GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

H	1 

HOUSE BILL 1457

Short Title:  Health Care Access Grants.	(Public)
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Sponsors: Representatives Edwards, C. Wilson; Arnold, Balmer, Barbee, Berry, J. Brown, Ellis, Grady, Hayes, Ives, J. Preston, Tallent, and G. Thompson.
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Referred to:  Appropriations.
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May 17, 1993

A BILL TO BE ENTITLED
AN ACT TO APPROPRIATE FUNDS TO THE DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES TO EXPAND ACCESS TO PREVENTIVE AND PRIMARY CARE PROVIDED BY LOCAL HEALTH DEPARTMENTS AND NONPROFIT COMMUNITY HEALTH CENTERS.
Whereas, over one million two hundred thousand North Carolinians either have no health care insurance coverage or are underinsured for health care; and
Whereas, providing access to preventive health care is an effective and efficient means of reducing long-range health care costs to the individual and to the State; and
Whereas, services of local health departments and nonprofit community health centers have long focused on preventive care, and more recently, in response to the health care insurance crisis, these agencies have also been providing primary care to uninsured persons; and
Whereas, State support of local health departments has not kept pace with demands for services; and
Whereas, in many rural communities, the local health department is the only source of affordable primary and preventive care for uninsured and underinsured persons; and
Whereas, expanding the availability of preventive and primary care services in local health departments and nonprofit community health centers located in rural areas would provide uninsured and underinsured North Carolinians in those areas with access to preventive and primary care services during the period when the State and federal government are attempting to address the access to health care crisis; Now, therefore,
The General Assembly of North Carolina enacts:
Section 1. (a) There is established in the Department of Environment, Health, and Natural Resources the Access to Preventive and Primary Care Grant Program.  The purpose of the Program is to expand access of eligible persons to preventive and primary health care services provided through local health departments and nonprofit community health centers. The Program will be a pilot program implemented in 10 rural counties that apply for grant funding.  The Program will be subject to renewal and expansion based upon Program outcomes and available resources.  The Program shall address the following:
(1)	During the first two years of implementation, 10 rural counties will be selected by the Department to receive grants.  The maximum amount that may be awarded to one county during the first two years is five million eight hundred one thousand six hundred dollars ($5,801,600).  Counties will be selected for participation from county applications and will be based upon:
a.	Demonstrated need;
b.	Feasibility of implementation, including easy access by eligible recipients in terms of transportation and access to services in evenings and on weekends;
c.	Evidence of provider collaboration, especially the use of mid-level providers for primary care services; and
d.	Demonstrated commitment to preventive health services in the community.
(2)	Counties selected will provide primary and preventive services delivered at local health departments and nonprofit community health centers by licensed physicians, physician assistants, nurse practitioners, and other mid-level providers approved by the Department.
(3)	Services reimbursable from Grant funds shall include:
a.	Office visits;
b.	Limited lab and radiology services;
c.	Periodic physical examinations;
d.	Prenatal and maternity care;
e.	Well baby visits;
f.	Childhood immunizations;
g.	Mammograms and pap smears;
h.	Cholesterol screening;
i.	Colon screening;
j.	Adult vaccinations; and
k.	Dental health care. 
(4)	Eligibility for services under the Program will be based upon the financial resources of the individual or family being served.  Primary and preventive care services will be provided to individuals and families whose total annual incomes do not exceed one hundred percent (100%) of the federal poverty guidelines.  Primary care services will be subject to a patient copayment that shall be determined on a sliding fee scale for each encounter.  Preventive care services shall have no copayment requirement.  Services to individuals and families whose total annual incomes exceed one hundred percent (100%) of poverty will be subject to a sliding fee scale for the services.  Prescription drugs shall be provided without copayment, and shall be dispensed by Medicaid pharmacies pursuant to the Medicaid fee schedule paid to the pharmacy.
(5)	Grant recipients will be required to demonstrate that patients requiring services beyond those covered under the Program will be served, to the extent possible, within the county.  These services include, but are not limited to, hospital care and laboratory and other diagnostic services not available under the Program.
Sec. 2. There is appropriated from the General Fund to the Department of Environment, Health, and Natural Resources the sum of twenty-four million eight hundred sixty-four thousand dollars ($24,864,000) for the 1993-94 fiscal year and the sum of thirty-three million one hundred fifty-two thousand dollars ($33,152,000) for the 1994-95 fiscal year for implementation of the Access to Preventive and Primary Care Grant Program established under Section 1 of this act.
Sec. 3. There is appropriated from the General Fund to the Department of Environment, Health, and Natural Resources the sum of five million dollars ($5,000,000) for the 1993-94 fiscal year and the sum of five million dollars ($5,000,000) for the 1994-95 fiscal year for allocation to county health departments that apply to the Department for matching funds under this section.  Funds allocated under this section shall be used to enable local health departments to expand their hours of service to the community by not less than 12 additional hours of operation per week.  The additional hours shall be used exclusively to provide some or all of the following preventive health services:
(1)	Prenatal and maternity care;
(2)	Well baby visits;
(3)	Childhood immunizations;
(4)	Mammograms and pap smears;
(5)	Cholesterol screening;
(6)	Colon screening;
(7)	Adult vaccinations; and
(8)	Dental health care.
Funds allocated under this section shall be matched by counties at the rate of one dollar ($1.00) of county funds for every three dollars ($3.00) of State funds.  Funds allocated under this section shall be used to supplement and not supplant federal, State, and local funds appropriated for local health departments. 
Sec. 4. The Department shall report to the General Assembly on or before January 1, 1995, on the use of funds appropriated under Sections 2 and 3 of this act.  The report shall include:
(1)	Number of counties that applied for grant and matching funds;
(2)	Number of counties that qualified for funds but did not receive them because funds were limited;
(3)	Services to be provided in each county receiving funds, including numbers of persons expected to be served;
(4)	Recommendations regarding continuation and expansion of the grant and matching funds programs, including appropriation amounts necessary to continue and expand the programs; and
(5)	Recommendations on the feasibility of requiring private health coverage to reimburse local health departments and community health centers for services provided under Sections 1 and 2 of this act.
Sec. 5. This act becomes effective July 1, 1993.