GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1995

H	1 

HOUSE BILL 287

Short Title:  Health Reform Funds/HPC.	(Public)

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Sponsors: Representatives Dickson, Blue, Wright; Ives, Alexander, Earle, Shaw, Boyd-McIntyre, Wainwright, and Rogers.

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Referred to:  Insurance, if favorable, Appropriations.

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February 23, 1995

A BILL TO BE ENTITLED
AN ACT TO APPROPRIATE FUNDS TO IMPLEMENT THE HEALTH CARE REFORM RECOMMENDATIONS OF THE NORTH CAROLINA HEALTH PLANNING COMMISSION.
The General Assembly of North Carolina enacts:

PART I – PRIMARY CARE
Section 1.1.  (a)	There is appropriated from the General Fund to the Department of Human Resources the sum of ten million three hundred thousand dollars ($10,300,000) for the 1995-96 fiscal year and the sum of twelve million dollars ($12,000,000) for the 1996-97 fiscal year to enhance Medicaid reimbursement for primary care services to eligible primary care providers in areas designated by the Office of Rural Health and Resource Development as medically underserved.  Providers eligible for payments under this subsection shall be those medical doctors, physician assistants, nurse practitioners, or certified nurse midwives whose practice serves a significant proportion of the Medicaid population in the provider's service area, and who provide primary care under the provider's practice of general pediatrics, general internal medicine, family medicine, or obstetrics-gynecology.
(b)	There is appropriated from the General Fund to the Department of Human Resources the sum of six hundred thousand dollars ($600,000) for the 1995-96 fiscal year and the sum of seven hundred thousand dollars ($700,000) for the 1996-97 fiscal year to provide bonus payments to primary care providers in medically underserved areas.  Bonus payments may be awarded only to medical doctors, physician assistants, nurse practitioners, and certified nurse midwives who provide primary care under the practice of general pediatrics, general internal medicine, family medicine, or obstetrics-gynecology, and who meet one or more of the following criteria:
(1)	Participate in a group practice or network;
(2)	Utilize mid-level providers;
(3)	Provide obstetrical services;
(4)	Teach medical students, primary care medical residents, and physician extenders;
(5)	Provide services through the local health department;
(6)	Participate in hospital practice;
(7)	Provide backup services to State rural health clinics;
(8)	Provide nursing home care;
(9)	Establish satellite clinics in medically underserved areas.
Bonus payments made under this subsection shall be in addition to the payments made under subsection (a) of this section.  A provider is eligible to receive bonus payments under one or more of the criteria listed in this subsection.
(c)	In consultation with the Office of Rural Health and the Department of Environment, Health, and Natural Resources, the Department of Human Resources, Division of Medical Assistance, shall adopt rules for the implementation of this section.  
Sec. 1.2.  The Department of Human Resources may combine and allocate funds appropriated for the Office of Rural Health and Resource Development for recruitment and retention of primary care providers in medically underserved areas into one Provider Incentive Fund.  Funds in the Provider Incentive Fund may be allocated for purposes of enhancing recruitment and retention of primary care providers in medically underserved areas and for other purposes related to the enhancement of health services to medically underserved communities.
Sec. 1.3.  There is appropriated from the General Fund to the Department of Human Resources, Office of Rural Health and Resource Development, the sum of one million dollars ($1,000,000) for the 1995-96 fiscal year and the sum of one million dollars ($1,000,000) for the 1996-97 fiscal year for the development and implementation of a locum tenens program in the Office of Rural Health and Resource Development.  Funds shall be used to provide interim clinical services to patients in medically underserved areas during the period that the physicians and other health care providers who serve these patients are away from their practice because of illness, continuing medical education, or vacation.
