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House | May 14, 2015 | Committee Room | Appropriations: Health and Human Services

Full MP3 Audio File

We are going to call this meeting in order, it is going to be a good and very interesting meeting, so I hope you have sharpened your pencil and you are ready to study. I start this rodeo with Susan Jacobs, Physical Research. I beg your pardon, I need to do introductions. House sergeant of arms are, Young Bay, Bill Morris, and Jimmy Rand and I don't see any pages here so we'll just turn it over to Thank you. Mr. Chair, members of the committee, you have copies other rules for appropriations or appropriations committees. These rules have not changed from last year significantly from previous years. Very quickly I will go through the rules with you, the amendment it must be offer, any amendment must be offer by formal amendment. They cannot increase total spending within your committee report. Amendments can only offer a appropriations within H. H. C and can not affect other committees. Amendments can not change salary or benefit appropriations they can not spend reversions or include language like shall not [xx] or carry foreign language. They can not use recurring reduction from recurring items, amendments cannot change recurring or non-recurring designation of funds, amendments cannot change substantive policy or law they can not fund items with management flexibility reductions, amendments may not affect agency or program transfers to other committees and amendments may not include this or other finance related matters. Mr. Chair the plan will be for us to go through but the documents this morning, and we will plan to go through all the money items and then for special provisions we will cover new provisions significant provision of those have significantly changed but not spend a lot of time on board [xx] technical changes in order to leave a significant amount of meetings for questions if that's okay. Please. So I'll start with [xx] secretary and then we'll recognize the next analyst to cover the next section. The first division in your money report we are getting on page G1 is the division of central management and support, item one is personal services contract, this was the item that was included in the Governor's budget and there is a reduction of $7000. Item two was not included in the governor's budget but it is related to session law 2015-7, which changes the designation of funds for the health information exchange from recurring and the current's year budget to non-recurring. So you will see a recurring reduction here but you will see a corresponding increase later in this money report. So that is a requirement based on that session law. Item three is a vacant position reduction and the department and this division which was included in the governor's budget as well. Health net grants $2.25 million was included in the governor's budget, this eliminates that program, reduces half the money and transfers half of the money into the community health grants program. Item five funds the Department of Justice Settlement Agreement, and it is funded at the governor's recommended amount of $7.8 million from the first year recurring and 15.6 million and the second year. Item number six transfers and items out of the competitive [xx] grant in the Office Of the Secretary into the Division of Mental Health. Item seven is a modified governor's item and partially funds a structural shortfall within the agency and the division of Information Resource Management of 5.8 million nonrecurring. Item number 8 funds the governors request for the NC system at 5.8 million nonrecurring the first year, and 13 million nonrecurring the second year, and provides funds for 37 positions the first year and 40 positions the second year. on page G-2 you have funds for NC trucks, 400, 000 recurring each year and then 2.3 nonrecurring the first year 900, 000 nonrecurring the second year, you have an item that was not included in the governors budget item 10 competitive grant additional funds, and item and this funds long term residential substance use services

in that broad grant. The first year is in accordance with how you've handled this program before the nonprofit or the recipient of the grant will not have to compete for the first year or two years, after that the recipient would have to compete for funds, you will see specifics on that in a special provision we get a special provision. Item number 11 as what our reference earlier in item, and is related to item number two on the first page, and that is additional funds for the health information exchange, you will see a special provision alleged this item writer as well, it provides 3.1 million dollars which of course . 1 million hire than the amount that was induced in session law 2015 Item 12 is a $1 million extension item that you find the contract with GDAC and the specific going for a health data analytic, contract and number 13 finds the new officer we discussed in committee and funds has a special revision on this as well and it finds a new procurement the officer the evaluation within the department of community services, this offers would be like okay then the officer, the secretary. Item 14 is related to something we discussed in committee as well and you will see a special provision on this and this is basically review for programs that are focusing on improving infant mortality and reducing birth outcomes. None of these programs has been reduced. The program funds have been changed form recurring or non-recurring and they will be contingent upon a state-wide plan to be developed by the Department and the School of Public Health. The funds are also being restored on. If you turn to the next page. All of the funding is included on a reserve on page G3, and will be available for re-appropriation depending on the recommendations of the department and the school of public health for ongoing funding of those programs and how those programs fit into a state wide state plan. The last item in the office of the secretary is a residential hospice. It is a non-recurring expansion item and it provides grant funds for capital to increase capacity and hospice residential facilities and requires a match. Mr. Chair, that completes the office of the secretary and Debra Landry will now begin on page G division of ageing and adult services. Mr. Chair, members of the committee, on due[sp?] for with the division of ageing and adult services, the homeland community care block is increased by $969, 000. This restored the cut that they received last year and this is non-recurring for two years. you turn over to page G5, we'll start with Division of Child Development Early Education. The first item is a governor's modified item and it's using temporary assistance for needy families, Block Grant funding for pre-K. There is no change in overall funding with this. This budget's federal funding and then reduces to state funding. Item 19 in lottery funds, budget's lottery fund. It's for pre-K again there's no change in overall budget for Pre-K, this just uses lottery funds and little state funding for Pre-K. Item 20 is a cost allocate staff within the division child development early education, it allows the division to use federal block grant money for positions within that division. Item 21, smart structured health dated activities, this budget's temporary assistance for needy families block grant funds for a smart start, again in this case the overall funding is not changed, it's just changes the source of funding. Item 22 budget temporary assistance for needy families contingency block grant families on a nonrecurring basis for childcare subsidy, again there's not change in overall funding's. Pre-K is a governor's item and it provides recurring funding in 2.3 million in general fund money and 2.7 million in lottery funds, free care received funds on a nonrecurring basis for this year the $5 million this makes that funding recurring. Item 24 is North Carolina early childhood integrated data systems program, it did as a governor's item, it isn't integrated system of early childhood education, health and social services information and it's focussed on children 0-5 receiving in federal services and it is designed to provide information about when and how children are served, and the and services they received and it will connect with the department of public instructions data system to allow analysis over time. if you'll all turn over to page G 7,

