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House | June 10, 2014 | Committee Room | Health and Human Services

Full MP3 Audio File

If everyone would take their seat, I’d like to call our committee meeting to order. We do have a rather lengthy agenda for this day. There’s lots of information we’re going to try to cover. I’m not sure where the committee’s at. Carl, thanks for being here. There’s Representative Martin coming in. Where’s she at? Well they will come in. We had a press conference earlier. I know some of them were in that conference. Let me just give you sort of the schedule for today. We will go until noon and then we will break at noon, and then we will be back at one and then we will finish up at three, and I do ask – I’ll have to mention this again when the committee gets here – that we have all amendments in by noon. We do have our Sergeant-At-Arms here; Young Bay – he’s coming in, Martha Gaddison, back in the back, David Collins, behind me, and Carl Morello, and we thank them for what they’re doing. We do have several pages with us this morning, and if you’ll just raise your hand as I call your name. Dajia Gainey, Gates County; Rachel Harris – where’s Rachel? – from Wake County; Tyler Cop, Brunswick County; Mary Manon, New Hanover; and Kate Maxwell from Cumberland. [SPEAKER CHANGES] Just one ?? [SPEAKER CHANGES] We’ll reiterate that when the committee all gets into our session. Amendments. Why don’t we wait a couple minutes to see if the remainder of the committee arrives? So at ease for a few minutes as we distribute information as well.

We do have a very long agenda that we need to work through today. I will mention again that we need the amendments requested of staff by noon. So if committee members have any amendments, please request those of the staff by noon so we can keep things moving today. I have asked fiscal research staff, Susan Jacobs, to talk about the rules for sub-committee procedure. So, Miss Jacobs will come forward and start this morning. Thank you. [SPEAKER CHANGES] Mr. chair members of the committee, Good morning. Susan Jacobs, fiscal research. You should have a single page in your handouts that is titled rules for sub-committee procedure. The majority of these are the same that you saw last year and in previous years. The first amendment says that of course amendments have to be offered by formal amendment. Amendments can not increase total spending within the proposed committee report. Amendments can only reflect appropriations within departments or agency programs, so within the department of health and human services it is not limited to divisions within this agency. Rule number four is actually a new amendment, amendments can not adjust salary and benefit appropriations in the department. You saw in both the governor's budget and senate budget that the salary changes or actually included within the sub-committee money reports this session. Generally, they are included in the salary and the reserve section of the bill. This year is different. So there is a new rule that says that amendments can not adjust those items. Amendments can not spin reversions or include funds shall not revert or court carried foreign language. It also means that you shall not have amendments that say that the agency shall fund the item within existing resources. You have to identify where the funds will come from in order to fund an item. Number six, amendments can not use non recurring reductions to fund recurring items. Amendments can not change the recurring and nonrecurring designation of funds, is number 7. Number 8 is amendments can not change substances, policy, or law. Amendments can not fund items with management flex cuts. Amendments may not affect agency or program transfers to other sub committees. Amendments may not include fees or other finance related matters. Mr Chair, that is a review of all the rules. I am happy to answer any questions with those. [SPEAKER CHANGES] Thank you, Mrs Jacobs. Any questions of the committee? ... I know there were some hard copies distributed, but this information is also on the website for those of you who may have not obtained a hard copy. So you can go to the website and follow along as well. We will proceed right into the committee reports. We are gonna go through both the documents and then will respond to questions. Jot down your questions, hold your questions and let the staff go through. Some of your questions may be answered as we go through the presentation. We will start with Susan Jacobs, again. [SPEAKER CHANGES] Okay, as well as the money report you also have a document that is entitled "Governor and Senate items not included in the house budget." As the staff goes through each individual agency we will refer to that, I think it is about a 3-4 page document, and let you know which items are actually in the senate or governor budget but are not included in the current house proposal. Item number 1 on page G1 is a senate modified item, it is a compensation increase reserve of 7.5 million dollars. The senate had this funded at approximately 6 million dollars. Item number 2 is the corresponding benefit increase associated with that salary adjustment. It is also a senate modified item, the house budget has it at approximately 1.9 million dollars recurring.The senate budget had this item funded at about 1.1 million dollars. Item number 3 is a governor modified and senate modified item and it is contracts and vacant positions,reductions department wide. The senate had this item included at 16 million dollars recurring. The governor had limited this reduction to contracts only, and it was a reduction of 3 million dollars. The current house proposal is a recurring reduction of 8 million dollars. Item number 4 was an item included in both the senate and governor's budget. It is a maintenance cost allocation item of -----

dollars recurring. And it allocates allowable federal funds from maintenance expenses at the division of child development early education. Item number 5 is also a senate and governor item, and it funds the NCTracks system within prior year earned revenue. On page G2, item number 6, NCFast similar to the NCTracks item, it funds the ongoing funds for this system, out of prior year earned revenue so there’s no general fund appropriation necessary. It’s the same as it was in both the senate and governor budget. Item number 7, the competitive block grant transfers, was not in the senate budget, was not in the governor’s budget but it was in the senate budget, and it carves out two items that you will see in two divisions in just a few minutes. It moves items from the competitive block grant and the office of the secretary into the division of social services and the division of, I’m sorry the division of public health and division of mental health. Competitive block grant additional funds. This is a senate modified item. It addes $375,000 to the competitive block grant and the office of the secretary. The senate had funded this item at the same amount but in the first year, fiscal year 14 15, had actually required that these funds go for non-profit, specifically Big Brother Big Sisters. And the house budget simply increases the overall block grant by 375,000 recurring. Item number 4 creates two actuary positions. You see one FTE in the description because these positions are funded 50% by federal Medicaid funds. It creates two actuary positions in the office of the secretary. It’s the same as was included in the senate budget. Item number 10 is the health information exchange and funds that item, it’s actually matching funds for the health information exchange. Four million dollars. If these funds are matched at 50% the total available will be eight million dollars for this project. Mr. Chair, Deborah Landry will cover the next three agencies within the committee report. [SPEAKER CHANGES] Thank you, Ms. Jacobs. [SPEAKER CHANGES] Good morning Mr. Chair, members of the committee. I am Deborah Landry with fiscal research division. We’re going to start on page G3 with the division of aging and adult services. Item 11 is a house only item and funds $100,000 non-recurring for senior capital projects. The senate had a home care and community block grant to reduction of $969,000 which is not included in the house budget. On page G4, we’ll begin with the division of child development and early education. The first item, item 12 is a governor and senate item, and it’s a ?? funds for pre-K, and it’s a swap-out of ?? grant funds of $15,842,334 non-recurring. And it simply swamps out ?? funds for state appropriations for no change in total funds for pre-K. The next item is a house only item. Item 13 is pre-K lottery funds. This replaces general fund appropriation with lottery receipts on a recurring basis for pre-K. It is a house only item and it brings the lottery receipts for pre-K program to $124.7 million. Item 14 is a governor item that’s been modified and the same as the senate. It’s administrative savings due to efficiencies in cost allocation. It is mostly using child care development block grant funds for administrative purposes in the division of child development. It does also budget $60,000 in over-realized receipts, and there is some efficiencies achieved by the division of child development and early education moving to Dix campus. Particularly they are now sharing some staff with the division of social services in the reception area, so there is one position that’s being eliminated and it is a vacant position. Item 15 is a governor modified same as senate item. It’s child care subsidy block grant swap out for $13.9 million. The governor had it at $13.8 million, and it does use child care subsidy funds and temporary assistance for needy families emergency contingency funds to swap out those dollars. On item 16 on page G5 is a senate modified item. It is child care subsidy eligibility changes. The current childcare subsidy is 75% of state median income. This changes it for children 0 – 5 and special needs children to 200% of poverty, and

Children age 6 to 12 to 133% of poverty. The change from the senate is the implementation date is now October 1st instead of September 1st. And also the house, from children currently receiving they will have their eligibility determined at the new levels with their first recertification after October 1st. Item 17 is a senate modified item. Childcare subsidy co-payments set at 10% of income. Currently families pay 8, 9, or 10% of their income for gross income as a co-payment for their childcare subsidy. This makes it 10% for all children and the change from the senate to the house is it’s effective October 1st instead of September 1st. Item 18 is Childcare subsidy co-payment is no longer pro-rated for part-time care - 2.1 million dollars. It is senate modified; the change is the effective date is October 1st and also because of the effective date, the previous item and this item is slightly lower than the senate because of the one month change. The Senate had 2.3 million dollars for this one and the house has 2.1. The three items we just went over – 16, 17, and 18; all the savings from those items are reinvested in items 19 and 20. Item 19 is a senate modified item. It provides funding for the childcare subsidy wait list. The senate had 15 million dollars in this item. Item 20 is childcare market rates. This is a house only item. This provides money for market rate increases for the childcare subsidy program. The childcare market rates are increased by 40% of the difference between the current childcare market rate and the 2013 childcare market rate survey recommended rates. And that is effective January 1st, 2015. Item 21 is Pre K and it is a senate modified item. There’s 5 million of non-recurring State appropriation. And the difference between the senate is there is a 4 million in additional temporary assistance for needy families emergency block grant funds. This item is also to ensure that because of the teacher pay raises there is no loss of slots in PreK because the per child cost will go up. And there’s also funds for additional slots. There is a Governor’s only item that is not included and it replaced Prek funding with a combination of lottery receipts on a recurring basis and TANA funds on a non-recurring basis. The lottery was 14.75 million recurring and 17.1 million non-recurring TANA funds for the Governor. On page G7 is the division of Social Services. Item 22 is a Governor and senate item – the State County Assistance Case loads. The case loads for county assistance has been decreasing so this just takes the funds that are not going to be needed next year because of the decreasing case load. Item 23 is state funding for county MEDICAID administration. It is a Governor and senate item. Counties will now be able to get an enhanced match for MEDICAID administration. So this money that was going to them, 1.8 million is being taken and they’ll get their enhanced federal match. Item 24 is Adult Care Home Case Management. It’s eliminating funds for a program that ended last June, June of 2013. So it’s just budget that’s not needed any more. Item 25 is county Child Protective Services case loads. It provides funding to replace 4.5 million in Federal block grant funds that counties lost coming into this year and also provides additional funds so that the total funds are 8.3 million dollars and it is to try to get the Child Protective Services case loads down to the recommended 10 cases per worker. Over on page G8, item 26 is to enhance oversight of County child welfare services. It’s a Governor modified item and it’s identical to the senate item. For $750,000 for 9 positions with the division of Social Services to provide monitoring, technical assistance, training for county departments of social services. The Governor had 30 positions at 2.6 million dollars. Item 27 is a senate item also. It’s Child Welfare In-Home Services expansion. It provides 4.5 million dollars for counties to provide in-home services for child protective services cases. Item 28 is a Child Protective Services statewide evaluation. It provides $700,000 of non-recurring