Sec. 1.4.  (a)	The Department of Human Resources, Office of Rural Health and Resource Development, shall award grants from the Aid for Clinic Construction Program and the Operational Subsidy Program.  Grant funds awarded from these programs shall be used to assist medically underserved communities in constructing and operating health centers in communities where no health centers currently exist, and for capital improvements and operating expenses for existing rural health centers.  Funds allocated for capital expenditures shall be matched by local funds.
(b)	There is appropriated from the General Fund to the Department of Human Resources, Office of Rural Health and Resource Development, the sum of three million dollars ($3,000,000) for the 1995-96 fiscal year and the sum of three million dollars ($3,000,000) for the 1996-97 fiscal year for the allocation of grant funds for the construction and operation of new health centers and for the expansion of existing health centers in medically underserved communities. Of the funds appropriated under this subsection, not more than one million five hundred thousand dollars ($1,500,000) may be allocated in each fiscal year for grants from the Aid for Clinic Construction Program and not more than one million five hundred thousand dollars ($1,500,000) in each fiscal year may be allocated for grants from the Operational Subsidy Program.
(c)	There is appropriated from the General Fund to the Department of Human Resources, Office of Rural Health and Resource Development, the sum of three million seven hundred fifty thousand dollars ($3,750,000) for the 1995-96 fiscal year and the sum of three million seven hundred fifty thousand dollars ($3,750,000) for the 1996-97 fiscal year for grants to assist existing rural health centers in making capital improvements and recruiting and retaining health care providers.  Of the funds appropriated under this subsection, not more than two million dollars ($2,000,000) in each fiscal year may be allocated from the Aid to Clinic Construction Program for capital expenditures and not more than one million seven hundred fifty thousand dollars ($1,750,000) in each fiscal year may be allocated from the Operational Subsidy Program for operational costs to recruit and retain health care providers.  Appropriations made pursuant to this subsection are one-time appropriations and shall not be part of the Department's continuation budget.
Sec. 1.5.  There is appropriated from the General Fund to the Department of Human Resources the sum of one hundred seventy thousand dollars ($170,000) for the 1995-96 fiscal year and the sum of one hundred seventy thousand dollars ($170,000) for the 1996-97 fiscal year to award planning grants to establish incentives that lead to the development of integrated service networks for health care systems serving rural and urban underserved populations. The networks would link primary care facilities, small rural hospitals in small communities, and urban underserved neighborhoods to larger secondary and tertiary care centers.  These linkages would enable small providers to attain the most appropriate intervention services for their patients. The incentives should be aimed at providers in rural and underserved areas and should be designed so that health services in those areas are coordinated and case management provided for at-risk populations.  To be eligible for grant funds, an applicant must be an organization consisting of a consortium of three or more health care providers or facilities, at least two of which are located in a rural, underserved area as defined by the Office of Rural Health and Resource Development.  Of the funds appropriated under this section, the sum of one hundred thousand dollars ($100,000) in each fiscal year may be used for grants, and the sum of seventy thousand dollars ($70,000) in each fiscal year may be used to provide technical assistance to networks and communities. The Department of Human Resources shall, in consultation with the Office of Rural Health and Resource Development and the Department of Environment, Health, and Natural Resources, develop guidelines for awarding the planning grants.