we, ll go on with the division of social services, the first item is the governors item and it is reduces funding for the state county special assistants program and this is due to a decline in the number of individuals participating in the program, everybody who applies for the program will continue benefits, the program's been reducing over time so this just brings the budget to what's needed. Item 26 is a governor first item and it's dextol[sp?] and personal services contracts, item 27 is also a governors item and it is past a case load increase most case care case load has been increasing so this provides funds for that. And 28 is a non-recurring item for child advocacy centre at $40000, this is in addition to social service funds that you'll see later that the child Africa's center scate[sp?]. I'm 29, is successful transition of Houston Foster Care it is a demonstration project, its 1.3 million first year in 1.75 and in the second. And it provides funds to support demonstration project around, with services eucologist[sp?] to improve outcome of children and youth aging out of foster care. There is a special provision regarding this change that you will see later on. And Mr Chair that concludes this area of my report and then Mr. Thomas will talk about public health. Good morning public health starts with item 30 on page G8. Item 30 is a personal services contract cut that you've seen in some of the other divisions that is the governor's request and that is the reduction of $70000 each year. Item 31 is also a governor's request is office of minority health it is budgeting some additional prevented [xx] receipts reducing the need for general fund in this one Year only. Item 32 is also a Governor's request, it is the Age Drug Assistance Program or Aid App, again budgeting higher than anticipated receipts. Item 33, a governor's item again, it is for the physical activity and nutrition program. It is also budgeting some additional receipts and reducing the general fund appropriation for one year. Item 34 is a governor's item, providing reducing the quit line funding by $100, 000 each year and that is budgeting some additional Medicaid receipt. Item 35 is a governor's item for the office of the chief medical examiner. It is providing in the second year of the bianium about 2.2 million non-recurring to replace and upgrade the existing IT system. Item 36 also a governor's item is providing 100 thousand dollars recurring to implement mandatory annual training for the appointed county medical examiners. Item 37 a governor's item is to provide $400, 00 in each of the year's biannum to replace obsolete, outdated equipment in the office of the Chief Medical examiner, item 38 is the governor's request, it is to provide funds to develop and implement the electronic death record system Item 39, also a governor's item. It is 175, 000 non-recurring in each year to use temporary staff to provide customer service while the electronic death record system is being developed and implemented in vital records item 40 is a modified governor's item. It is providing 110, 000 recurring to state public health lab to use to provide rabies drugs to indeginous persons who who have been exposed to rabid animals. Item 41 is a house item, it is to improve, it is to provide and 2.5 million recurring, 2.5 million non recurring and first year to the local health department  to improve our outcomes, the funds will be proved as a competitive block grant process, and you'll see more about that there's more about that in the provision tat follows this item. Item 42 is also a governor's item, it is 250, 000 recurring to establish  forensic pathologists fellowships, one each at ECU and wait for [xx] university and this fellows will perform autopsies at the State autopsy centers. Item 43 is a house item that's a nurse family partnership providing 900, 000 recurring, this replaces the non recurring additional of the past years of 675, 000 and provides in additional 225, 000 to expand the program, and the final item in the public health item 44 is the perinatal quality collaborative that North Carolina referred to us picnic.