… unclaimed dollars to evalauate child protective services from the county to state administration also. It’s to look at case load sizes, performance, administrative structure, funding, worker turnover, and also is to include recommendation on improving the child protective services system. Item 29 is a Senate item. Child protective services pilot. Provides funds to develop and implement a private pilot program to improve communication with local county offices of social services, local law enforcement, the court system, guardian light up program, and any other agencies the department requests. I also point out from item 25 to item 29 these were our recommendations out of the legislative oversight committee. Item 30 is a governor and senate item. These are foster care case load has been increasing. This is money to fund for the foster care system payments to foster care parents. Item 31 is a senate item. Susan mentioned earlier about this swap out of the competitive block grant. The maternity home funding is taken out and put into the maternity home fund, which exists in the division of social services. That consists of 375,000 dollars. Item 32 is a house only item. It is to provide funds for the implementation of the drug screening and testing for the work party program as past and section 2013-417. There’s 218,000 of reoccurring dollars and 125,000 of non-reoccurring. The non reoccurring is for system implementation. The senate also had an item that changed eligibility for special assistance programs from the current level to %100 of poverty and that is not included in the house’s budget. Mr. Chair that concludes my section to this conference. Someone’s coming is to talk for the next couple of agencies. [SPEAKER CHANGES] Thanks you Ms. Landry. Denise Thomas will be up next. [SPEAKER CHANGES] Good Morning. Denise Thomas, division of fiscal research. I am going to start on page G-10 with the division of public health’s budget. Item 33 is the AIDS Drug assistance program or ADAP. This is a modified governor’s item. This is identical to an item included in the senate budget. It is basically a carrying over of unanticipated higher than expected revenues that the ADAP program received this year from pharmaceutical rebates and from federal receipts. This is a one time reduction of about 5.8 million dollars. These funds will be carried over into FY 14 and 15 and thereby the house is taking a one time reduction of the 5.8 million to the budget next year. The governor had recommended about 3.8 million, but in looking at the expenditures year to date it appeared that the receipts will be much higher than that. Item 34 is a governor’s item and also in the Senate budget. This is eliminating the 100,000 reoccurring that was remaining in the UNC incubator project budget. This is a program that the general assembly has been ratcheting back over years. The only amount left was 100,000 dollars that was being used for a contractor for the UNC Institute of public health. This money is eliminated and the health departments will continue to carry this work on their own. Item 35 is a governor’s item and a senate item. It is eliminating the remaining funds in the vector control program. Again, this is a program that the funding had been reduced over the years. There was very little left. It was being used to provide small grants to just a selective number of counties for mosquito control. Item 36 is the child and family support team. It was a governor’s item and a senate item. This is a reduction of about 251,000 and it is eliminating the funding for child and family support team. This was a pilot program that was started several years ago. It has been fully implemented around the state and the start up funds are no longer needed. On page G-11. Item 37. Operational Efficiencies. This is a governor’s item that was also included in the senate. It is a reduction of about 298,000 dollars reoccurring. It is in several units and the division of public health in which they are identifying operational efficiencies and positions, five positions that may be eliminated. Effective July 1st. Item 38. Public health program adjustments. These are some residual funds that were left in the budget from programs that basically no longer exist. The purchase of medical care. The early detection and intervention and the tobacco prevention and control programs. The reduction is for about 337,000 dollars reoccurring.

Item 39 is a Governor’s item also in the senate. And this was an expansion of $350,000 for the Vital Records Unit. And these funds will go into the Vital Records Automation fund to be used for the enhancement of the electronic birth record system. Item 40 is also a Governor’s item and it was a senate budget also. It is providing a million dollars recurring expansion for the office of Chief Medical Examiner to address some of the operational deficiencies that have been identified in the Medical Examiner system in the recent months. The final item under Public Health on page D12 is item 41, Well Water Testing. This is a Governor’s item, was also in the senate budget and it was a request that is budgeting increased receipts that will be realized from increasing the fee that is charged by the State Public Health Lab to analyze private well water samples. The fee will increase from currently $55 to $74. The full amount of the increase is to cover the increased cost of the supplies that are used to analyze the water samples. The fees will be collected by the public health lab and will be retained in the lab’s budget. So there is a net impact of zero for this item. There were two items that were included in the senate budget that are not in the house budget. One item was to reduce the funding for the School Nurse Funding Initiative and that reduction was about 3.5 million recurring. It would have eliminated the funding for about 70 school nurse positions and would have target the remaining 166 positions to the 41 tier one counties only. The second item that is not included that was in the senate budget, was to transfer the On-site Water Protection section from the Environmental Health branch back over to the Department of Natural and Economic Resources. It was to transfer the On-site Water Protection Unit that is currently in the division of Public Health in their Environmental Health Branch. It would have transferred that unit only back over to DNER. The Division of Mental Health’s items start on page G30. Item 42 was in the senate budget. This is to reduce to take back those 16.6 million dollars non-recurring, that was provided in last year’s appropriation act and it was provided for one-time funding to purchase equipment, furniture, and IT infrastructure for the new Brighton Hospital. That at that time was anticipated to open in December of 2014. Due to some construction issues, the opening of this facility is not scheduled to take place until May 2016. So these funds are being eliminated from the reserve and they will be reconsidered during the long session. Item 43 is a Governor’s item that has been modified. It was also in the senate budget. This was the elimination of 2.4 million dollars of funding that had been used for two IT claims processing contracts. This was to process the claims for community services. These community service claims are now processed in the NC Track system. Item 44 Local Management Entity and Managed Care Organizations. This is a reduction of 1.8 million dollars recurring. It was a Governor’s item and also in the senate. And it was reducing the budget for LME-MCO Administration by 1.8 million in anticipation of the consolidation of the current nine LME-MCOs to seven or fewer LME-MCOs in a year from now. And the savings were mainly coming from the elimination of administrative positions in these LME-MCOs. Item 45 is for $448,000 recurring reduction to the central office administrative budget. And it was identifying some operational deficiencies that could be achieved by eliminating some vacant, 7 vacant positions. Item 46 is a senate item only. It was also a modified item in the Governor’s budget. It is LME-MCO General Administration. There had been a 6 million dollar financial risk reserve that was held at the department in case one of the LME-MCOs became insolvent and the department needed to pay outstanding claims for the providers. But you passed the bill last year that really strengthened the responsibilities at

Had to take their oversight responsibilities for monitoring the financial solvency of the LME MCOs and so the governor had proposed eliminating, removing the $6.1 million reserve. Item 47, the brain injury association this is recurring funding of $225,000 and Susan mentioned removing this funding from the competitive block grant process under the central management division because we wanted to retain these funds to be used exclusively for the contract with the brain injury association of North Carolina. Item 48 is a house item only, this is providing expansion of $5 million recurring for community based crisis services. This was one of the recommendations that came out of the mental health subcommittee of the joint HSS legislative oversight committee and these funds are to be used to develop crisis services in the community to divert persons from going to local emergency departments or having to be referred for in-patient services at the state operated facilities. Item 49 is also a house only item, it’s for unpaid LME liabilities for about $7.3 million nonrecurring. For several years the department has been carrying over some liabilities of funds that it owes to the LMEs in prior years from budget shortfalls and so they would withhold the last payment for June and carry it over to be paid out of July which would create a shortage for the upcoming fiscal year. This is $7.3 million is being provided to address that issue with some of the LME MCOs. Item 50 is critical time intervention, this again is a house only expansion of $750,000 nonrecurring. This is again another one of the recommendations that came out of the mental health oversight committee and it is providing funds for short term case management services for persons who are leaving the in-patient psychiatric facilities, adult care homes, and other institutions. Item 51, the final item is a house only item. It is providing $41,000 nonrecurring expansion for assistant technology to be used for persons who have mental and other disabilities who are transitioning from facilities to live in community based settings. There were several governor’s items that were modified. The items 43, 44, 45 and 46 had really been combined into one item in the governor’s budget with a zero impact. It was basically the governor’s basically identifying about $10.8 million in reductions which he was then proposing to transfer to address the shortfall in the facilities. That item was not taken in the senate and also in the house. The house just took the resulting $6.1 million and took the cut to the risk reserve. Another item that was in the senate budget but was not included in the house budget was an item to close the Wright school. And Mr. Chair that concludes the mental health and public health and Mr. Owen will now come, oh I’m sorry one more on page G16 for the division of vocational rehabilitation there’s one item that was a governor’s item, also it was in the senate, and that was reducing the budget through operational efficiencies by about $575,000 recurring and that was basically from the elimination of about 21 full time positions but equivalent to 11.95 general fund equivalents from several of the units within the division and it would not affect the delivery of services. Steve Owen will now come up to do the health services regulation and Medicaid. [SPEAKER CHANGE] Thank you Ms. Thomas. Mr. Owen. [SPEAKER CHANGE] Mr. Chairman, Steve Owen with the fiscal research division. Beginning on page G17 is a health service regulation. Item 53 is a governor and senate item. What this is is a new receipt where costs will be allocated through the Medicaid administrative claiming process to create a match through the Medicaid program of $263,000. Item 54 is also a governor and senate item. This is budgeting over realized receipts for the health care personnel registry. Beginning on page G18 is Medicaid. Item 55 is a senate item only. What this is recognizing a reduction in the contract for high tech imaging services with..

