million to each of the state’s six LME/MCOs to support opioid remediation programs.

- $600,000 to support opioid remediation project management and community partnership outreach at North Carolina Central University.

- $1.9 million to make competitive grants available to each of the UNC System schools for opioid abatement research and development projects.

- $2.6 million to fund an opioid abatement research partnership with the Eshelman Institute for Innovation at the UNC Chapel Hill School of Pharmacy.

- $3 million to establish and support innovative healthcare delivery through ECU’s Telehealth/Healthcare Digital Transformation program.

- $8 million to the UNC School of Medicine for staff and faculty sufficient to increase medical class sizes by 40 students.

Healthcare-related proposals passed by the legislature during the short session include:

HB 791: Lic. Counselors Compact/DHHS Contracting makes North Carolina a member of the Counseling Compact, an interstate licensure compact for licensed professional counselors, and implements contracting reform within DHHS. HB 791 passed both chambers unanimously and was signed into law July 7.

HB 823: Child Advocacy Centers/Share Information would establish criteria for Children’s Advocacy Centers to receive state funds, requirements for sharing information and records held by the centers, and immunity from civil liability for individuals working for a center. HB 823 passed the Senate by a 45-2 vote and the House unanimously concurred in a 108-0 vote. The bill was vetoed by the Governor July 11.

SB 138: Funeral Dir. Exam/Death Certificates requires electronic filing of death certificates beginning September 1, 2022, through the North Carolina Database Application for Vital Events system. SB 138 passed the House with two dissenting votes and the Senate with one dissenting vote. It was signed into law July 8.

SB 448: Amendments to Schedule VI of the CSA automatically allows a prescription drug approved under federal law and classified as a Schedule VI controlled substance in North Carolina to be lawfully used. SB 448 passed the Senate unanimously and passed the House in a final 92-9 vote. The bill was signed into law June 14.

Several healthcare-related bills did not make it across the finish line in time for the July 1 adjournment, including:

HB 144: Medicaid Children and Families Specialty Plan would require DHHS to issue a request for proposals for a Medicaid managed care statewide children and families specialty plan contract to begin operating December 1, 2023. In 2021, HB 144 began in the House as a teledentistry and local anesthetics bill. The Senate passed their version (current version) of HB 144 in a unanimous vote in 2022. When it returned to the House for concurrence, the bill was referred to the House Rules Committee.

HB 169: State Health Plan Data Transparency-AB would remove certain restrictions on the State Health Plan’s use or disclosure of Claim Payment Data but would provide that Claim Payment Data is exempt from the public records law and any other provision requiring information and records held by state agencies to be made public or be made accessible to the public. This bill was an agency bill requested by the Office of the State Treasurer. HB 169 first passed the House in May 2021 in a final 110-1 vote and unanimously passed the Senate in June 2022, 42-0, however, was sent straight to the House Rules Committee upon its return from the Senate.

HB 990: Medicaid Hospital Assessments Adjustments would make technical updates to the modernized hospital assessments, require the development and submission of a request for federal approval of a directed payment program, to be entitled the Healthcare Access Stabilization Program (HASP), to increase Medicaid reimbursements to hospitals. The nonfederal share of the increased reimbursements would be funded through a new hospital assessment enacted by the legislature should the state’s submission be approved. HB 990 passed the House unanimously but was never taken up by the Senate.

SB 345: PA – Team-Based Practice would allow experienced physician assistants (PAs) practicing in a team-based setting to do so without the direct supervision of a physician. SB 345 unanimously passed the Senate in 2021 and the House in 2022 but did not make it to the Senate floor in time for a concurrence vote to be taken by the chamber.

SB 580: Dental Practice Act Revisions/HIE Exemption would allow procedures to be performed on an approved alternative method to satisfy the clinical examinations of dentistry applicants, adds requirements for dental applicants to receive a license by credentials by holding an Instructor’s License, and exempts dentists from the requirement to submit demographic and clinical data to the Health Information Exchange (HIE) Network, otherwise known as NC HealthConnex. SB 580 began in the Senate in 2021 as an agriculture and energy bill In 2022, the House gutted the bill, replacing the language with the Dental Practice Act revisions and HIE exemption language. The House passed its version of SB 580 unanimously, sending it back to the Senate where the bill was returned to the Senate Rules Committee.

As expected, the topic of Medicaid expansion dominated discussion and debate during the short session. While expansion was not ultimately passed by the General Assembly, leadership in both the House and Senate offered their own stand-alone Medicaid expansion proposals, a major shift for lawmakers that have stood firm against expansion for years.

The Senate’s proposal, HB 149: Expanding Access to Healthcare, combines Medicaid expansion with three other healthcare policy proposals that have been a top priority for many North Carolina senators for years, including Certificate of Need reform, parameters for insurance coverage of telehealth services, and lifting restrictions on advanced practice registered nurses (APRNs). HB 149 passed the Senate by a final 44-1 vote in early June but was never taken up in the House.

The House’s proposal, SB 408: Rural Healthcare Access & Savings Plan Act, would not immediately expand Medicaid in North Carolina and did not address many of the additional policy issues included in the Senate’s proposal. Rather, SB 408 would create the Joint Legislative Committee on Medicaid Rate Modernization and Savings that would be tasked with considering a Medicaid Modernization Plan developed by DHHS by December 15, 2022. The House passed SB 408 by a final 102-6 vote a few days before the legislature’s July 1 adjournment. The bill was never taken up by the Senate.