This has been funded with a combination of a lot of grant funds and another state funds you were providing none re-curing funds in the amount of 465, 000 in the first year 635, 000 in the second year and this funds are to sustain picnic while they come up with the plan to transition to becoming fully resit support starting with 2017, 19 per Annam, that's completes the items for public health going on with to the next page on item G10 on page G10 are the items for the division of middle half development disabilities and substance abuse item 45 is the personal services contract that you've seen in the other divisions this's the governors item. Item 46 is the house item it's a para-medicine ER diversion pallet you are providing 225, 000 non re-curing general funds to expand the pallet that was started in the current year with some grants from one site to 14 sites and this's the pallet that uses EMS workers to access persons who are in [xx] and if appropriate take it to another non hospital behavior house setting to stabilize them. Item 47 is a governors items that had been modified these are providing the non re-curing funds needed for the technology infrastructure, furniture and equipment, at the new Brandon Hospital that's scheduled to open in December 2016 you've modified the amounts instead of providing it in year one you have spread it over the two years because of the delay in the schedule for opening that hospital. Item 48 is the governors item it's providing re-curing funds to address the inflationally increase as in state facilities, they have gone for several years without getting inflationally increases in their budget, Item 49 is also a governor's item, you are providing 8.5 million in each year, the buyer name recurring to address them on the budget, deficit on particular at central regional hospital, item 50 is the governor item modify you are providing recurring funds to increase the number of beds in the contract from 165 to 180 Item 51 is also a governor's item, it is to expand the start teams to up to 14 that will focus on providing community based service to children and have a lesson to have intellectual to their development on possibilities. Item 39 it's the vital records customer service this is to fund that will providing to Item 52 is the substance induced criminal for this program otherwise to task program, otherwise this is a governor program that providing 1.8 million recurring for them to provide additional fund to the RMA and NCOs to add staff who has test and refer a crominal offenders who has been given a community sentence to substance abuse services. Item 53 is a governors item providing 2 million non recurring establish more behavior help urgent care center and facilities by this crisis around the state again this is an item that will keep people in the community instead of sending hospital emergency department where the state like hospitals and then item 54 is governors item, it is developing it's providing funds to develop a crisis bed registry which is an online real time registry that will allow the department to know which facilities around the state public and private have available child adolescence and adult inpatient beds. That completes the items from mental health. Going on to page 12 you took no actions on a division of locational rehabilitation and now colleague Steve Owen was start with division of health services and regulation. Mr. Chairman members of the committee I'm on page 12 the house service regfulation this item provides staffing for two positions, 83, 000 dollars in the first Year, and 88, 000 in the second Year these positions will provide rise drone and inspection to support a new way relative to over night respite services. on G14 I'll begin Medicated Divisional Medical Systems 57 is beggining 1st of 2016, the state will discontinue the 2% add on to the capitation rates to the LMEMCS for funding the risk that amounts to $17.4 million in the

second year, item 58 comes from a special provision that we'll hear more about later this provision actually authorizes DHHS to administer medicated health choice within the enacted budget. What we've done here is consolidated number of governors items, governors modified items in request from the department to come up with that's recurring and not recurring reductions, in the first year current reduction of 14.9 million, a non recurring reduction of 19.6 million and second year of recurring reduction of 19.6 million to the overall budget. Item 59 provides funds of $2 million each year recurring for a new service package relative to traumatic brain injury waiver and directs the department to submit a white 1915 item 60 provides funding for programming, [xx] track systems for immunizing pharmacists to allow that as a service. item 61 provides nonrecurring funding and this is a governor's modified item in both 2.55 five in the first year, 3.7 in the second year, this provides for planning and reform the medic aid program to ship utilization from the state model, item 62 as a governor's item. This is the re-base that recognizes the cost that changes in Rome that changes in the mix of enrollment as well as changes in utilization. Item 63 recognizes that when the SCHIP program which we call Health Choice was reauthorized, it actually provided for a 23 percentage point increase in the F map, so what this does is recognize that 23% point increase for those populations that we historically report under Medicaid but actually get the SCHIP or that health choice match rate, so this is additional federal receipt. And that concludes Medicaid I'll now turn it back over to Devrin Andre for health choice. On page G-16 is the health choice item, item  64 is the same item that Steve just talked about Medicaid but it's for Health Choice, it is the federal matching percentage rate has increased by 23 percentage points so it's nonrecurring 33 million in the first year, 46 million in the second reduction item 56 is the governor's request for the health choice rebase, and it is 5.5 million the first year and 6.2 in the second and it is to fund anticipated growth in the health choice program including population growth utilization in coins. that concludes Health Choice and it go to Denise[sp?] for the special funds pages. On page G-17 are the items for the Division of Services for the Blind and Services for the Deaf and Hard of Hearing. Item 66 is the governor's cut for the personal services contract, item 67 is the House item and that is to remove the funds that had been put into the competitive block grant put them back on a recurring basis and base budgets are providing in $75, 000 to the National Federal For The Blind newsline to provide electronic reading sevices for the blind. And then finally on pages G-18 and G-19 this is a budgeting exercise this is the same expansion that you saw in public health it is budgeting to the special vital records automation on that extension that you provided for the new electronic dept record system and this is just putting it to the automation fund and Mr. Chair that concludes the money item. Thank you and we are going to move on to special provisions. Mr. Chair members of the committee if you are turning down your provisions package to page one the first several provisions are new provisions and items that we discussed in our presentations as we were meeting jointly here in appropriations, the first one involves contracts and that we discussed and that's transitioning to performance based contract for health and human services so this is a new provision and it is a provision that requires that health related contracts human services include the clause that clearly defines objectives measurable outcomes and improvements in health status that basically they are outcome based item number two in subsection A also includes a retainage clause specifying that during the first year of the contract HHS should withhold 5% in other words not pay for the whole contract up front, withhold 5% until the objectives are actually achieved item number three includes language that would