Item 56 is a senate modified item. The senate budgeted $9.4 million, the house has $8.1 million. What this does is implement ??? new retention for the assessment under the physician UPL program for UNC and ECU. Item 57 is a senate item only. What this does is reduces the payment for hospital outpatient services at UNC and Vidant Hospitals to 70% to be consistent with other hospitals in the state. This is a reduction of $6.1 million. On page G19 item 58 is a senate modified item. This appropriates nonrecurring funds to address the projected shortfall from this year. The senate had budgeted $143.8 million, the house has $75.3 million. Item 59 provides funding to change the pricing methodology for paragard IUDs so that they’re consistent with other IUDs. Item 60 provides $100,000 nonrecurring for a dispensing fee study, and this is a house item only. Item 61 is another house item only, this provides $4 million to restore the 3% reduction taken January 1st, 2014 that will be effective January 1st of 2015. This restores the 3% reduction that was taken in last year’s budget item for the shared savings plan. Item 62 is a senate modified item. The senate had budgeted $200,000, the house budgets $300,000 nonrecurring to provide funding for a study to look at personal care services to really design a new program as well as look at the adult care home inspection processes and procedures. Item 63 is a house item only. This provides $1 million of funding for consultants, contractors, and staff to perform or to support the Medicaid reform process. There are a number of items in the governor’s and senate budgets that were not included in the house budget, specifically in the governor’s budget the governor restored $6.2 million of savings that was put into last year’s budget for provider payments under the shared savings plan. This was handled through the rebase in the senate budget. The governor also had a reduction for private duty nursing rates to create a differentiated rate for ??? vs. LPNs. The governor had a reduction of $1.2 million. The governor and senate also had $6 million reduction for mental health drug management which would have implemented prior authorization for these medications. The governor and the senate also had an assessment for LME MCOs of just under $60 million. It was ultimately proven that we could not do that. The governor and the senate also had a budget reduction to increase the retention for the hospitals gap assessment plan from 25.9% to 28.85%. This would have resulted in a $15 million reduction. The senate had included an item to de-link the eligibility for county state special assistance individuals. It would have affected about 5,200 individuals. The senate also had eliminated the medically needy individuals as eligible. This would have affected about 33,00 individuals and would have reduced spending by about $3.6 million. The senate also had frozen the case mix for nursing homes which would have reduced spending about $2.2 million. The senate also included the implementation of average acquisition cost for drug pricing as well as a change in dispensing for a net impact of $975,000 savings. The senate also had a 2% rate reduction for FIFA service providers. This would have excluded nursing homes, it would have excluded all cost based providers, it would have excluded those providers where CMS sets the fees or the payment rates, it also would have excluded the LME MCOs. The senate also had a single base rate for all hospitals which would have resulted in about $10.8 million reduction. The senate included a provision for personal care services so that the rates would be adjusted down further to compensate for the additional 50 hours that were added..

As a result of the state plan amendment that was just approved. The senate included a rebase of $206 million. The senate also had non-recurring funds for consultants, contractors and initial staffing to develop a new organization for division of medical assistance. Health choice begins on page G21. Item 64 is a governor modified and it was also in the senate budget. The governor had budgeted $8.5 million surplus in the rebase and the senate and house budgeted 14.5. Item 65 was a governor and senate item. This realigned and readjusted administrative expenses to reflect expenses more in line with what they’re actually spending today. In terms of health choice there was one item that was included in senate budget that was not included in the house budget and that was the impact of the single base rate for hospitals. Mr. Chairman that concludes my presentation. Joyce Jones is going to comment. [SPEAKER CHANGES] Thank you, Mr. Owen. While we’re in transition, your other document, special revisions, I would remind the committee that if you have amendments, please request those of the staff by noon. And that way the staff can work on it over the break and we can come back at 1:00 and deal with amendments. Ms. Jones. [SPEAKER CHANGES] Good morning, Mr. Chairman and good morning members of the committee. I am going to be walking you through your special provisions for the health and human services part of the budget. And we are actually going to start on page 72. My colleague Lisa Wilkes will cover section 12A.1 on page 71 when she comes up. Right now we’re going to start in the division of central management and support. Page 72 of your packet. 12A.2, funds for state-wide health information exchange. This is identical to a senate provision. It follows the money, and you’ll notice that in subsection A it states the general assembly’s intent to maximize receipt of federal funds for state-wide health information exchange, with the non-profit entity known as NCHIE leading these efforts for fiscal year 14 15 in hopes of receiving a sufficient amount of federal matching funds to eliminate or reduce participation fees imposed by the non-profit entity on hospitals that are required by law to connect to the HIE network. Beginning with fiscal year 15 16, it is the general assembly’s intent that the department of health and human services would take primary responsibility for drawing down these federal funds. Subsection B requires the division of central management to allocate a sufficient amount of appropriated funds to the non-profit entity NCHIE to represent the state share for maximum amount of approved federal matching funds for allowable Medicaid administrative costs related to the HIE network. The next provision 12A.4 on page 72, this is a new house only item. It repeals last year’s budget provision that required the department to implement system modifications to the replacement MMIS also known as NCTracks by January 1, 2015, in order to allow contract entities like the LME NCOs to perform Medicaid claim adjudication within the NCTracks system. The next item, 12A.5 on page 73, funds for replacement MMIS. This is a new house only provision but it is technical. It follows the money. It simply revises the amount of prior year earned revenue that may be used for the replacement MMIS during fiscal year 14 15, for consistency with the money report. The next item on page 73, 12A.6, funds for NCFast. This is again new, a house only provision that follows the money. It just revises the amount of prior year earned revenue that can be used for NCFast during fiscal year 14 15, again for consistency with the money report. I’ll be turning now to the division of aging and adult services, so if you could flip with me over to page 81 of your packet, page 81. Section 12D.1 clarification of eligibility for state county special assistance program. This is a senate modified item. The house version clarifies eligibility for special assistance with respect to age and disability. As Debra Landry previously stated, the senate version set

Eligibility for this program at 100% of the federal poverty level effective November 1st, 2014. The House provision does not include that adjustment. Subsection B. The House version does not include a subsection B. The Senate version just grandfathered eligibility for all SA applicants approved to receive SA prior to November 1, 2014. Page 82. State, county share of costs for special assistance program. Section 12(d).2 This was identical to the Senate. In order to implement proposed reductions for the SA program, this deletes the statutory requirement compelling the department and county DSSs to maintain the appropriations for this program at the same level as in the fiscal year, 12-13. Page 82. 12(d).3 Examination of ways to improve the public guardianship system. This is also identical to a Senate item. By October 1st, 2014, the department is directed to develop and submit to the HHS Oversight Committee a plan for improving the process by which it evaluates complaints pertaining to wards under the care of publicly funded guardians, as well as a plan for transitioning wards to alternative guardianship arrangements when a guardian of a person is unwilling or unable to continue serving. It requires the department to study whether use of coordination services would safeguard against a conflict of interest from guardian service paid providers. This is also identical to a Senate and House bill. And, again, as a recommendation of HHS Oversight. On page 82. 12(d).4 Status reports filed by corporations or disinterested public agents serving as guardians for incompetent wards. This is identical to a Senate item. It amends the contents of status reports filed by corporations and disinterested public agents serving as guardians for incompetent wards, and it requires more detailed information about the ward’s wellbeing and about efforts to restore competency, seek alternatives to guardianship, or seek opportunities for more limited guardianships. It authorizes the clerk or other interested party to move for modification of orders appointing guardians. This is similar to a bill that is currently Senate Bill 803 or House Bill 1179. It’s a recommendation of the HSS Oversight Committee. On page 84. 12(d).5 Development of strategic state plan for Alzheimer’s disease. This is a new item. It only appears in the House budget, and it adds to the statutory duties of the Division of Aging and Adult Services. The development of a strategic state plan for Alzheimer’s disease, and that plan must address 16 different issues related to Alzheimer’s. Page 84. 12(d).6 Reinstatement of volunteer development program as a service under the Home and Community Care Block Grant, or HCCBG. This is also a new House only item. It also is a governor’s item. It requires the Division of Aging and Adult Services to reinstate the volunteer development program as a service category under the Home Community Care Block Grant. And it allows counties to use this program to provide services to older adults from these funds. Moving now to the Division of Public Health, page 84. 12(e).1 Children’s Developmental Service Agencies. This is a Senate modified item. Subsection A requires the department to close four of its state operated CDSAs by January 1, 2015. This differs from the Senate in that the House is also requiring the department to consider expanding its use of contractor-operated CDSAs in order to continue delivering uninterrupted services in the areas that will be impacted by the closures. It requires the department to report to HH Oversight identifying the CDSAs selected for closure, as well as any plans to expand use of contractor-operated CDSAs. And that report is due March 1st of 2015. Subsection B also requires that for the 14-15 fiscal year, the department maintain the same eligibility requirements for this CDSA program as existed on June 30th, 2013. Page 85. 12 (e).3 Increased fee for private well water testing. This is an identical Senate item. It follows the money and it was also in the governor’s budget. It increases the fee for analyzing water samples from private wells from $55 to $75. And it expands the Division of Public Health’s authority to test

