GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1995

H	1 

HOUSE BILL 99*

Short Title:  Aging Comm. Sub./Long-Term Care Changes.   	(Public)

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Sponsors: Representatives Edwards; Buchanan, Culp, Gardner, Howard, H. Hunter, and Justus.

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Referred to:  Welfare Reform and Human Resources.

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February 2, 1995

A BILL TO BE ENTITLED
AN ACT TO CREATE THE LONG-TERM CARE SUBCOMMITTEE AND TO PROVIDE FOR THE CREATION OF OTHER SUBCOMMITTEES OF THE NORTH CAROLINA STUDY COMMISSION ON AGING AND TO MAKE CHANGES TO THE LONG-TERM CARE LAW.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 120-186.1 reads as rewritten:
"§ 120-186.1.  Commission; Alzheimer's Subcommittee, Long-Term Care Subcommittee, and other subcommittees.
(a)	The Commission cochairs shall appoint subcommittees as needed to assist with the completion of the work of the Commission.  These subcommittees may include an Alzheimer's Subcommittee, a Long-Term Care Subcommittee, or other special subject subcommittees.  The cochairs shall appoint as members of any subcommittee not more than four Commission members and at least four but no more than six non-Commission members.
(b)	The Commission cochairs shall prescribe the duties of any subcommittee created.  Duties of the Alzheimer's Subcommittee may include conducting studies on the availability and efficacy of currently existing geriatric or memory disorder services and programs, advising the Commission on matters regarding Alzheimer's services and programs, and recommending to the Commission solutions to related problems.  Duties of the Long-Term Care Subcommittee may include developing a long-term care policy for the State that has at least the following elements:
(1)	Promotes elder independence, choice, and dignity;
(2)	Provides a seamless, uniform system of flexible and responsive services;
(3)	Provides single-entry access;
(4)	Includes a wide range of home and community-based services available to all elderly who need them but targeted primarily to the most frail, needy elderly;
(5)	Provides care and services at the least expense in the least confusing manner and based on the desires of the elder population and their families;
(6)	Expands Medicaid income eligibility to allow more services in the home and community;
(7)	Creates a single agency and budget stream to administer services to the elderly; and
(8)	Approaches long-term care within the context of the entire health care system."
Sec. 2.  Part 14B of Article 3 of Chapter 143B of the General Statutes reads as rewritten:
"Part 14B. Long-Term Care.
"§ 143B-181.5. t Long-term care policy.
The North Carolina General Assembly finds that the aging of the population and advanced medical technology have resulted in a growing number of persons who require assistance.  The primary resource for long-term care provision continues to be the family and friends.  However, these traditional caregivers are increasingly employed outside the home.  There is growing demand for improvement and expansion of home and community-based long-term care services to support and complement the services provided by these informal caregivers.
The North Carolina General Assembly further finds that the public interest would best be served by a broad array of long-term care services that support persons who need such services in the home or in the community whenever practicable and that promote individual autonomy, dignity, and choice.
The North Carolina General Assembly finds that as other long-term care options become more available, the relative need for institutional care will stabilize or decline relative to the growing aging population.  The General Assembly recognizes, however, that institutional care will continue to be a critical part of the State's long-term care options and that such services should promote individual dignity, autonomy, and a home-like environment.
"§ 143B-181.6. Purpose and intent.
	It is the North Carolina General Assembly's intent that:
(1)	Long-term care services administered by the Department of Human Resources and other State agencies include a balanced array of health, social, and supportive services that promote individual choice, dignity, and the highest practicable level of independence and that these services be open to all persons regardless of income;
(2)	Home and community-based services be developed, expanded, or maintained in order to meet the needs of consumers and to maximize effective use of limited resources;
(3)	Long-term care services be responsive and appropriate to individual need and also cost-effective for the State;
(4)	Institutional care is provided in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident and timely discharge to a less restrictive care setting when appropriate; and
(5)	State health planning for institutional bed supply take into account increased availability of other home and community-based services options.
"§ 143Bà 
"§ 143Bi 
"§ 143Bi 
"§ 143B-181.9A.  Advisory Committee on Home and Community Care.
(a)	There is established the Advisory Committee on Home and Community Care for Older Adults within the Department of Human Resources.  In order to achieve a coordinated, county-based, full service system for older adults and their families, this Committee shall recommend to the Department of Human Resources and the General Assembly the design and implementation of managed care programs for high-risk older adults at the county level; initiatives and strategies to address the social, income security and employment, mental health, health, and housing needs of at-risk older adults.  To the end of achieving coordinated Programs on Aging in all North Carolina counties that both care for and invest in older adults, the Committee shall make recommendations regarding common service standards and guidelines for county-based Programs on Aging, county aging plans, and managed care programs for high-risk older adults.  These recommendations shall build on the needs and goals developed through local input of all 100 North Carolina counties and with the assistance and consultation of the Area Agencies on Aging and the Division of Aging.