allow for any bonuses to be paid for the contract item four is actually repeating language that you've seen in a separate provision before then allows for termination clause for HHS to terminate in any contract without cause upon 30 days notice. That has been on the budget before and has just been now consolidated into this provision. Section B is provide a participation agreement were not considered contract related provision of the services for this purpose in other words contract for hospitals position are not considered prior to this provision. If you will turn to page we have another new provision this is what the majority of presentation were surrounding this past during this session. The first section includes findings including the fact that, you've heard about a presentation for a school of public health that they are speeding more money than other countries in the United state are not the same so we talked earlier about the fact that services and health human services are fragments when it comes to there is no real clear agency for birth outcome, infant mortality and health status for children. So section B requires that HSS designate a lead agency for these programs and the secretary past the authority to designate the lead agency. Subsections 1, 2 and 3 actually talk about what it is, the General assembly expects HSS the lead agency is responsible for including all contracts that are responsible for reducing infant mortality, improving birth outcome and the overall status of children. Subsection C outlines those problems that we talked about earlier and provides for non recurring funds for all these programs as stipulated in the money report. Subsection D includes the justification review and by March 1st requires a statewide plan and including recommendations for those justifications reviews be provided to the legislative oversight committee. New funds than Denise talked about in the division of public health is discussed in subsections E and F and there is a $2.5 million recurring for public health departments and 2.5 million none recurring in first year that will be awarded to health departments. You've heard presentations from doctors on the wide variations of infant mortality rate across the state by county. This will allow HSS to establish a competitive process to allow them to fund counties based on specific county needs. And subsection G requires them to design an evaluation tool for future program funding and they would work with the School of Public Health to design that evaluation tool. If you would turn to page G5, we also talked about the fact that the Department of Health needs some assistance with the evaluation of their programmes. You heard presentations from the Pew Center about the importance of investing in evidence based programs and the need for the continuous evaluation of programs. So this provision creates an Office of Program Evaluation, Report and Accountability. This office would be created within the Office of the Secretary, and would report directly to the Secretary of Health and Human Services, it is similar to the Office of Program Evaluation here at the General Assembly. The duties of the Program Evaluation Office begin on lines 23, and will require them to review all department programs as well as, the request was made in the committee to see a list of all programs within HHS, and you did not receive that but you made that request office that will be require to do that, and also publish those programs to its website. On page G7 you will see that where we start the IT special provisions, the majority of the IT provisions are bullet played. Page 27 I s bullet play provision and there has being no significant they can change is that special provision. On page G9 you have a provision that follows money and is the funds for the health information exchange and this Million Dollars that we talked about is simply for funds to transfer the health information exchange back to the state of North Carolina is currently in the preview of a non profit on page 10 you see a bullet provision that appropriates the funds for empty trucks and on page 11 you see a bullet provision appropriate sponsoring too fast there have been no significant changes to those special provisions. Page 12 is funding for non profit competitive glance process, and Lisa Will will cover that special provision. Good morning regarding the non profit competitive grant process