And charge the fee for analyzing water samples not only from newly constructed wells, but also from existing wells. 12B.6 operational efficiencies for office of the chief medical examiner. This is a new house only item. It changes the current method of appointing medical examiners. The chief medical examiner will still make the appointments but will no longer be bound by referrals by the county medical society. The chief medical examiner must give preference to physicians licensed to practice medicine in the county, but may also appoint licensed physician assistants, nurse practitioners, nurses, coroners or EMT paramedics. Subsection B requires the division of public health to study and report to HHS oversight any inadequacy of the current fees paid by the state and counties for death investigations and reports. And as well as for autopsies. Subsection C directs that a portion of the money for this office be used to establish an oversight system to achieve greater operation efficiencies and approve quality assurance of death investigations. It also requires the department to develop and implement uniform protocols for conducting death investigations in accordance with established best practices. Page 86, 12B.7 is an adjustment to the reporting date for diabetes coordination. It extends the deadline by one month just to make it consistent with the due date for a similar report on chronic care coordination. Both reports are both due on January 1 of each odd-number year and this is a new house only item. Moving on now to mental health, page 86 12F.1 traumatic brain injury funding. This is an identical senate item. It requires that $2.3 million of funds appropriated to the division of mental health, developmental disabilities and substance abuse services be used to support specific TBI services, namely contracts for the brain injury association of North Carolina and Carolina’s rehabilitation to support TBI specific residential programs and to support individual consumer requests for support as deemed necessary by that individual’s LME and primary care physician. 12F.3 report on strategies for improving mental health, developmental disabilities and substance abuse services begins on page 87. This is a senate modified item. Subsection A requires the department to develop and submit a report to HHS oversight on various strategies and plans for improving delivery and availability of mental health, developmental disabilities and substance abuse services. The house amends subsection A3 by inserting a reference to the Medicaid state plan definition of facility-based crisis programs for children and adolescents. Subsection B of this provision requires the department to report to HHS oversight on the development of a comprehensive strategy for addressing the dearth of licensed child and adolescent inpatient psychiatric beds throughout the state, and meaningful outcome measures to assess the impact of impatient treatment at our ??. This was a recommendation of the HHS oversight committee. Section 12F.4 on page 88, report and plan regarding budget shortfalls within the division of mental health, developmental disabilities and substance abuse services. This is a new house only provision. By December 1 of 2014, it requires the department to report to HHS oversight on the budget shortfalls resulting from liabilities associated with community services for mental health, developmental disabilities and substance abuse, and state operated health care facilities under the jurisdiction under the department. 12F.5 funds appropriated to implement recommendations of the joint legislative committee on health and human services regarding behavioral health crisis services. Page 89, this is a new house only item. It requires the division of mental health to use $5.2 million of the funds appropriated in the 14 15 fiscal year to increase the number of behavioral health urgent care centers that provide outpatient crisis services and facility based crisis services at the same location. It also requires the use of those funds to increase of facility based crisis centers designated as involuntary commitment facilities with priority given to those areas of the state currently experiencing a shortage of these

Types of facilities as well as to provide reimbursement for services provided at those centers. And finally it requires the department to use funds to establish facility-based crisis centers for children and adolescents. Moving on now to the division of health service regulation on page 89, 12D.1. This is just a technical correction to last year's certificate of need exemption for replacement of previously approved equipment. Page 90 12G.3 is a study of expansion of healthcare cost reduction and transparency acts to additional healthcare providers. It requires the department by December 1st of 2014 to report HHS over site it's recommendation for extending that out to additional healthcare providers. And this was a recommendation by one of our legislative research commissions. On page 90, 12G.4 Moratorium on Home Care Agency Licenses for In-Home Aid Services. This is a Senate-modified item. Subsection A, the house version extends this moratorium by two years until July 1, 2016. it was set to expire this year on July 1st. The Senate version made this moratorium permanent, and required that the general assembly take legislative action in order to lift it. Page 90, prohibition on using tanning equipment. This is a new house-only provision. effective on October 1st, 2014. It increases the minimum age for the use of tanning equipment from 13 to 18. And it repeals the exception for youth below minimum age presenting written prescription from a medical physician. Mr. Tanner, that concludes my provision and now Lisa Wilkes will come up and review her areas. Thank you. ?? Good morning Mr. Chair and members of the committee. I'd like to ask you to turn back to page 71 of your provision packet. We have one provision that will cover regarding the division of central management and support. On page 72, item 12A.1, HHS Competitive Grants Process Provision. This is a Senate-modified provision that follows the money, and under subsection A, it removes from the competitive grants process and funding the brain injury association and North Carolina and maternity home. And it also clarifies the reference to source of funds. It also provides the additional $375,000 for the competitive grants process and is distinguished from the Senate version. It removes from the funding, the competitive funding, the Big Brothers and Big Sisters Triangle Funding for the fourteenth-fifteenth fiscal year. Now if you turn with me to page 73, we'll begin the division of child development and early education. Page 73, item 12B.1 Childcare Sub C rate provides co-payment. This is a senate modified item and it follows the money as well. Under subsection A, it says beginning October 1, 2014, it establishes new eligibility levels based on a percentage of the federal poverty level versus 75% of the state median income which is current law. Again, it says for ages 0 to 5, as well as any child with special needs, the poverty level will be 200% and for 6 to 12 year olds, it will be 133% of poverty. Termination. This is again the distinction from the senate version, which did not allow for maintaining current eligibility until re-determination. Also another distinction, is that is referenced September 1, 2014 as the beginning date. Subsection B, it says beginning October 1, 2014, it revises the co-payment to 10% for all families regardless of family size and requires full co-payment for part-time care so there's no longer a pro rated care for that group. Again,

Speaker 1: …version, had it at September 1-20-14. Subsection B1 is new to the House version only, and it states by January 1-20-15, it requires DCDEE to revise its subsidy policy to include in the policy’s definition of income unit a stepparent, stepparent’s child, and nonparent relative caretaker, or the caretaker’s spouse or child when the parent of the child receiving subsidy is not in the home. It also makes various other clarifying changes. On page 74, Item 12B.2, Smart Start require fundraising assistance, codify 10 of MOE requirement: this is a Senate modified item; subsection A, which is new to the House version, requires NCPC to hire three staff to assist local partnerships with grant writing and fundraising. Again, the Senate version does not have this subsection. Subsection B is the language that codifies the $52 million 10 of maintenance of effort required of local partnerships. Page 74, Item 12B.3, Study Child Care Subsidy 11 and 12 year olds: this requires DCDEE to study child care subsidy for 11 and 12 year olds to determine available options for before and after school care, available resources other, than subsidy, to pay for before and after school care, and average cost of care for 11 and 12 year olds. A distinction with this House version is that it requires the report to include separate findings and recommendations for each age group. Page 75, Item 12B 4, revised child care allocation formula: this is a Senate modified item; Subsection A1 makes a conforming change based on the revised income eligibility of child subsidy under Section 12B 1 of the act; Subsection C requires the department to include the market rate increase in, versus outside, of the formula when implementing the formula under subsection A; subdivision 1 of subsection A further provides, beginning 2014/15, the department is to use 1/3 implementation of new census data allocation formula for every two years, however, for the 2014/15 allocations, a county that did not have a subsidy waiting list in the 2013/14 fiscal year, does not receive an allocation based on the allocation formula; also, beginning 2015/16, a county whose spending coefficient is below 95% than the previous fiscal year, does not receive an increase in its allocation in the following fiscal year, or 2016/17. It also provides for a waiver based on this last exception, due to extraordinary circumstances, and it also would requires report by the department due October 1 of each year, on the number of counties granted the waiver pursuant to that subdivision. Subdivision 2 provides that, immediately upon the release of new Census data, the department show you 1/3 by annual implementation reflecting a six year phase in approach for each census cycle thereafter. Again, the Senate version had a new Subsection B that requires that any reallocated funding, in the 2013/14 fiscal year, become part of that counties allocation in future fiscal years. Beginning with fiscal year 2014/15, the revised formula applies to both increased and decreased allocations. Again, the Senate version did not contain Subsection C. Moving on to page 76, Item 12B.5, child care market rate adjustments, this is a new House only item, and it adjusts market rates for 3-5 star rated child care centers and homes to 40% of the difference between the current market rates and the 2015 study market rates. Page 76, Item 12B.6, NC pre-k audits, this is new House only item, and addresses an issue regarding…

... duplicative audits by requiring that a local partnership administering the NC pre-k program be subject to audits required under current law. Page 76, item 12B 7, Childcare License Certification by DHHS. This is a new House-only item and allows the division to assume responsibility for issuing certifications for childcare early educators. Moving onto the Division of Social Services, page 76, item 12C.1, Child Protective Services Improvement Initiative. This is a Senate-modified item and it follows the money. Under subsection A, it provides various findings and intent regarding child protective services, and these are based on various findings under the HHS Oversight Committee. Subsections B through F again relate to items that my colleague Deborah Landry referred to, based on the funding for various items under the initiative. Subsection B provides 8.3 in funds for CPS workers to reduce caseloads to the recommended standard. Subsection C provides funds for in-home services for child safety and protection, family preservation and prevention of abuse and neglect. Subsection D provides funds for nine positions to enhance oversight of child welfare services in county DSSs. Subsection E provides funds for a pilot program to enhance coordination of services among the various local agencies involved in child welfare services. It requires a progress report to the Senate and the House of Representatives’ HHS appropriations committees and fiscal by March 1 2015, and requires a final report to HHS Oversight by March 1 2016. Subsections F provides fund for an independent comprehensive statewide evaluation of the state’s CPS system. It list the specific criteria to be evaluated and requires a report to HHS Oversight by January 1 2016. There was just one slight distinction in one of the listed criteria. Instead of saying “any funding needs” under the list, it says “adequacy of funding”. And under subsection D, it requires DSS to study conflicts of interest regarding public guardianships and CPS. This was a recommendation of the HHS Oversight. Again, it lists out the criteria to be studied and requires a report to Senate and House appropriations committees as well as fiscal research by February 1 2015. Page 78, item 12C.2, Clarify Work First Family Assistance Income Levels. This is an item identical to the Senate, and clarifies that Work First Family Assistance income eligibility and payment levels remain unchanged from the levels in the 2013-14 fiscal year. Page 79, item 12C.3, Eastern Band of Cherokee Indians, Assumption by Tribe of Various Human Services. This is an item identical to the Senate. Under subsection B it provides the purpose, which is the enable to eastern band of Cherokee Indians to assume responsibility of certain human services. Under subsection B, it provides that beginning October 1 2014, the tribe will begin assuming responsibilities for the Supplemental Nutrition Assistance Program, or SNAP, and in doing so, state laws relating to the provision of SNAP services by the county DSS for members of the tribe shall not apply to the tribe, and the responsibilities relating to SNAP are delegated to the tribe. It also provides that by October 1 2014, and with the exception of services related to special assistance, childcare and adult care homes, the tribe shall assume responsibilities for certain other programs of public assistance, and in doing so, again, the state laws relating to the provision of those services will no longer apply to the tribe, and the responsibilities relating to those programs will be delegated to the tribe as well. Subsection C revises the law to add a new subsection to require that once a federally-recognized tribe assumes responsibilities of certain human services programs previously performed by a county, the county is no longer legally responsible. Subsection D revises current law…