PART II – PRIMARY CARE TRAINING FUNDS
Sec. 2.1.  There is appropriated from the General Fund to the Board of Governors of The University of North Carolina the sum of one million eight hundred thousand dollars ($1,800,000) for the 1995-96 fiscal year and the sum of one million eight hundred thousand dollars ($1,800,000) for the 1996-97 fiscal year to be allocated to health professional schools that offer outreach programs in geographic areas with high percentages of under-represented racial and ethnic groups, or that offer required courses during nontraditional and flexible hours to accommodate students training to be primary care providers who have young families or daytime jobs that interfere with efforts to complete their training in as timely a manner as possible.  As used in this section, the term 'primary care provider' includes physicians, physician assistants, nurse practitioners, and certified nurse midwives.

PART III – MEDICAID EXPANSION
Sec. 3.1.  Effective October 1, 1995, the Department of Human Resources shall, to the fullest extent possible, expand Medicaid coverage to the following groups according to the following priorities:
(1)	Priority one – Infants under the age of one year who are at or below two hundred percent (200%) of the federal poverty level, as adjusted annually;
(2)	Priority two – Elderly and disabled persons who are at or below one hundred percent (100%) of the federal poverty level, as adjusted annually;
(3)	Priority three – Two years' postpartum coverage of women who are at or below one hundred eighty-five percent (185%) of the federal poverty level, as adjusted annually;
(4)	Priority four – Children ages one through five years who are at or below one hundred eighty-five percent (185%) of the federal poverty level, as adjusted annually;
(5)	Priority five – Children ages one through five years who are at or below two hundred percent (200%) of the federal poverty level, as adjusted annually;
(6)	Priority six – Pregnant women who are at or below two hundred percent (200%) of the federal poverty level, as adjusted annually;
(7)	Priority seven – Children ages six through eighteen years who are at or below one hundred thirty-three percent (133%) of the federal poverty level, as adjusted annually;
(8)	Priority eight – Children ages six through eighteen years who are at or below one hundred eighty-five percent (185%) of the federal poverty level, as adjusted annually;
(9)	Priority nine – Children ages six through eighteen years who are at or below two hundred percent (200%) of the federal poverty level, as adjusted annually; 
(10)	Priority ten – Two years' postpartum coverage of women who are at or below two hundred percent (200%) of the federal poverty level, as adjusted annually; and
(11)	Priority eleven – Elderly and disabled persons who are at or below two hundred percent of the federal poverty level, as adjusted annually.
Sec. 3.2.  (a)	There is appropriated from the General Fund to the Department of Human Resources the sum of one hundred forty-seven million eight hundred ninety-one thousand nine hundred sixty-six dollars ($147,891,966) for the 1995-96 fiscal year and the sum of three hundred forty-nine million sixty-nine thousand two hundred sixty-five dollars ($349,069,265) for the 1996-97 fiscal year to implement fully the expansion required by Section 1 of this act.  Of these funds, the following amounts are for the following priority groups:
(1)	Priority one – Five million five hundred thirty-one thousand nine hundred two dollars ($5,531,902) for the 1995-96 fiscal year and seven million nine hundred ninety-five thousand two hundred fifty-four dollars ($7,995,254) for the 1996-97 fiscal year.  Of these funds, eight hundred twenty-nine thousand seven hundred eighty-five dollars ($829,785) for the 1995-96 fiscal year and one million one hundred ninety-nine thousand sixty-three dollars ($1,199,063) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to infants newly eligible as a result of the program expansion authorized under Section 1(1) of this act. 
(2)	Priority two – Four million seven hundred sixty thousand seven hundred fifty-one dollars ($4,760,751) for the 1995-96 fiscal year and  thirteen million sixty-one thousand four hundred forty-nine dollars ($13,061,449) for the 1996-97 fiscal year.  Of these funds, seven hundred fourteen thousand one hundred thirteen dollars ($714,113) for the 1995-96 fiscal year and one million nine hundred fifty-nine thousand two hundred and seventeen dollars ($1,959,217) in the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to elderly and disabled persons eligible as a result of the program expansion authorized under Section 1(2) of this act.
(3)	Priority three – Four million five hundred eighty-one thousand four hundred fifty-eight dollars ($4,581,458) for the 1995-96 fiscal year and eighteen million ninety-three thousand eight hundred two dollars ($18,093,802) for the 1996-97 fiscal year.  Of these funds, six hundred eighty-seven thousand two hundred nineteen dollars ($687,219) in the 1995-96 fiscal year and two million seven hundred thirteen thousand five hundred sixty-one dollars ($2,713,561) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to postpartum women eligible as a result of the program expansion authorized under Section 1(3) of this act. 