general provision this follows the money in first appeared in the 2013 budget, the significant changes under subsection a that's how I see the funding for the 2015- 2017 physical pioneer if you look on page 13 under subdivision k there's been qualifying which says no less $400, 000 shall be awarded for a program or even the requirement of this subdivision and this relate to the provision of direct services for ARS and those diagnosed with the disease and as you look at under subdivision M these adds a new program initiative, a program providing long term residential substance and services and also defines what long term means and context of the provision. On line 14 subdivisions 6 takes this requires the gross to be awarded to non profit for two years, on line 30 this aligns with the two year requirement regarding reporting and then subsection E adds to a direct the propriation to triangle resedential option for seps abusers or trosa for the 2015-2017 by inium and in the amount of 1.3 this follows the money and then provides they'll compete in a competitive process going forward. On page 14 you have a community you have an item the governors provision that follows money and it's related to the elimination of the community health net program and it stipulates that $2.5 million will moved from that program to to the housing community care program so this provision simply follows the money. On page 15 you have the governors provision that is not related to money it's a provision related to the rule house loan repayment program section A is a provision that you implemented and I believe back in 2009 that consolidated these three loan repayment programs subsection B expands the scope with that program and now allows for general surgeons practicing in critical access hospitals to be eligible to receive loan repayments from the program also expands on item number two beginning on line 14 to include eligible providers to who are just paying teller medicine in rule undeserved ares to receive loans as well, Mr Chair that concludes my special provisions and list of all continue Alright beginning on page 16 against the provision for the division of child development in early education on page 16 this's your pullet plate for the NC Prigate program no changes have made to this provision on page 18 this is boiler plate for the childcare subsidy rates provision. The significant changes are, begin on line 12 subsection B this relates to Representative Stopsen[sp?] and Representative Mallons[sp?] House Bill 832 and House Bill 743 that now revises the, requires the division of child development and early education to revise its child care policy, subsidy policy to exclude form the policy's definition of income unit, a non-parent relative caretaker. Under subsection C the change begins on line 18. This now requires co-payments to be for part-time care based on policies that were in place prior to October 21, 2014. That ends all significant changes to that provision moving on to page 21, this is a child care allocation form provision which is boiler plate. Again page 23, this is a boiler plate provision for a child care funds matching requirements. Page 24 boiler plate, child care revolving loan. On page 25 again, another boiler plate for your administrative allowance per county department of social services and the use of subsidy funds for fraud detection. Page 26 this is is the smart-start provision which is [xx] and no significant changes were made to the provision this year. Page 29 is a new provision, and it requires the joint legislative oversight committee to appoint a sub committee the study, early childhood and family support programs which the child care subsidy programs, which shall include the

childcare subsidy and the NC pre-care program and the small start program, it lays out the criteria that to be studied as well as any other relevant issues is sub committee deems irrelevant. On line 11 the sub committee is allowed to seek input from other states, stakeholders and national experts relating to early child and family support programs and then on line 13 it requires the Sub-committee to develop a proposal for a state where it plans and it addresses how to meet county or reigonal needs of children by county or region and that report is due by April 1, 2016 to the Oversight Committee. Moving on to the division of social services on page 30, [xx] benefit implementation, this is a boilerplate plate provision no changes. Page 31 intensive family preservation services funding and performance enhancements, again this is boilerplate, no changes to the provision page 32 child caring institution again a boilerplate provision, no changes. Page 33 use of foster care budget for guardianship assistance program, this appeared last year in your 2013 budget and there have been no changes to provision Page 34 Child Welfare post secretary support program or NC Reach this is and follows the money and no changes for me in this provision. Page 35 this is a new provision successful transition foster care use, this based on Representative Avila's bill and it follows the money and as Debra mentioned in the money report it creates the foster care transitional living initiative fund that will support a demonstration project with services provided by youth villages to improve out comes of youth ageing out of foster care. It lays out the strategy use under sub-section B and move on to sub-section C, it increases the representation on the permanency innovation initiative Oversight Committee by one person to allow for representatives from [xx] villages and also as to the different purposes and powers of the committe, various initiatives related to both secure Youth Aid youth aging out of Foster care. On page 37, this again is a new provision and it came out of this study is house bill 121, and it was introduced by Representative Rena Turner and this is the Federal Child Support Incentive Payment, what this does, it requires DSS to retain up to 15% of the annual federal incentive payments it receives from the Federal Government to enhance centralised Child Support Services lays out what they ought to do to accomplish that requirement, under sub section B, it requires that funds be allocate that no less than 85% of the Annual Federal Incentive Payment that the Child Services Programme receives from the Federal Governmnet be used to improve effectiveness and efficiency for Federal Performance Measures and again it lays out what they're to do to meet that requirement Child Support Services Programmes to be met to establish Gash lands, and identify appropriate uses for the Federal Incentive Funding, and moving on to page 38 subsection D, requires both of planning a report with the plan being required to be reported to the HHS oversight by November, 1, 2015 and the report do not one implementation of the plan to [xx] just oversight by November 1 of each year and that would be an ongoing report. On page 39 this was a provision that was in last year's budget based on a sub-section in the overall child protective services improvement initiative. This updates a reporting requirement, last year there was a requirement to establish a state wide evaluation and in last year's budget it was due January 1, 2016 and this just changes it to March 1st, 2016. And Mr. Chair that concludes the division of social services On page 40 we will go with the division of aging adult services, this is a boiler plate division. Boiler plate provision it just

