A BILL TO BE ENTITLED
AN ACT to expand the definition of Home care Services to Include In‑Home Companion, Sitter, and Respite care services provided to an individual and to Increase the annual license fee for Home care Agencies. 
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 131E‑136 reads as rewritten:
"§ 131E‑136.  Definitions.
As used in this Part, unless otherwise specified:
(1)	"Commission" means the North Carolina Medical Care Commission.
(1a)	"Geographic service area" means the geographic area in which a licensed agency provides home care services.
(2)	"Home care agency" means a private or public organization that provides home care services.
(2a)	"Home care agency director" means the person having administrative responsibility for the operation of the licensed agency site.
(2b)	"Home care client" means an individual who receives home care services.
(3)	"Home care services" means any of the following services and directly related medical supplies and appliances, which are provided to an individual in a place of temporary or permanent residence used as an individual's home:
a.	Nursing care provided by or under the supervision of a registered  nurse.
b.	Physical, occupational, or speech therapy, when provided to an individual who also is receiving nursing services, or any other of these therapy services, in a place of temporary or permanent residence used as the individual's home.
c.	Medical social services.
d.	In‑home aide services that involve hands‑on care to an  individual.
e.	Infusion nursing services.
f.	Assistance with pulmonary care, pulmonary rehabilitation or ventilation.
g.	In‑home companion, sitter, and respite care services provided to an individual.
h.	Homemaker services provided in combination with in‑home companion, sitter, respite, or other home care services.The term does not include: health promotion, preventative health and community health services provided by public health departments; maternal and child health services provided by public health departments, by employees of the Department of Health and Human Services under G.S. 130A‑124, or by developmental evaluation centers under contract with the Department of Health and Human Services to provide services under G.S. 130A‑124; hospitals licensed under Article 5 of Chapter 131E of the General Statutes when providing follow‑up care initiated to patients within six months after their discharge from the hospital; facilities and programs operated under the authority of G.S. 122C and providing services within the scope of G.S. 122C; schools, when providing services pursuant to Article 9 of Chapter 115C; the practice of midwifery by a person licensed under Article 10A of Chapter 90 of the General Statutes; hospices licensed under Article 10 of Chapter 131E of the General Statutes when providing care to a hospice patient; an individual who engages solely in providing his own services to other individuals; incidental health care provided by an employee of a physician licensed to practice medicine in North Carolina in the normal course of the physician's practice; or nursing registries if the registry discloses to a client or the client's responsible party, before providing any services, that (i) it is not a licensed home care agency, and (ii) it does not make any representations or guarantees concerning the training, supervision, or competence of the personnel provided. The term sitter does not include child care facilities licensed in accordance with Chapter 110 of the General Statutes. The term respite care does not include facilities or services licensed in accordance with Chapter 122C of the General Statutes. The terms in‑home companion, sitter, homemaker, and respite care services do not include (i) services certified or otherwise overseen by the Department as not providing personal care or (ii) services administered on a voluntary basis for which there is not reimbursement from the recipient or anyone acting on the recipient's behalf.
(4)	"Home health agency" means a home care agency which is certified to receive Medicare and Medicaid reimbursement for providing nursing care, therapy, medical social services, and home health aide services on a part‑time, intermittent basis as set out in G.S. 131E‑176(12), and is thereby also subject to Article 9 of Chapter 131E."
SECTION 2. G.S. 131E‑138 reads as rewritten: 
"§ 131E‑138.  Licensure requirements.
(a)	No person or governmental unit shall operate a home care agency without a license obtained from the Department. Nothing in this Part shall be construed to extend or modify the licensing of individual health professionals by the licensing boards for their professions or to create any new professional license category.
(b)	Repealed by Session Laws 1991, c. 59, s. 1.
(c)	An application for a license shall be available from the Department, and each application filed with the Department shall contain all information requested by the Department. A license shall be granted to the applicant upon a determination by the Department that the applicant has complied with the provisions of this Part and the rules promulgated by the Commission under this Part. The Department shall charge the applicant a nonrefundable annual license fee in the amount of  four hundred dollars ($400.00).(d)	The Department shall renew the license in accordance with the rules of the Commission.
(e)	Each license shall be issued only for the premises and persons named in the license and shall not be transferable or assignable except with the written approval of the Department.
(f)	The license shall be posted in a conspicuous place on the licensed premises.
(g)	The Commission shall adopt rules to ensure that a home care agency shall be deemed to meet the licensure requirements and issued a license without further review or inspection if: (i) the agency is already certified or accredited by the Joint Commission on Accreditation of Health Care Organizations, National League for Nursing, National Home Caring Council, North Carolina Accreditation Commission for In‑Home Aide Services, or other entities recognized by the Commission and (ii) the agency is certified or accredited for all of the home care services that it provides; or (iii) in the case of continuing care retirement communities licensed by the North Carolina Department of Insurance under Article 64 of Chapter 58 which also have nursing beds licensed by the Department of Health and Human Services under Article 6 of Chapter 131E, the Department certifies, as part of its licensure review or survey of the nursing beds, that the facility also meets all of the rules and regulations adopted by the Commission pursuant to this Part. The Department may, at its discretion, determine the frequency and extent of the review and inspection of home health agencies already certified as meeting federal requirements, but not more frequently than on an annual basis for routine reviews."
SECTION 3.  The North Carolina Medical Care Commission shall adopt rules to implement Section 1 of this act.
SECTION 4.  Section 1 of this act becomes effective January 1, 2010.  Section 2 of this act becomes effective July 1, 2009. The remainder of this act is effective when it becomes law.