Speaker: …regarding allocations of nonfederal shares, and requires that the when the tribe assumes responsibility, meaning the Eastern [xx] Cherokee tribe - they assume responsibility, non federal matching funds designated to Jackson and Swayne counties for serving the tribe previously, which was the tribe’s responsibility previously, excuse me, the previous responsibility of the state, those funds are going to be directly allocated to the tribe, and any portion of non federal matching funds born by counties for the public assistance and social services, that part is now going to be born by the tribe itself. And lastly, under Subsection E, it requires DMA to submit to CMS any medical spas necessary to effect change in this section by October 1, 2014, with the spas to be effective no later than October 1,2015. It also allows DMA to request waivers to the extent services, under the waivers would be 100% federally funded. Page 80, Item 12C.4, expiration of terms, social services commission, this is a new House only item, and it revises current law that governs membership on a social service commission to have 13 members appointed by the governor and a general assembly: 5 of those appointments will come from the governor, 4 from the speaker, and 4 from the president pro tim. It also further requires each appointing authority to appoint at least one member form the east, west and central regions of the state. Subsection B expires the terms of all current members on the commission: it requires appointment of members in accordance with this subsection by October 1, 2014. And lastly, if you will turn ahead with me, I am going to cover the block grants provision, this is on page 102 of your provision packet. Page 102, Item 12J.1, block grants, this revises the HHS block grants and it also follows the money. Just to give some highlights: it appropriates nearly $93 million+ grant funds for the 2014/2015 fiscal year. A few items of note: it provides NC pre-k swap out of 10 block grant funds that matches the reduction of general fund appropriations, it increases funding of child subsidy in the child care development block grant, and 10 contingency block grants as well. In the provisions, beginning on page 114, there is a clarification to the requirements of the outreach plan, and that is to Subsection 12J.1T, regarding the low income energy assistance program block grant, and the change to the outreach plan is to ensure eligible households are made of assistance, ensure the plan includes efforts by county DSS’s in contacting other local agencies, outreach and the receipt of applications, and it also requires prior approval of the plan by county DSS or the human services board. And lastly, there is also funding provided to establish a calling center for veterans. Mr. Chair, that concludes my remarks, and my colleague, Mr. Ryan Blackridge will continue with DMA. Chairman: Thank you Ms. Wilkes, and we will call on Mr. Blackridge. Blackridge: Mr. Chair, members of the committee, Ryan Blackridge. I am going to cover about half the Medicaid provisions and then Jennifer Hillman is going to come up and cover the rest. Medicaid is on page 91, it starts with 21H.1. You will recall, when we went through the Senate Budget, the Senate had a very lengthy 12H.1 which called for both reform, and for some reorganization of the department. This provision does neither of those, instead, it states that the $1 million, dedicated to Medicaid, may only be used for remain, not for any other purpose. Sections 12H.2, 12H.4, 12H.5, 12H.6, are all identical to what was in the Senate, and in the interest of time I will just mention that and if you have any specific questions we can address those later. Turn to page 92 please, Section 12H.8 deals with drug reimbursements…

Speaker: …the federal government is considering switching to average acquisition costs. It is a different methodology than what we currently use in the state. Just as a reminder for drug pricing, there is the cost of the ingredients that the state pays, and there is also the cost to dispense the drugs. Average acquisition is going to be lower ingredient cost as what we have right now. So what this provision does says if the federal government does make that change then the department needs to increase the dispensing fees so that, on the whole, the change is budget neutral for the pharmacists. The Senate provision wasn’t conditioned on the federal government requiring the change, instead, it made it effective January 1, and it required a savings of, I believe, $975,000. So again, the House version is budget neutral on adjusting those dispensing fees. Section 12H.10 is a contracted study of personal care services. Most of this language was in the Senate version. The Senate version had this study, but additionally had some adjustments to the rates that Steve already talked about in the money report. The House version does not have those adjustments. Over on page 93, 12H.11, that is identical to the Senate. There is a statutory requirement for report – just haven’t been receiving it. This is a directive to the department to reinstate those. Section 12H.12 deals with regional base rates. This is different from what the Senate did. The Senate required a shift to a state wide based rate for hospital services. This modifies last year’s budget provision to require the department to perform a study of what those rates might be, and then come back and report those. Continuing on page 93, 12H.13: this provision deals with the supplemental payments to UNC and ECU physicians. This is very similar to what the Senate had, with two changes that I would like to point out: on the top of page 94, lines 1 and 2, an additional requirement that the supplemental payments shall not be made for services provided in Wake County; and also down on line 28-30, you will see two percentages, those percentages are different than what was in the Senate, which had 28.5% - that corresponded to a percentage change on the hospital provider assessment program that the Senate made and the House does not make that change, so it retains that 25.9%, which is what the hospitals currently pay under their assessment. 12H.14, Subsections A and B are the same as the Senate’s, it is a repeal of the shared savings but it does maintain a 3% rate withhold. It clarifies that withhold although is a true reduction. At the top of page 95, though I would like to point out: line 8, the item there, i.e. nursing homes, is struck through, that means that nursing homes, effective January 1, 2015 will get their 3% back. This differs from what the Senate had, which struck through items 4-7, that’s optical services and supplies, podiatry, chiropractors and hearing aids. Section 12H.18 is new to the House. The Senate had something different – it had the [xx] LMEO assessment – that’s not included in this budget; instead, there is here an assessment on 1915C innovation waivers. There is currently an assessment on intermediate care facilities for individuals with mental retardation, also known as IFCMR. There is an assessment on those entities, but the 1915C innovation waivers are an alternative to that. So there are several states that are trying to get the federal government to allow an assessment on those services. The federal government currently does not allow that. What this provision does is give three year authorization to the department to implement those waivers if the providers of the services are agreeable to the implementation. So it is conditional on federal government, changing law regulation, and also those providers agreeing to it. I would like to talk about one more provision, before Jennifer comes up, that is over on page 100, 12H.36. There is a provision here regarding the appointment and confirmation of the Medicaid director.

This is new to the House. It would require that the Medicaid director position be recommended by the Secretary of Health and Human Services, actually appointed by the Governor, but subject to confirmation by the General Assembly. There’s some additional details here on some of the mechanics. It would be an appointment for a five-year term, and they can be removed for some of the grounds that are set forth for removal for commission such as malfeasance and nonfeasance, but the idea with this is that it would be a five-year term of office. With that, Mr. Chair, Jennifer Hillman will cover the rest of Medicaid. [SPEAKER CHANGES] Thank you, Mr. Blacklidge. Ms. Hillman. [SPEAKER CHANGES] Thank you Mr. Chair, members of the committee. My name is Jennifer Hillman. I’m with the research division. I’m going to continue on with 12H.20, which begins on the bottom of page 95 in your packet. This is a Senate-modified item. The Senate provided for the elimination of the CC&C contract, and this House provision instead directs DHHS to submit – sorry, to draft wavers, to allow primary case management entities such as CC&C to require duel eligibles to enroll in primary case management programs. It also allows LME-MCOs to do primary care case management for duel eligibles with a primary diagnosis of mental illness. It requires a report of the draft wavers to the appropriations subcommittees. Item 12H.21 is a Senate identical item. It was also a recommendation of the LOC. 12H.22 on page 97 is a Senate-modified item. It requires the consolidation of program integrity contracts into one program integrity contract covering the functions of post-payment review, data analytics, medical necessity reviews, investigations, recovery audit contracts and pre-payment reviews beginning September 1st 2015, and prohibits the department from entering into contracts for these functions that would extend beyond that date. 12H.26 on page 97 is a Senate identical item. It clarifies that DHHS may include two related findings in one notice of overpayment, and clarifies that DHHS may use contractors to send notices to providers. 12H.27 on page 98 is a Senate-modified item. The Senate version made additional changes to the recipient appeals process including shortening the deadline for filing an appeal, but the House provision only makes one change which would allow for the dismissal of a case – of a recipient appeal case – if the recipient requests mediation but does not attend the mediation without good cause. 12H.30 on page 98 is a Senate identical item that follows the money. 12H.31 on page 99 is a new House provision that requires DHHS to issue a request for proposal for a contract to manage the statewide non-emergency medical transportation services, beginning January 1st 2015. 12H.32 is a new House provision that directs DHHS to study the practice of reimbursing for ambulance transports that would direct individuals in mental health crisis from the emergency department to an alternative appropriate location for care. DHHS is to examine current pilots, including the Wake County advanced practice paramedics pilot, and requires a report on the findings to the appropriations subcommittees. 12H.33 follows the money. It requires DHHS to reimburse for the ParaGard IUD using the same methodology as used for other IUDs. 12H.34 is a new House provision. It directs DHHS to report on the PACE program. It actually requires two reports – one in September of 2014 and one in December. It requires a report on the number of individuals who are being served and in which service area they’re being served, the cost of serving them, cost of serving them in the PACE program as compared to cost of serving them in a nursing home, as well as a proposal of how to make the program more sustainable. And then 12H.35 is a new House provision that would exempt individuals who are currently served by the 1915 BC waivers from the Medicaid county of origin requirement. It requires individuals to be served based on their current county of residence and requires that 1915 C slots be portable on counties. And that concludes the Medicaid provisions, and I believe that concludes our review of…