sets out the rights for state county special assistants and those have not changed. Starting on page 41 are the provisions for division of public health. On page 41 this is boiler plate language for the funds for the school nurses as provide to the counties. Section A a direct hather[sp?] funds are to be allocated to each county. Section B directs the responsibilities of the school nurses who are funded with this money. Moving on to page 42 the Age Drug Assistance Program, ADAP. This is boiler plate, it allows the age drug expenditure of the department in a public safety to be counted as the state match for the federal Ryan White funds that are received at the department of health and human services. Moving on to page 43, this is blatantly plain language, it directs how the funds are to be provided to the community for the minority health grant and it also requires that a report be submitted on October 2017. On page 45 this is the governors item, it is the mandatory medical examiner training and revocation of appointment for cause. This mandate annual training for the appointed county medical examiners and it also gives the authority to the chief medical examiner to remove any county medical examiner from their position for failure to perform. On page 46 this is a governors item that's been modified, it was to, is increasing the North Carolina medical examiner fee from the current fee of $1250 by $500 to alson[sp?] $750 this was modified and that the governor requested the fee be increased to $2250 in the second year of the bianium[sp?] but the chairs have accepted to keep it at the first, at that 1017 750 Dollars for both years. On page 47 this is an increase of the medication examiner fee, is a modification of the governors request. The governor request to increase the medical examiner fee from 100 Dollars a case to $150 a case, this is is increasing the fee to $200 per case. On page 48, this bhoylert play if I was the money for the three contract beds Page 50. This is Boiler play and this are the directs the department provide at least 1/12 of the funds owned to the Elamy MCOs at the beginning of each fiscal year. On page 51, this is also Boiler play for the North Carolina child treatment program directs how those funds are to be used, and section B specifies that all data that is stored into the sorting the system is and remains the property of the state. On page 52 this follows the money for the item thou expansion money that was provided to develop more behavioral health urgent care centers and crises center in the community. Page 53 this is also boiler clay it directs the integration of behavior health and physical health treatment, it also continues to provide clean data to CCNC and section C directs the department to develop out data. On page 54 this is Boiler play for the dramatic brain injury for our funding it is just directing that the funds that are provided in the continuation budget continue to be used only for the dramatic brain injury needs. Item 55 this is an house item the establishment of the behavior health partnership program. This authorizes a three air pallet to convert unused beds in real hospitals to license and patient psychiatric beds. Section B directs the HHS to conduct monitoring visits to these hospitals and the pallets at least two times a year. Section C directs the HHS to report on the outcome of the pilot. Section D directs the general assembly's program evaluation division to consider doing it in that evaluation of the pallet and reporting its findings to the legislative over sites committee no later than November first 2018 section E directs that the process from the sells of the daves property and Walli be deposited into the mental health trust funds and allows up to $25 million of these profits to be used to pay for the capital conversions of those bids into the license like psychiatric and patient bids and

it also directs that 50% of the bids that converted with these funds be reserved for the use LME MCO's to very feral under the three way contract or with Medicaid or other funds that are available to the LME MCO's on page 57 the community paramedics marble crisis are following the money item to use EMS to access and divert the hydra health patience from the emergency rooms from community hospitals and that concludes the mental health and public health sections Excuse me just going to interrupt for just a quick second just remind everybody that we need to be out of here ate 10 half Thank you go ahead page 60 is anew provision it's, I'm sorry did I skip one? This is Jennifer Helmen from the research division on page 58 we have a provision that has appeared on past projects continuing the moratorium on care agency licenses for any home services, that know significant changes to that provision, on page 59 we have another provision that has appeared in past budgets continuing the more otorium[sp?] on special care unit licences and their changes, their significant changes to that provision. so now I'm on page 16, this is a new provision based on house bill 19 Representative [xx] bill and also as a subject of the PED report and this is to allow the licensing of facilities to provide over section eight says that facility and subsection one since the facilities are adult day care, facilities certified to provide adult day care services or adult House services and also adopt care homes or families care homes. Subsection six, limits the provision of the 24 hour care, to not more than 14 consecutive calendar days and not more than 60 total calendar days [xx] 365 the period or for individuals under the innovations waiver or community alternative programs waiver, it would be under the rules for those programs. Subsection C also sets out rules also allows the department to to promulgate rules  and then set out what those rules are cover the next several subsection don't give health service regulation the authority to enforce rules and expect the if facilities you go down to subsection C, and that is almost the money that you saw in the money report, subsection D allows the division of aging adult service to add over night programs as a service liable under a community home program and the counties like to use adult day care, adult care home or family care homes licence under subsection A and subsection E requires the departement of health human services division and medical systems to take actions necessary under the waivers, that community alternative this programs for disabled waiver and if innovation waivers to allow adult day health over night response  services Alright moving on we have the division of medical assistant on page 63, That provision is repeated on in the 2014 budget with no changes, on page 64 we have the foil plate provision set that the income eligibility limit for the program it's been modified to reflect the income threshold the state has been using since 2014 these percentages are slightly different from last years budget due to implementation of the conversion factor that was required by the ACA, this provision will still update the figures and then and that help choice eligibility statue in this same manner. On page 68 we have from a provision that related to representative average county of origin bill that contains some revised language that requires lm mcas to out of network agreement with behavioural health and individuals with developmental disability providers to serve a single patient if the provider is located outside Ylmcs catchment

