Saturday, May 9, 2009

Friday Wrap Up: Committee Meetings, Bill Updates and Other Information

House Health and Human Services Appropriations Subcommittee:
On Tuesday, May 5, 2009 the House Health and Human Services Appropriations Subcommittee met for the last time before the House releases its budget proposal.
The primary reason for the committee meeting was for members to discuss programs that they individually feel are important to continue funding or to consider programs that may receive cuts.
Schools that are supervised by DHHS were highlighted during this meeting. These schools include; the North Carolina School for the Deaf, the North Carolina Eastern School for the Deaf, Governor Morehead School for the Blind and two schools that serve students with mental illness, Wright and Whittaker.
Representative Farmer Butterfield expressed concerns regarding the consolidation of the deaf schools. The deaf schools are operated in the far west and eastern part of the state. These are residential facilities that transport children home on the weekends. The deaf schools currently serve a total of 205 students. Secretary Cansler stated that if we consolidate the two schools for the deaf with the school for the blind into one school over time the state would see a savings.
Representative Dollar expressed concerns with the proposed closing of the Wright and Whitaker schools centers on the lack of a clear plan for where these children would be served in the community and how the transfer of care for these students would be handled. Representative Insko requested staff to research what other programs in our state could readily provide services for this community and which programs provide residential services equal to the ones provided by Wright and Whitaker.
Representative England expressed concerns regarding long term care and rest home reimbursement rates. Secretary Cansler stated that the department has looked closely at the reimbursement rate and indicated that the study has found a substantial underfunding of that industry. The Department is looking at waivers and other options to assist this industry.
Representative Brisson expressed concerns over the health care personal services authorization. Secretary Cansler expressed that there are some people who need personal care who are not receiving them and those who are receiving them who do not qualify. The Department is looking at the Carolina Center for Medical Excellence in developing plans to ensure that those who need the services qualify and receive them.
The final concerns expressed by members of the committee revolved around the proposed move and long-term merger of More at Four with Smart Start.
Base Budget Appropriations House and Senate:
The House and Senate held a Joint Appropriation Budget meeting on Wednesday, May 6, 2009 to present an updated revenue outlook to the members of the Appropriation committee.
Representative Michaux opened the meeting by stating that we will be hearing bad news and good news. He stated that North Carolina is in dire straits. Representative Michaux stressed that we are facing serious and difficult decisions as we move forward with the budget.
The bad news is that we are facing an additional 1 billion dollar deficit for the current fiscal year. This puts the current deficit for FY2008-2009 at $3.2 billion dollars. The April 15th tax revenue collections were 40% lower than expected. During the previous two recessions the reduced tax revenue collections were between 20-21%.
Fiscal research staff stated that the certified budget for July 2008 was $20.8 billion dollars. In January 2009 the estimated forecast was $18.6 billion dollars. This was the figure used by both the Governor and the Senate in creating their proposed budget plans. The current forecast for May 2009 is $17.5 billion dollars. This is the new base budget goal that must be used as the House creates its budget proposal. This figure is $1.3 billion dollars less that the previous base budget targets. Fiscal research staff stated that for fiscal year 2010-2011 the General Assembly must find an additional $2 billion dollars.
Fiscal research staff stated that their will be a recovery in the fourth quarter of 2009 but it will be fiscal year 2013-2014 before we see another $20 billion dollar budget target.
Representative Michaux closed the meeting by stating that “we had heard the bad news and that the good news is that there might not be more bad news”.

House Health Committee:
On Tuesday, May 5,2009 the House Health committee met to hear two bills of interest are that will create policy regarding smoking in foster care homes.
The first bill is House Bill 692: Establish Policy/Smoking/Foster Care-Cotham
This bill will require the county Departments of Social Services to develop policies on how to address the issue of foster parents who smoke.
This bill was displaced from the calendar. Representative Nelson Dollar expressed concern regarding writing policy before completing a study on this issue. We expect to see this bill come back up next week.
The second bill is House Joint Resolution 694: Study/Smoking Ban/Foster Care Homes-Cotham.
This joint resolution would authorize the Legislative Research Commission to study the impact of a smoking ban in foster care homes.

Representative Tricia Cotham expressed her concern for the health of children who are being placed in foster homes with foster parents that smoke. Committee members did feel that this study should move forward and voted it out of committee with a favorable report. This bill received a serial referral to the rules committee.

Senate Health Care Committee:

This committee will take up Senate Bill 331: MH/National Accred. Benchmarks-Berger.
This bill will make changes to the national accreditation benchmark requirements for certain Medicaid enrolled facilities.

This bill received a committee substitute that changed the title and the intent of the bill. The new bill will permit Five Counties LME to join the state health care plan.
New bill edition:

Senate Mental Health and Youth Services:
This committee will take up Senate Bill 721: Allow Electronic Supervision/MH/DD Facilities-Hoyle.
This bill will require the Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services to adopt rules establishing acceptable electronic supervision standards and alternate staffing requirements at facilities for children and adolescents with mental illness or developmental disabilities during client sleep hours.
This bill received considerable debate. The type of electronic supervision alluded to in this bill would be camera surveillance. Grandfather Home for Children currently uses this type of monitoring during client sleep hours. They are operating this system under a Mental Health Commission waiver that was provided to them in 2008 for one year.
Many of the concerns with this legislation are focused on the breadth of the bill. It includes facilities for children and adolescents with developmental disabilities, some of whom may require personal care during sleep hours. This camera monitoring system may not be appropriate for this population.
This bill will be worked on by Senator Nesbitt and Senator Hoyle and will be re-written so that it is more narrowly focused.

Bills To Watch This Week:

House Floor Vote:
HB 672 Committee Substitute - Earle, Brisson, Hurley and Hughes (Primary Sponsors) -
This bill will require LMEs to hold a public meeting twice a year during their regularly scheduled board meeting to explain how single stream funds were used to serve people with mental illness, developmental disabilities and substance abuse. The second part of the bill deals with state dollars that are used to secure HUD group homes and apartments. The third part of this bill directs the Division of MH/DD/SA to analyze the effectiveness of single stream funding.

House Mental Health Reform:
Tuesday, May 12, 2009 Room Time

H.B. 457 Recommended Approp. MH/DD/SAS Oversight Comm.
This bill is the appropriation suggestions from the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services.

H.B. 458 Recommendations of MH/DD/SA Oversight Comm.
This bill is the special provision suggestions from the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services.

H.B. 600 Mental Health Services for Children/Kids' Care.
This bill will ensure that all children in North Carolina that are eligible for health services under NC Health Choice or NC Kids’ Care will receive mental health services, as recommended by the legislative study commission on children and youth.

H.B. 1086 Guardianship/Incompetency.
This bill will amend the procedures for determining incompetency under the laws relating to guardianship as recommended by the House Study Committee on State Guardianship Laws.

H.B. 1188 Improve LME Accountability.-AB
This act pertains to the appointment of area authority and county program directors and membership on a Local Management Entity Board of Directors.

H.B. 1309 Residential Treatment Facil./TBI.
This bill directs the Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services to adopt rules providing for the licensure and accreditation of residential treatment facilities for persons with traumatic brain injury.

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