(4)	Priority four – Six million one hundred two thousand seven hundred thirty-nine dollars ($6,102,739) for the 1995-96 fiscal year and fourteen million one hundred sixty-one thousand four hundred twenty-six dollars ($14,161,426) for the 1996-97 fiscal year.  Of these funds, nine hundred fifteen thousand four hundred eleven dollars ($915,411) in the 1995-96 fiscal year and two million one hundred twenty-three thousand eight hundred fifteen dollars ($2,123,815) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to children ages one through five eligible as a result of the expansion authorized under Section 1(4) of this act.
(5)	Priority five – One million six hundred seventy-five thousand three hundred ninety-nine dollars ($1,675,399) for the 1995-96 fiscal year and three million eight hundred eighty-seven thousand seven hundred eighty-eight dollars ($3,887,788) for the 1996-97 fiscal year. Of these funds, two hundred fifty-one thousand three hundred ten dollars ($251,310) for the 1995-96 fiscal year and five hundred eighty-three thousand fifty-nine dollars ($583,059) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to children ages one through five years newly eligible as a result of the program expansion authorized under Section 1(5) of this act.  
(6)	Priority six – Two million four hundred four thousand four hundred eighty-four dollars ($2,404,484) for the 1995-96 fiscal year and three million four hundred seventy-five thousand one hundred thirty-five dollars ($3,475,135) for the 1996-97 fiscal year.  Of these funds, three hundred sixty thousand six hundred seventy-three dollars ($360,673) for the 1995-96 fiscal year and five hundred twenty-one thousand one hundred seventy-two dollars ($521,172) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to pregnant women  newly eligible as a result of the program expansion authorized under Section 1(6) of this act.  
(7)	Priority seven – Six million six hundred eighty-seven thousand seven hundred ninety-eight dollars ($6,687,798) for the 1995-96 fiscal year and fifteen million seven hundred forty-three thousand four hundred forty-one dollars ($15,743,441) for the 1996-97 fiscal year. Of these funds, one million three thousand one hundred seventy dollars ($1,003,170) for the 1995-96 fiscal year and two million three hundred sixty-one thousand seventy-three dollars ($2,361,073) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to children ages six through eighteen years newly eligible as a result of the program expansion authorized under Section 1(7) of this act.  
(8)	Priority eight – Seventeen million nine hundred twenty-six thousand seven hundred six dollars ($17,926,706) for the 1995-96 fiscal year and forty-two million forty-five thousand dollars eight hundred fifty-four ($42,045,854) for the 1996-97 fiscal year.  Of these funds, two million six hundred eighty-nine thousand six dollars ($2,689,006) for the 1995-96 fiscal year and six million three hundred five thousand ninety-seven dollars ($6,305,097) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to children ages six through eighteen years newly eligible as a result of the program expansion authorized under Section 1(8) of this act.
(9)	Priority nine – Two million two hundred forty-two thousand eight hundred seventeen dollars ($2,242,817) for the 1995-96 fiscal year and five million five hundred eighty-eight thousand nine hundred six dollars ($5,588,906) for the 1996-97 fiscal year.  Of these funds, three hundred thirty-six thousand four hundred twenty-three dollars ($336,423) for the 1995-96 fiscal year and eight hundred thirty-eight thousand one hundred seventy-nine dollars ($838,179) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to children ages six through eighteen years newly eligible as a result of the program expansion authorized under Section 1(9) of this act.
(10)	Priority ten – Four hundred eighty-seven thousand five hundred forty-two dollars ($487,542) for the 1995-96 fiscal year and six hundred seventy-one thousand seven hundred eighty-seven dollars ($671,787) for the 1996-97 fiscal year.  Of these funds, seventy-three thousand one hundred thirty-one dollars ($73,131) for the 1995-96 fiscal year and one hundred thousand seven hundred forty-nine dollars ($100,749) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing postpartum benefits to women newly eligible as a result of the program expansion authorized under Section 1(10) of this act.
(11)	Priority eleven – Ninety-five million four hundred ninety thousand three hundred seventy dollars ($95,490,370) for the 1995-96 fiscal year and two hundred twenty four million three hundred forty-four thousand four hundred twenty-four dollars ($224,344,424) for the 1995-96 fiscal year.  Of these funds, fourteen million three hundred twenty-three thousand five hundred fifty-six dollars ($14,323,556) for the 1995-96 fiscal year and thirty-three million six hundred forty-five thousand three hundred fifty-one dollars ($33,645,351) for the 1996-97 fiscal year shall be allocated to counties as grants-in-aid to offset the costs of providing benefits to elderly and disabled persons newly eligible as a result of the program expansion authorized under Section 1(11) of this act.
(b) The grants-in-aid amount to each county for each priority item shall be calculated by a formula that estimates the county's relative share of the statewide total of new eligibles who qualify due to the program expansion authorized under Section 1 of this act.