area or does not wish to become a network provider and the provider is serving no more than two Ellemy MCO in roll ease or unless the agreement is for in-patient hospitalization. Page 69 boiler plate with no changes on page 70 is just provision follows and directs the Department to enroll immunizing pharmacist as medicare providers for the purposes of receiving reimbursement for administration of proper vaccine ever allowed under a state law. On page 71 provisions follows the money director of departments request PMS approval for the medicate waiver for individual with dramatic brain injury which was designed pursuing to last years budget subsection B requires two reports from the progress. On page 72 this's the governors provision with no changes page 73 this item follows the money. On page 74 this's boiler plate with no changes the same for page 75, 76, 70 and 77 page 78 is a provision regarding non-emergency medical transportation, directs the department to issue RFP for a contract beginning January 1 2016 for the state-wide management of Medicaid non-emergency medical transportation services. Page 79 is the gorvernors provision with no significant changes. Page 80 is a new provision with authorized DHHS, but we're fully authorized to make any changes or take any actions necessary for the 2015-2017 fiscal biennium to take to administer and operate the Medicaid and Health Choice programs, provided that the total expenditures that agency receipts for the program do not exceed the enacted budget for those two programs. Subsection B prohibits GOJ just form creating liability in future years. Subsection C creates a new legislative oversight committee for Medicaid and Health Choice. Subsection D requires a quarterly report on the outcomes operations and budgets of both programs. Subsection B requires a report each January 1, that would include a detailed four-year forecast and enrollment would you tell what changes the department expects to make to keep the program within its budget and the cost to maintain the current level of services in the next fiscal year. Subsection F requires the department to give notice of state-planned amendments and waivers to the General Assembly at the same time it gives notice to native Americans as required by federal law which will give the General Assembly an additional notice period before state-planned amendments are submitted. And subsection G directs that prior to submitting any state-planned amendment or waiver, the department shall submit a detailed report that's related to Medicaid reform, the department shall submit a detailed report of their form plan to Gov. Ops and consult with Gov. Ops. And the last medicate provision is on page 83, it directs that if federal law regulation is amended to allow in position of a 1915 C, assessment then as otherwise allowed or as otherwise allowed by CMF then providers acceptance hence provider access services are willing to participate in the assessment programme than their Department may recommend the assessment up to the maximum percentage offered by Federal Rags. It gives the Department the Authority to do this through the end of the episcobionium, the end of medic aid provisions. The block rate start on page 84, much of the block rate section is boiler play just a couple of items, on page 84 line 29 is a reserve for a state wide early education for family support programs and also the plan for one proposal to improve children's health, this money is reserved in the second year after those studies plans comes out and there's funding available to implement recommendations most plans. If you will turn over to page 91, line 11 is evidence-based programs in counties with highest infant mortality rates. This goes along with the health, trying to improve infant mortality rates and it's $600, 000 in each year. And then on page 97, the mental health services block grant section W and the maternal and child health block grant section AA both require the department to utilize specific evidence-based treatment or evidence-based programs. And that concludes the special provisions. Thank you very much.