All the provisions. [SPEAKER CHANGE] Thank you very much. The staff, both fiscal research and the legislative drafting staff have worked very very hard and very long hours over the past few weeks so thank you for not only the reports this morning but the work that you’ve been doing over the last few months. Okay we will open it up to questions by the committee members. We’ll start with Representative Insko. [SPEAKER CHANGE] Thank you Mr. Chairman. I think I asked this question earlier maybe during the senate presentation but I’m interested in the swap money for TANF. It looks like either that we got new TANF money in or else that we have cut some programs that were funded by TANF earlier so if you could clarify that again for me. [SPEAKER CHANGE] Ms. Landry. [SPEAKER CHANGE] Yes sir Deborah Landry with fiscal research. There is an additional about $7 million more in regular TANF funds and then there are additional TANF emergency contingency funds also that were received by the state in order to do these swap outs so there is no cut to any programs. [SPEAKER CHANGE] Other questions? I know we went through this very fast. Representative Earle. [SPEAKER CHANGE] Thank you. I just want to say that I like this budget much better than the last time we were here looking at budgets and I want to thank you for that. I have a couple of questions, I don’t have them all together but one jumps out at me. On page G7 number 22 the decrease in the state county special assistance case load, could somebody help me understand at one point this was a very popular program if I’m thinking about what I think it is, it was a very popular program and it was almost like we had a waiting list for people wanting to get on state county special assistance and be able to stay at home and not have to go to a facility so I’m trying to see if I can get a little explanation as to why the case load has gone down to the point that we can take $4.2 million from that? I don’t know who would address that. [SPEAKER CHANGE] We’re going to ask Ms. Landry if she would respond to that. [SPEAKER CHANGE] Deborah Landry again with fiscal research. There are actually three different special assistance programs or three programs within special assistance. There’s adult care homes, special care unit, and then the in home program. The in home program is continuing to grow but the other two programs have seen reductions in their case loads over this last year and of course when we put together the budget over the last few years there was increases for each of the two years of the biennium so those increases aren’t needed for next year as well as the reduction in the case load in those areas. In home is a lot less expensive even though it’s growing than the adult care home and special care units which are decreasing. [SPEAKER CHANGE] I’m sorry but I’m not sure I understood everything you were saying. Could you? We’re talking about state county special assistance where adults get.. [SPEAKER CHANGE] Follow up? [SPEAKER CHANGE] Follow up, I’m sorry. Where adults get assistance to stay in the home is that? [SPEAKER CHANGE] The state county special assistance program was actually originally created to provide assistance for individuals to be in adult care homes and so the adult care home population had been increasing over the years and then over this last year it’s been decreasing. There’s only a small portion of the program, the in home program was created a few years ago to try to help people stay in the home and it’s a much smaller program out of the whole special assistance program and it does continue to grow, but it’s a less expensive part of the program than the two programs that have a decreasing case load. [SPEAKER CHANGE] Thank you, got you. [SPEAKER CHANGE] Thank you Ms. Landry. Ms. Farmer-Butterfield, Representative Farmer-Butterfield. [SPEAKER CHANGE] Thank you Mr. Chair. My question is on page G18 number 57. I wanted clarity on the statement on the reduction and settlement percentages being factored into the supplemental payments. Could you give me a little bit more specifics in terms of what that will mean to the hospitals involved? [SPEAKER CHANGE] Mr. Owen. [SPEAKER CHANGE] Steve Owen, fiscal research. Currently UNC and Vidant Hospital..

Speaker: …are settled to 100% of the cost, hospitals receive 70%. Reducing them to 70%, as other hospitals, if they are treated as other public hospitals are, what will happen is that the dish plan will actually restore that 100% , the effect of this reduction will actually be felt in the private hospitals, what it will do is remove dish funds that typically go to those hospitals, to restore this, and those hospitals will receive less dish funds, will require them to put in more of their gap plan assessment, so that is where the effect of this particular reduction will be felt. Chairman: Representative Enscoe Rep. Enscoe: Thank you. This is also a question I asked of the Senate Budget, and I do not have the page of that one, the changes in the House changes of the child care subsidy, could somebody tell me how many children will be losing subsidy. I think in the Senate budget, 10,000 lost but we were adding 5,000 back; so, can you tell me under this budget, how many children will be losing subsidy support? Debra Landry: This is Debra Landry again with Fiscal Research. What I can tell you Rep. Enscoe is that over the course of a year, in state fiscal year 1213, the average monthly children receiving subsidy are about 77,000, but over the course of a year, there is over 110,000 different children served. So, the number I have is over the 110,000 different children served. So for ages 0-5, there would have been about 2100 children that would not have received, with the new eligibility, about 9800 for age 6-12, and about 7 for children ages 13+. So, that is about 12,000 children, out of the 110,000 served, that, with the new eligibility, would not have been served. What the House does, by reinvesting those savings into the child care subsidy waiting list, there is about $500,000 that is going towards the subsidy waiting list, which, I will find how many children that is in a second, when we annualize all the changes from the eligibility changes that is reinvested into the market rate and the child care subsidy rate on an ongoing basis, there are about 2100 children that will come off the waiting list. Rep. Enscoe: Okay, thank you. I have a couple of other questions. On #36 in the many report, child and family support teams, so, this is eliminating the administrative support for the school based child and family support teams, and so, I believe you said that program was fully implemented and functioning and that these administrative support positions were not needed because they were only part of the start up? Did I get that right? Denise Thomas: Denise Thomas, fiscal research. Yes, Rep. Enscoe. If you recall a couple years ago, the funding for child support teams was eliminated from the social services budget and the mental health budget, and it was done so because that was only start up funding, and was only provided to about 14 of the 100 counties. It was operating in all 100 counties, and so the other counties were using their own funds and at that time, the funding for those two divisions were eliminated, for the family and child support team. So this eliminates the final child and support team that is there in the department because they were provided to get the program started, initiated, and it has been running for quite some time. So these are no longer needed. Rep. Enscoe: Just a follow up to that question. So, the child and family support teams are functioning across all 100 counties – I would be surprised if they are in every school? Thomas: They are functioning – the initiative is operating in every county Enscoe: Those are school based teams, they are not social services teams – they collaborate with the social services? Thomas: That is correct. It is a collaboration between the LEA’s, the social services, and the health departments. Enscoe: Okay, thank you. Then I have #46, this has to do with a reduction in the LNE general administration…

That was money held in reserve for risk management so do the LME MCOs still have significant fund balances? We’ve looked at that several times so it is true that they have issues with cash flow where they need to actually have money to pay bills before they get reimbursed. [SPEAKER CHANGE] Ms. Thomas [SPEAKER CHANGE] Yes Representative Insko they are still required to have their risk reserves and their fund balances, this is not the risk reserve that each individual LME MCO retains, this was an amount of money that was held at the department in case there was a problem with some financial insolvency by one of the LME MCOs and they needed to pay the providers. [SPEAKER CHANGE] Okay thank you. ??? review the projected Medicaid shortfalls that were in the governor’s budget, the senate budget, and the house budget so we can just sort of see the differences in those and if anyone has any comments to make, I’m not sure how those figures are reached, but if we could just see a difference that would be a help. [SPEAKER CHANGE] Ms. ??? [SPEAKER CHANGE] Representative Insko, ??? on fiscal research. Is your question relevant to this year or to 2015? [SPEAKER CHANGE] Projected shortfalls. [SPEAKER CHANGE] I think she’s talking about the $75 million that we put in there to cover this year’s shortfall. [SPEAKER CHANGE] This year’s shortfall. There are shortfalls projected in both, there is a shortfall this year and the projected shortfall in this year is different. [SPEAKER CHANGE] Correct. What’s being put into the budget in the house budget, the $75 million represents the liabilities that are going to be carried forward from this year, from this fiscal year, which pretty much is the backlog. There will actually be in this fiscal year a cash surplus. We have a backlog of liabilities that amounts to $75,250,000 and that’s what’s being put into the budget. [SPEAKER CHANGE] So are those figures the same in the governor’s budget and the senate budget? [SPEAKER CHANGE] The senate budget had $143.8 million. The difference between the house budget and the senate budget, the senate budget had been forecast using a backlog, the worst case scenario for backlog on claims and enrollment. The house budget used the governor’s backlog numbers to actually run through the model, that’s what’s in the house budget. [SPEAKER CHANGE] How about next year’s budget? Have we come to some agreement what the Medicaid budget will be? Do you project a shortfall for next year too? [SPEAKER CHANGE] The senate budget had $206 million included as a rebase for next year. I believe in the house budget it’s $117.8 million. [SPEAKER CHANGE] That’s correct. [SPEAKER CHANGE] Okay thank you. And I want to make a comment, and I’m not sure where this is, but there’s a provision I believe in the special provision that has a study done of why we are having repeated shortfalls in the MHDDSAS budget and then at the same time, and I don’t know where this is either, you all are asking for MHDDSA to spend $5 million on I believe it’s on establishing crisis services. Did I get that right? Do I have those two things right? So I’m curious about and I think we are concerned about the shortfall and part of the problem is that when we send somebody to a state institution we pay 100% of that and when we have people coming in through the emergency rooms and rotating in and out of the state facilities it’s hard to project how many people it’s going to be so that’s really hard to project how much money is going to have to fund the state facilities. This is a comment, when we have so many people who have mental illness who have no health insurance at all, it’s very hard to get providers to provide care for them and so they end up more often in our emergency rooms and so one way to keep them from going into the emergency rooms and the state institutions is to put more money into our mental health services that are funded for the IPRS system that’s funded..