PART IV – LOAN GUARANTEES/RURAL HEALTH CARE FACILITIES
Sec. 4.1. (a)	G.S. 131A-4 is amended by inserting a new subdivision to read:
"(8a)	To provide at its discretion, loan guarantees of from fifty percent (50%) to seventy-five percent (75%) of the principal amount borrowed through the Commission by any public or nonprofit agency for rural hospitals and other health care facilities in underserved areas for the development, expansion, renovation, or equipping of physical facilities for more appropriate uses.  The total amount of such guarantee is not to exceed the amount of funds appropriated for this purpose, including any interest earnings thereon, plus any other funds the Commission receives and designates for this purpose."
(b) There is appropriated from the General Fund to the Department of Human Resources the sum of two million five hundred thousand dollars ($2,500,000) for the 1995-96 fiscal year and the sum of two million five hundred thousand dollars ($2,500,000) for the 1996-97 fiscal year to implement this section.

PART V – QUALITY IMPROVEMENT COMMISSION FUNDS
Sec. 5.1. There is appropriated from the General Fund to the Department of Human Resources the sum of one hundred fifty thousand dollars ($150,000) for the 1995-96 fiscal year and the sum of one hundred fifty thousand dollars ($150,000) for the 1996-97 fiscal year for allocation to the North Carolina Quality Improvement Commission for its operations. Funds appropriated under this section are contingent upon enactment of a bill establishing the North Carolina Quality Improvement Commission.

PART VI – HEALTH PLANNING COMMISSION FUNDS
Sec. 6.1.  There is appropriated from the General Fund to the North Carolina Health Planning Commission the sum of eight hundred seventy-five thousand dollars ($875,000) for the 1995-96 fiscal year and the sum of eight hundred seventy-five thousand dollars ($875,000) for the 1996-97 fiscal year for the operations of the Commission.

PART VII – PUBLIC HEALTH FUNDS
Sec. 7.1.  (a)	There is appropriated from the General Fund to the Department of Environment, Health, and Natural Resources, the sum of one million dollars ($1,000,000) for the 1995-96 fiscal year and the sum of one million dollars ($1,000,000) for the 1996-97 fiscal year to be allocated to local governments who apply for funds from the Healthy Community Block Grant Program established pursuant to this section.
(b)	There is established in the Department of Environment, Health, and Natural Resources, Office of the State Health Director, the North Carolina Healthy Community Block Grant Program (hereinafter referred to as "Program" ).  The purpose of the Program is to enable county governments to apply for funds to assist them in addressing public health needs in the county.  The program shall be implemented as follows:
(1)	In order to be eligible for funds, a county must apply to the Department and include with the application a plan for meeting local health priorities determined by the results of a community health assessment conducted by the local health department serving the county and indicating the specific health needs for which funds are applied.  A county may receive funds for one or more of the following core public health functions:
a.	Assessment of community health status, health services, and needs;
b.	Prevention, detection, and remediation of environmental health risks;
c.	Monitoring the adequacy of health facilities and health providers to meet the needs of the community;
d.	Health data collection and evaluation to measure progress toward health outcome objectives;
e.	Promulgation of public health policies and regulations necessary to promote and protect the health of individuals and communities;
f.	Communicable disease investigation and control;
g.	Community education and advocacy for preventive health services;
h.	Provision of essential public health services for all citizens;
i.	Outreach to assure access to all basic health services; and
j.	Provision of clinical health services as needed to assure primary health care for all citizens.
(2)	Funds shall be awarded first on a per capita basis to all eligible counties; if there are funds remaining after all eligible counties have been awarded grants, then the remaining funds may be awarded according to rules established by the Health Services Commission.
(c)	The Department shall report to the General Assembly and the Fiscal Research Division of the Legislative Services Office the amount of funds allocated to each county including additional funds awarded, and the specific purposes for which the funds were allocated.  The Department's initial report shall be submitted on or before April 1, 1996.  Thereafter the report shall be submitted on or before April 1 of each year for which funds were appropriated for that fiscal year for the Program.
Sec. 7.2.  There is appropriated from the General Fund to the Department of Environment, Health, and Natural Resources the sum of three hundred eighty thousand dollars ($380,000) for the 1995-96 fiscal year and the sum of three hundred thirty thousand dollars ($330,000) for the 1996-97 fiscal year to expand the capacity of the State center for Health and Environmental Statistics to provide technical assistance to local health departments in conducting community health assessments.
Sec. 7.3.  There is appropriated from the General Fund to the Department of Environment, Health, and Natural Resources the sum of two million dollars ($2,000,000) for the 1995-96 fiscal year and the sum of two million dollars ($2,000,000) for the 1996-97 fiscal year to improve the availability and quality of case management services for persons living with HIV and AIDS, and to expand AIDS prevention work.  Of this amount, the sum of one million dollars ($1,000,000) shall be allocated for prevention and the sum of one million dollars ($1,000,000) shall be allocated for case management.
Sec. 7.4.  There is appropriated from the General Fund to the Department of Environment, Health, and Natural Resources the sum of two million four hundred thousand dollars ($2,400,000) for the 1995-96 fiscal year and the sum of two million four hundred thousand dollars ($2,400,000) for the 1996-97 fiscal year to be used to provide needed improvements to the Safe Drinking Water Program.