(b)	The Committee shall be guided by the following program and policy goals:
(1) 	To provide high-risk and at-risk older adults and their families with options for quality home and community based care;
(1.1) 	To provide older adults with opportunities for continued productive aging through employment, volunteer, and self-help activities; 
(2) 	To ensure a coordinated and efficient utilization of public and private resources; and
(3) 	To build on the current strengths and initiatives in North Carolina's aging and long-term care service networks.
(c)	The Committee's recommendations will include consideration of the following:
(1) 	Repealed by Session Laws 1991, c. 711, s. 1.
(1.1) 	Comprehensive County-Based Programs on Aging:  the establishment of comprehensive, coordinated county-based programs on aging in all North Carolina counties by the year 2000;
(1.2) 	Managed Care for High-Risk Older Adults:  The establishment of managed care programs for high-risk older adults in all North Carolina counties by the year 2000.  These programs shall provide high-risk older adults with the option of remaining in the least restrictive environment of their choice with the support of a core of supportive home and community services;
(2) 	Repealed by Session Laws 1991, c. 711, s. 1.
(2.1) 	Options for At-Risk Older Adults:  Strategies and initiatives for at-risk older adults that provide them with home and community care options for an improved quality of life in the areas of social functioning, employment and income security, mental health, health care, and housing;
(2.2) 	Investment in Well Older Adults:  Strategies and initiatives for well older adults that facilitate productive aging in the areas of continued employment, volunteerism, and self-help;
(3) 	Coordinated Aging Services Budget:  Compilation of a State aging services budget to coordinate existing program funding sources, to develop a common funding stream, and to identify new funding resources to meet the needs of older adults; and
(4) 	Guidelines, Standards, and Procedures:  To the greatest extent possible, development of compatible service definitions, service standards, assessment instruments, eligibility criteria, reimbursement methods, and reporting requirements for in-home and community based services for older adults, throughout the Department of Human Resources.
(5), 	(6)  Repealed by Session Laws 1991, c. 711, s. 1.
(d)	The Committee shall consist of the Secretary of the Department of Human Resources and 32 members, to be appointed as follows:
(1) 	One member each appointed by the Secretary of the Department of Human Resources from the Divisions of Aging, of Medical Assistance, of Mental Health, Developmental Disabilities, and Substance Abuse Services, of Social Services, and one director of an area agency on aging elected from among all the directors of the area agencies on aging.  One member appointed by the Secretary of Environment, Health, and Natural Resources.
(2) 	One member each appointed by the Secretary of the Department of Human Resources from the North Carolina Institute of Medicine, the North Carolina Health Care Facilities Association, the Center for Aging Research and Educational Services at The University of North Carolina at Chapel Hill, the Long-Term Care Resources Program at Duke University, the North Carolina Association of Long-Term Care Facilities, the North Carolina Association for Home Care, the Center for Creative Retirement, University of North Carolina at Asheville, the Geriatric Medicine Programs at the following institutions: (i) Bowman Gray School of Medicine of Wake Forest University, (ii) the School of Medicine of the University of North Carolina at Chapel Hill, (iii) the School of Medicine at Duke University, and (iv) the School of Medicine at East Carolina University, the North Carolina Association of Continuity of Care, the North Carolina Association of Hospital Social Work Directors, the North Carolina Medical Society, and the North Carolina Hospital Association.
(3) 	One member appointed from the House of Representatives by the Speaker of the House of Representatives;
(4) 	One member appointed from the Senate by the President Pro Tempore of the Senate;
(5) 	One member who is a county commissioner appointed by the Secretary of the Department of Human Resources, upon the recommendation of the North Carolina Association of County Commissioners; and
(6) 	Eight members appointed by the Secretary of the Department of Human Resources, one upon the recommendation of the North Carolina Association on Aging, one other upon the recommendation of the Association of Local Health Directors, one other upon the recommendation of the Association of the County Directors of Social Services, one other upon the recommendation of Hospice of North Carolina, one other from the Governor's Advisory Council on Aging, upon recommendation of that organization, two others upon recommendation of the American Association of Retired Persons, and one other from the North Carolina Senior Citizens Association, upon recommendation of that organization.
The Secretary of the Department of Human Resources shall be Chair of the Committee.  Members shall serve at the pleasure of the Secretary.  Vacancies shall be filled in the same manner as the initial appointment.
(e)	The Committee shall, in performing its charge, develop an annual work plan and convene task forces or work groups comprised of interested State and local public and private service providers, older adult consumer groups, university programs on aging, distinguished gerontologists, and others, as appropriate for making recommendations.
(f)	The Committee shall make a written progress report of every odd-numbered year, beginning in 1991. The report shall be submitted to the Governor, the Lieutenant Governor, the Speaker of the House of Representatives, the President Pro Tempore of the Senate, the Legislative Services Office, and the North Carolina Study Commission on Aging."
Sec. 3.  This act is effective upon ratification.