…percent with state dollars. Our population has grown. We have more people in this state with mental illness problems. If anything we’ve cut that fund. We haven’t expanded it. It makes a lot of sense to me that that division would have a shortfall every year. In addition to that, I’m curious about how you can…I mean I support setting up these crisis centers. I think it’s really important to do that. I’m curious about taking the money out of MHDVSA. Was that? Maybe I’ve got the wrong? [SPEAKER CHANGES] Ms. Thomas. Let’s see if we can clear that up. (metallic noise) [SPEAKER CHANGES] Denise Thomas, fiscal research. Representative (??) the money is not coming out of the division. There are two separate expansion items being provided. One is the 7 million dollars non-reoccurring to address some of those shortfalls and liabilities that is owed to the specifically to the LME NCO’s from prior years. That should help a little with paying them back for community services that they had provided but hadn’t yet been paid for. Then there is that second 5 million dollar reoccurring expansion item specifically for crisis services in an attempt to address all of the people who may be referred to…(interrupted) that is new money to provide new types of crisis services. Particularly, urgent care and facility based services to divert persons from going into the facilities. [SPEAKER CHANGES] And, that will help cut down the shortfall in the division? Because if we can get people provided with services they’re less likely to go into the state institutions. If we could just get them into homes, and with jobs, we would reduce that expense even further. Thank you. [SPEAKER CHANGES] A lot of work by the sub-committee over the last several months on mental health. A lot of that is incorporated into this budget which I think is a very positive step as you say. Mr. Chair? [SPEAKER CHANGES] Thank you Mr. Chair. I want to ask a question about guardianship on page 83. It’s section 12-d 4 around line 25. What, 39 maybe? My question is, are we putting more mandates, un-funded mandates as well as more work on the guardians? If they have to have notaries in terms of the status reports that are already being required in the statutes anyway? Some clerks require that they be notarized, and many don’t. Those who are not in an agency, such as local social services, and don’t have notaries with them in their offices such as the corporate guardians, they’re going to have to make sure that they find someone to notarize them. I believe there’s a cost for notaries. [SPEAKER CHANGES] Ms. Jennings, you want to see if you can respond to that? [SPEAKER CHANGES] Yes, on page 83 there is new language that requires corporations or disinterested public agents to submit more detailed information in their status reports. This is an expansion of the information that will be required. The intent is so that the courts will have better information about the status of these guardianships. One of the issues that we heard during the sub-committee is that there is a need perceived to have greater oversight of these guardianships so that the ward’s best interest would be attended. [SPEAKER CHANGES] Okay, follow up? [SPEAKER CHANGES] Much of this has already been recorded in the reports that I’m familiar with. They were created by people many years ago who had to do them for the courts and there was no formal form in place to use. The thing that I’m particularly looking at here is medical and dental examinations. Those reports, they are many times difficult to get from doctors and dentists who are very busy. I’m thinking that a summary might be realistic and some documentation on attempts to get that information when you don’t get…

… making sure that the courts know that there were several attempts to get that information but it was never provided, or you call and get a summary on the phone from a nurse who never talked to you. I think that might need to be amended somewhat. [SPEAKER CHANGES] We’ll look at that. Representative Ford? [SPEAKER CHANGES] Thank you, Mr. Chairman. Page G7 25, were counties picking up the slack on this, and how many projected workers are we talking about statewide? G7 25. [SPEAKER CHANGES] Ms. Landry? [SPEAKER CHANGES] Representative Ford, the counties in the ?? at one point had 4.5 million dollars directly for child protective services workers. When they lost that money, how each county reacted to it I can’t specify. I’m sure some counties did different things, but they are required to provide child protective services. And then the additional money that’s here was to ensure there was to be about 71 workers to get the caseload down to10 per worker. This was based on old data because the Division of Social Services didn’t have current data, and it was before they lost the federal funds. The counties lost about 23 million dollars in federal funds coming into this year that were used for child protective services and child welfare services, and about 40 counties were over the recommended rate of 10 per county, and many counties even had over 20 per worker. So about 4.8 million dollars would be about 71 workers, so it would be about 140 workers, but some of it will be used to replace money they were receiving for workers, so I can’t say it’ll be that many additional workers. [SPEAKER CHANGES] Thank you. Follow-up? [SPEAKER CHANGES] Proceed. Go ahead. [SPEAKER CHANGES] I know some case workers that had 20 plus, but I thought the recommended caseload was 12, but 10 is… what did the 10 come from? [SPEAKER CHANGES] Ms. Landry? [SPEAKER CHANGES] Deborah Landry again. The 10 is in the Division of Social Services Child Protective Services Manual. They’ve said it’s 10 per worker. [SPEAKER CHANGES] Representative Martin? [SPEAKER CHANGES] Thank you, Mr. Chair. I have a clarifying question I think probably for Ryan on the prescription drugs, and two things. One: we’re not addressing at all the mental health component that was included in the Governor and Senate. Is that correct? [SPEAKER CHANGES] Yes, that is correct. There was a prior authorization requirement in the Senate budget that is not included in this House budget. [SPEAKER CHANGES] Well I’m glad about that; I think that might have cost us more in the long run. And the second one, where you were explaining the changes, just to make sure I understand that there’s not really any change in the House budget on… It’s just if the federal budget changes then there’ll be provisions, so there’s not any change in the prescription drug. [SPEAKER CHANGES] Yes, that is correct. [SPEAKER CHANGES] Thank you, and second question, Mr. Chair? [SPEAKER CHANGES] Proceed. [SPEAKER CHANGES] This is just more of an overview to make sure I understand. Several times we talked about the money is being moved from a grant to a different place, and I heard this will have no impact on services, and I think we talked about an area where it will impact services is possibly on the childcare subsidies where we changed that formula, and in the Senate budget there were provisions that definitely had an impact on eligibility that we did not include in changing our Medicare eligibility, and then there’s several things on personal care services and then on pre-K with the changes. So the bottom line is, can you highlight for me areas where we are decreasing services to individuals in this state that fall out of this budget? It seems to me we’re not really… we’re not eliminating the Wright School, so are there things that come to mind? I think this is well done – great job on the budget overall – but I want to make sure I understand. [SPEAKER CHANGES] Ms. Jacobs back here, behind me. [SPEAKER CHANGES] Representative Martin, member of the committee, you’re correct. The majority of eligibility changes, specifically those that decrease eligibility, are not included in the budget, and those included are changes in state county special assistance, changing how the eligibility was delinked form the maximum payment. Maximum payment is out. The two eligibility changes that were in Medicaid are out. The one area that you mentioned was child protective service, and while I think Deborah gave some specific numbers on how those are changing, it basically is changing who will qualify rather than the number of people who will qualify, and the one primary thing that’s different in the House budget…

…This does not immediately result in people losing their subsidy. It waits until the next time the person is re-applying. Then that eligibility is re-applied. [SPEAKER CHANGES] It is significantly different in the house budget overall than it was in the senate budget? [SPEAKER CHANGES] What about personal care services? There are a number of provisions there. Is there any impact or long term strategy? [SPEAKER CHANGES] Representative (??). I’m sorry, Susan Jacobs, fiscal research. There was a provision that required a reduction in the PCS rate because of the additional fifty dollars that was passed last session. That item is not included. Additional money has been added back into Medicaid rebates in the house budget to take care of not requiring the rate to go down. [SPEAKER CHANGES] Representative Earl? [SPEAKER CHANGES] Thank you. My first question is about, not really a total question. It is on G-7 and 8. It is about the child protective services. I’m glad to see that money has been appropriated for to reduce the case load. It looks like 25 all the way to 30 are kind of connected. I’m just glad to see money has been put there to reduce the case load. I guess my question and my concern is about the number 26, the oversight and the evaluation. The oversight. Do we get any kind of follow up on that oversight? Specifically, I see where it says that they’re going to be looking at, but I’m still concerned. I’m very disturbed about what’s happening with our children across the state. It’s always something where a worker didn’t follow up with information that they received. There’s something going on in Mecklenberg in Gaston County right now and it’s just terrible. This oversight. Who gets a report on the oversight that is currently being done and what this additional funding… I mean, will we get to see what they…what they’re looking at? What the results of this oversight. I see where the evaluation. We’ll get that in a year and half. I’m just concerned about the oversight. If they’re just reporting to each other what they’re finding. It’s still going to mean where the system is going to get better. To me there ought to be more answers. Better than what we’re doing now. [SPEAKER CHANGES] Ms. Landry? [SPEAKER CHANGES] Yes sir. Deborah Landry, fiscal research. On item 26 of the hands oversight of county child welfare services. This will be under a division of social services that will be have the staff. There will be staff that goes out into the county. The division of social services does have some reporting online. There is not any specific reporting, special divisions at this point from this. [SPEAKER CHANGES] Is there something… [SPEAKER CHANGES] Follow up. [SPEAKER CHANGES] Excuse me, I’m sorry. Is there something that maybe we could put in a provision that will get us more feedback information of the report with the oversight? I’m just not happy with what’s going on across the state with our children. As far as abuse and neglect. [SPEAKER CHANGES] Representative. Members of the Committee. Susan Jacobs in fiscal research. You pointed to item 28 which is the child protective services state wide evaluation. I will tell you that fiscal research thinks that this is a critical item. We want to be in a position to help make recommendations to the general assembly on how to improve the child welfare system. We believe that this evaluation needs to include both the state functions as well as the county functions. There’s a long time allowed for this because we wanted it to include both the state and county functions. We hope Representative Earl that after this evaluation is complete, we’ll be in a better position to inform both LOC as well as the general assembly appropriations committee on where you can actually make improvements. Frankly, it is a matter of not having all the data that we need to be able to evaluate which counties where we are lacking…