PART VIII – HEALTH DATA COLLECTION FUNDS
Sec. 8.1.  There is appropriated from the General Fund to the Department of Human Resources the sum of three hundred thousand dollars ($300,000) for the 1995-96 fiscal year and the sum of three hundred thousand dollars ($300,000) for the 1996-97 fiscal year to be used for full-time staff positions for the Health Data Policy Council.
Sec. 8.2.  There is appropriated from the General Fund to the Department of Insurance the sum of two million dollars ($2,000,000) for the 1996-97 fiscal year to use electronic data interchange methodology to phase in the cost of expanding data collection from ambulatory care sites as required under G.S. 131G-2-3. 
Sec. 8.3.  There is appropriated from the General Fund to the Department of Human Resources the sum of five hundred thousand dollars ($500,000) for the 1996-97 fiscal year to provide electronic patient identification cards for the Medicaid patient population.  The cards shall be in the form required under G.S. 131G-2-3.
Sec. 8.4.  There is appropriated from the General Fund to the Teachers' and State Employees' Comprehensive Major Medical Plan the sum of five hundred thousand dollars ($500,000) for the 1996-97 fiscal year to provide electronic patient identification cards for State employee members of the Plan.  The cards shall be in the form required under G.S. 131G-2-3.
Sec. 8.5.  There is appropriated from the General Fund to the Department of Insurance the sum of one hundred twenty thousand dollars ($120,000) for the 1995-96 fiscal year and the sum of one hundred twenty thousand dollars ($120,000) for the 1996-97 fiscal year for two additional staff positions to carry out the responsibilities of the North Carolina Health Care Database created under the Health Care Data Coordination and Assessment Act.
Sec. 8.6.  (a)	The North Carolina Health Care Database shall design and implement a program to provide technical, educational, and implementation assistance to health care providers and payers to enable them to transition to the use of electronic data interchange.  The program may include assisting in the development of partnerships with private groups to promote EDI funding and utilization through the State.  It is the intent of the General Assembly that this program will be implemented for a three- to five-year period, as needed to educate payers and providers concerning EDI standards and technology implementation.
(b)	There is appropriated from the General Fund to the Department of Insurance the sum of two hundred thousand dollars ($200,000) for the 1995-96 fiscal year and the sum of two hundred thousand dollars ($200,000) for the 1996-97 fiscal year to be used for design and start-up implementation of the program authorized under this section.

PART IX – EFFECT OF HEADINGS
Sec. 9.1.  The headings to the Parts of this act are a convenience to the reader and are for reference only.  The headings do not expand, limit, or define the text of this act.

PART X – EFFECTIVE DATE
Sec. 10.1.  This act becomes effective July 1, 1995.  Funds appropriated under Sections 8.1 through 8.6 of this act are contingent upon the enactment of a bill enacting the Health Care Data Coordination and Assessment Act.