Good news. We moved Local Government. Alright. Thank you very much for an outstanding job, really, seriously. Alright. People have questions representative Penilton go ahead. Well, I really don't have a question but representative Stan I'm asking too much to go to do a study to possible cuts in executive level positions with DHHS and so I don't believe in I gave one to Adam with DHHS but if you committed members could get this thing out and sort of go out of the cover sheet Something for everybody to study. Say again. Something for everybody to study. Yeah, to study, but I'm just going to the front page when he asked me to do this I've been in the system secretary in number three person in one of the biggest state agencies way back in my life and I knew that whenever we would try to cut fat, and I was trying to do it in the secretary's office, they never would, they would always, they would always go down and out the lower people that are out doing that work, so give you an idea in the second paragraph, in 73 DOT had a deputy in sectors had 18, 000 employees, by 1985 they had reduced from 18 to 14, 000 but had 4 but isn't 14 systems, and this just goes on and on and on, the fat in the state government is in the secraties in the secretaries in the executive level know that there's going to be a lot of whining and nashing of teeth from executive branch, so what? In the last two weeks DOt actually announced that they were abolishing about 80 positions, so we contacted them this way to say, how many were in the area, executive area, the answer was none, they were all down people actually doing the work. Last paragraph, the only way to cut the area and I'm talking about health and human services right now, is to identify the physicians we want to cut, get the physician control number that's filed with office of state personnel and put a memo to the budget that those positions will be cut. Now this for you to look over there's a man in charge of the positions that I think easily can be cut and it would amount to savings of $2.5 million dollars per year in HH one last sentence. When I was chairman of the board of county commissioners on White county I knew we needed more money for mental health, so we went about funded by cutting fund in whole positions in Wake county government, what we ended up doing is standing on enough positions we can eliminate to fund $4 million a year for mental health. These are people that are being helped not have pad paid bureaucrats and I feel strongly about it and thank God that Wake did it, we can do it too. Thank you Representative, anybody else have any questions? Representative Insko I can see it. First I think I'd just like to comment that you've done some good problem solving, I was really glad to see the draw coming brain injuries section, I think the Respite Care Program is a really interesting approach and will solve a lot of problems that I've been hearing about, about people who need overnight care especially families with children who have mental illness who are high care, high risk, or BD who need, families need a break, and then I think the trust fund, I once studied that a little more because also an interesting way I guess the question I'd have about that is that's one time money, and so you're going to look at converting some local hospital beds into psychiatric bed which will be local beds but they'll also serve the entire state which is what we need. So is the one time money just to set that up, and then who will pay for? We see it as a pilot programme, Okay In which we will give them non recurring funds to set up the pilot, it's a voluntary, they don't have to do it. And from there, they're on their own, they understand that what we're giving them will convert the bed into the crisis bed, and then from there if the infrastructure were not, it's up to them Well, follow

up, unless I really don't understand what's going on, most of the people who end up in those beds are not insured, they are endogene patients and I don't know how the Hospital will make any money. I don't think that that's necessary sure, I do believe there are those that endogene, we need to look at that, but there are those on medic aid and there are those who were paying through insurance and that's part of one of the things each hospital is going to have to look at. I can tell you that my conversations, my personal conversations with people from the hospital association their support, they think it's a good idea, and they think that there will be amenities in hospitals that we have in yap, please follow up. I was just using that as a jump off, please, I'd like to just point out. Go to G10 number 48 my report what's that she turned which one well actually I think that's a really good provision there that that's not I guess I need to find I can what it is it's an is in it's a decrease in [xx] funding and an increase in indigent patients that we have in our state facilities and I can find that but as long as one of the big problems in our whole system is that we don't have the funds to provide services to the [xx]. That has always been a problem, we never have had enough IPRS money and that's in a lot of the people that end up in our ER's and they're, by the way that number is increasing right now as I understand it that we're there's an increase in the number of people that are being taken from our ER's out to our state's facilities, but so I'll find that I regret seeing cuts, in any cuts to our [xx] right now, I think that creating a medicate oversight committee committee is probably a really smart thing to do and I'm interested in seeing the provisions that have to do with to medicate reform, and just for right now, that's my comments in question I think I need to study this a little bit more. If I just could say, what could you help us understand we didn't get any information last night about how this sub-committee is going to be working. I mean do we have, will we have time? I'll let staff answer that. Representative Avila, I think the plan would be for the chairs who want to come back 15 minutes a day after session to do any amendment review, any amendments and though after session 15 minutes after session. And session starts at? Two today. I think at 11. Eleven o'clock yeah. Okay, so we have one hour now and then we come back and do amendments, and so we have one hour to create our amendments essentially right now, if we have amendments they need to be created right now. That's right. I believe that the plan would be the cut off of amendment to develop them at noon. We go ahead and start, we have prepared, when we get back in after session actually there is another session so we have that option of to come here earlier, so I would like like to request that we are able to have access to you will. As in penalty okay. No tirely this time, they are all this mental hospital deeds that close with a white man here in town and he was talking about that they don't have to use, but the small hospital there in the eastern facilitating there will lots survey

can land, so this could be a grandson for this smaller hospital to fill up this beds track bid here if they want to and what representative Insco was talking about on internet care funding and we don't do internet care funding, we do but only for UMC hospital in East Carolina hospital. They are the only two hospitals in the state that get that funding. Does anybody else have any question? We are going to move to, alright, ladies and gentlemen, first an announcement. What we are going to do is that we are going to come back at 1:30 instead of 15 minutes after. Gives you more time to work with staff. In the mean time we are adjourned.