We hope that this evaluation will help that. [SPEAKER CHANGES] Follow up? [SPEAKER CHANGES] Thank you, I want to move to another issue. About the tribe. Is this something that the federal government is directing us to do or is this something that the tribe is requesting. Or, is this something that we are imposing on them. I just don’t quiet understand. [SPEAKER CHANGES] Ms. Wilks? [SPEAKER CHANGES] Lisa Wilks, legislative drafting. Representative Earl, as we understand it, this is something the tribe has requested regarding this transition. They have already transitioned and are in the process of doing other functions and this is just additional responsibility that they are ready to begin the process of assuming. [SPEAKER CHANGES] We were told they were already doing it. They asked for this provision. [SPEAKER CHANGES] One more follow up. The liabilities … I’m sorry. It’s about the unpaid LME liabilities on number 49 on G14. That 7.2 million dollars that’s going to be given to them for I guess the unpaid liabilities. Now, if some of these LME’s I’m assuming this is liabilities that they have incurred over the past whatever. Some of these LME’s have I guess merged or done something that they no longer exist as they did at that point. Where is this money going to be going to and does it just, whatever the liability was going to be at this point does it still apply? Or was it just going to one entity? If you could just explain to me how that’s going to be used. [SPEAKER CHANGES] Before we go to stand, just a reminder that we are approaching the noon hour and we will break. If you have any requested amendments please go ahead and proceed to get those to the stand. They can work on those over the next hour. Ms. Thomas? [SPEAKER CHANGES] Denise Thomas, fiscal research. Representative Earl, we haven’t received an up to date listing of the individual liabilities. But, at one point it was almost 20 million dollars that was owed to about ten of the LME NCOs. Right now, as written the flexibility is left up to the department as far as how they would use this one time money to pay back those LME NCOs. [SPEAKER CHANGES] Representative Martin you have one last question and then we’ll break. [SPEAKER CHANGES] Thank you. This is another general one on all the administrative savings that we are asking the department to come up with. It sounds like they are mostly coming from vacant positions, were there any positions that were eliminated? Secondly, we have a lot of discussion in the oversight committee on IT issues. I see in here we’re funding these programs and not other programs. Is there a comfort level that we have the money needed for IT or is that covered in a separate budget? [SPEAKER CHANGES] Ms. Jacobs? [SPEAKER CHANGES] Representative Martin and members of the committee. The two IT systems that were included for funding in the governor’s recommended budget are being identified and paid for with receipts. They are included at the governor’s recommended amount. Of course you have a separate IT section in the complete money report that we had an analyst in our division call in and can probably give you some information on how the statewide IT funds are being handled. As of right now, in the Senate budget. [SPEAKER CHANGES] We need to break. The Sergeant at Arms will secure the room over the lunch break. We will need to clear the room and then we’ll start back probably about one o’clock and go through any amendments. If we finish early that’s okay too. We’ll leave early. Thank you very much. [SPEAKER CHANGES] Ladies and gentleman if you would please take your seat. We will be starting momentarily. We are in the process of getting everyone into positions to start on their amendments for this afternoon.

While we’re waiting to get the amendments logged in, I’d like to welcome a new group of pages for this afternoon. When I call your name, if you would please stand and be recognized. Halley Turner, Mecklenburg County. Chad Wiley, Wake County. Taylor Nordon, Wake County. Zacheas Raspberry, did I get that right, from Lenore? And Tate Repeledge, from Wake County. Thank you guys for being here. [PAUSE] We’ll start with an amendment put forth by Representative Susan Martin, S 744-AMG-49 version 1. It’s being distributed to committee members. [PAUSE] Representative Martin, would you explain your amendment please, ma’am? [SPEAKER CHANGES] Representative Avila? [SPEAKER CHANGES] I’m sorry, yes ma’am. [SPEAKER CHANGES] I think they’ve distributed my amendment? [SPEAKER CHANGES] I’ve got it. Yes ma’am. [SPEAKER CHANGES] Okay. Thank you. This is a very simple amendment. It’s on page 89, dealing with a facility based crisis. This came up earlier today. The work that we did in the mental health subcommittee, where I was able to co-chair, and then since that time we’ve had a working group with the department in trying to figure out how to move that forward, and this is just a very minor change in the wording of that, the outpatient crisis services and facility based crisis services could be co-located, or operationally linked. And this is just a practicality, that they’re not always the same, in the same building. So operationally linked is recommended by the department in order to make this happen, and I would ask your support of the amendment. [SPEAKER CHANGES] Thank you Representative Martin. Are there any questions from committee members regarding the proposed amendment? If not, then all those in favor please say aye. All those opposed please say no. The amendment passes. [SPEAKER CHANGES] Next we will take up an amendment by Representative Insko. S44-ALU-29 version 4. Representative Insko, would you please explain your amendment? [SPEAKER CHANGES] Thank you, Madame Chair. Members, if you will look on the budget bill, page 109 line 12 and 13, you will see that there’s an increase in the appropriation to the Carolina pregnancy care fellowship. This is actually an umbrella group that has a network of pregnancy crisis centers across the state. And my amendment has to do

With the services that are provided, not just by those organizations, but by any organization in the state ,including Planned Parenthood, that provide reproductive healthcare services or educational reproductive healthcare counseling. First of all, there’s a misunderstanding about abortion in general. I was on an airplane one time, flying somewhere, and the woman across the aisle from me was having a conversation with her seat mate. And she was talking about a presidential candidate who was pro abortion. And so, I did say, “I happen to know that person and that person’s not pro abortion and as a matter of fact, no one is pro abortion.” That we all would like to reduce the number of abortions. And so I am fine with crisis pregnancy centers that help women who want to have their pregnancy go to full term, who want to have their child adopted, who want to go ahead and raise that child. I think that any Planned Parenthood, also if a person goes into Planned Parenthood, and they want to put their child up for adoption, Planned Parenthood facilitates that. If they want to keep that child, Planned Parenthood facilitates that. But some of the crisis pregnancy centers do not provide information on both sides of the issue. For example, one of my earlier sessions here in the General Assembly, it was brought to my attention that some crisis counseling centers only talk about the dangers of abortion and how abortion is dangerous. I mean any health condition is dangerous. But it’s also true that carrying a child to term and having a child, child birth, is actually more dangerous, creates more healthcare problems and more deaths than abortion. And so it’s really important for people to provide both sides, non-directive, medically correct health information. And so that's all this amendment does is just says that anyone whose receiving tax payer dollars under the Maternal and Child Health Block Grant, should provide comprehensive, non directive reproductive healthcare counseling. So if there’s any Planned Parenthood organization that’s not providing options about adoption, and carrying your child to term, this would require them to do that. And if there’s any crisis center that’s not talking about the options, especially of contraceptive health, they would be required to do that. So this is a neutral amendment and I hope you’ll support it. [SPEAKER CHANGES] Are there any questions from members of the Committee? Representative Farmer-Butterfield. [SPEAKER CHANGES] I wanted to ask the sponsor of the amendment a question. [SPEAKER CHANGES] Yield. [SPEAKER CHANGES] Representative Insko, could you tell me what the opposite that’s going on right now. [SPEAKER CHANGES] I beg your pardon. [SPEAKER CHANGES] Could you give me an example of how it’s being done right now. [SPEAKER CHANGES] Well, I’m sure that there’s a variety. First of all, the crisis pregnancy centers really are not healthcare providers. They’re not licensed healthcare providers. Some of them have a medical staff associated with them, some of them don’t. And so typically, at least some of them, will require a person to watch a film that talks about the dangers of abortion. But it’s really one sided. And, with tax payer dollars, that’s not neutral. It doesn’t explain all the options that a person has and doesn’t really provide a person to make an informed decision on their own. So that’s my goal is that a person has all the options laid out and they can make a informed decision. [SPEAKER CHANGES] Any further questions? Representative Ford. [SPEAKER CHANGES] Statement. I don’t see how having a baby can cause more deaths than killing the baby. And with that being said I’ll be voting no on this. [SPEAKER CHANGES] Representative Insko. [SPEAKER CHANGES] Well it is…

A matter of fact that childbearing and childbirth is still dangerous. There are still many medical conditions that arise with a pregnancy and with child delivery. And we, our medical profession does a really good job with that, but it’s still true that there are more healthcare problems and more serious problems with actually carrying a child to term and having a birth. That is just a fact of medical care. We do as good a job, but sometimes you don’t intervene in a problem early enough, so I hope that you would vote for this amendment. [SPEAKER CHANGES] Any additional questions or comments? The Chair will take the privilege of making a comment. I question, to some degree, if this is a true budget item, and not a policy issue, and whether it belongs in a budget bill. So, with that said, I still will let it go forward with a vote, but I ask the members to consider making types of policy issues like this when it needs much fuller, complete debate with the full body is something we should avoid. So, at this time I will take a vote. All those in favor signify by saying aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] Those opposed signify by saying no. [SPEAKER CHANGES] No. [SPEAKER CHANGES] The motion fails. At this time the committee will be at ease for a few minutes while we check to see if we have any additional amendments. The committee will come back to order, and will somebody check outside and see if it’s snowing. We have no more amendments. At this time I’d like to make a motion. I move that the House Appropriation Subcommittee on Health and Human Services adopt the Appropriation Subcommittee report as amended. And further move that the staff be authorized to make technical corrections and conforming changes related to reconciling the various amendments adopted. And that the appropriate totals may be adjusted accordingly. All those in favor. [SPEAKER CHANGES] I would just like to speak on that motion, if I may. [SPEAKER CHANGES] By all means. [SPEAKER CHANGES] I would to, once again, compliment the Chairs of the Health and Human Service Appropriation Subcommittee for doing a really good job. You did a good job last year on the budget, and you followed this year with another good budget. So, thanks a lot for your work. [SPEAKER CHANGES] Any further comments or. We don’t mind hearing more kudos. By all means, please. I want to make those midnight meeting endings worth it. So, therefore, motion to approve, as stated earlier, those would signify by saying yes if you’re in favor of it. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] Yes. All those opposed. Motion carries. Thank you very much. There being no further business that I know of, meeting is adjourned.