A BILL TO BE ENTITLED
AN ACT implementing the recommendations of the HOUSING subcommittee of the blue ribbon commission on transitions to community living (1) to require the department of health and human services to establish a supportive housing program and an assistive TECHNOLOGY REUTILIZATION program for individuals transitioning from institutional settings to integrated community‑based settings, (2) to appropriate funds to the department of health and human services for the establishment and OPERATION of these programs, and (3) to create a TRANSITIONS TO community living housing budget within the transitions to community living fund to integrate individuals with mental illness into community‑based supported housing.
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 122C‑3 is amended by adding a new subdivision to read:
"(20c)	"Local management entity/managed care organization" or "LME/MCO" means an LME that has been approved by the Department to operate the 1915(b)/(c) Medicaid Waiver."
SECTION 2.(a)  Chapter 122C of the General Statutes is amended by adding a new Article to read:
"Article 1B.
"Transitions to Community Living.
"Part 1. North Carolina Supportive Housing Program.
"§ 122C‑20.5.  Definitions.
The following definitions apply in this Article:
(1)	In‑reach activities. – Education and information provided by the Department or an LME/MCO by individuals who are knowledgeable about community services and supports to residents of adult care homes or State psychiatric hospitals about the benefits and financial aspects of clinically appropriate, community‑based supported housing in an integrated setting. The term includes all of the following: (i) facilitating and accompanying residents' visits to supported housing apartments, (ii) assessing residents' interest in supported housing, (iii) exploring and addressing residents' concerns about moving to supporting housing, (iv) reviewing residents' housing preferences, and (v) providing opportunities for residents to meet with other individuals with disabilities who are living, working, and receiving services in integrated settings; their families; and community providers. This term does not include education or information provided by adult care homes or State psychiatric hospitals to residents.
(2)	Institution for mental disease. – As defined in 42 C.F.R. § 435.1009, as from time to time amended, a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment, or care of individuals with mental diseases, including medical attention, nursing care, and related services. The term does not include an institution for individuals with mental retardation.
(3)	Individual with serious mental illness or SMI. – An individual who is 18 years of age or older with a mental illness or disorder that is described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, that impairs or impedes functioning in one or more major areas of living and is unlikely to improve without treatment, services, supports, or all three. The term does not include a primary diagnosis of Alzheimer's disease or dementia.
(4)	Individual with serious and persistent mental illness or SPMI. – A person who is 18 years of age or older who meets one of the following criteria:
a.	Has a mental illness or disorder that is so severe and chronic that it prevents or erodes development of functional capacities in primary aspects of daily life such as personal hygiene and self‑care, decision making, interpersonal relationships, social transactions, learning, and recreational activities.
b.	Is receiving Supplemental Security Income or Social Security Disability Income due to mental illness.
"§ 122C‑20.6.  Department to establish statewide supportive housing program for individuals transitioning into community living; purpose.
The Department of Health and Human Services, in consultation with the North Carolina Housing Finance Agency, shall establish and administer a tenant‑based rental assistance program known as the North Carolina Supportive Housing Program. The purpose of the program is to transition individuals diagnosed with serious mental illness and serious and persistent mental illness from institutional settings to more integrated community‑based settings appropriate to meet their needs. Under the program, the Department, in consultation with the North Carolina Housing Finance Agency and LME/MCOs, shall arrange for program participants to be placed in housing slots available through the program with all the rights and obligations created by a landlord‑tenant relationship.
"§ 122C‑20.7.  Administration of housing subsidies for supportive housing.
The Department may enter into a contract with a private vendor to serve as the housing subsidy administrator for the North Carolina Supportive Housing Program with responsibility for distributing rental vouchers and community living vouchers to program participants based on a formula developed by the Department.
"§ 122C‑20.8.  Eligibility requirements for NC Supportive Housing Program.
The Commission on Mental Health, Developmental Disabilities, and Substance Abuse Services shall adopt rules to establish eligibility requirements for program. The eligibility requirements shall, at a minimum, include income eligibility requirements and requirements to give priority for program participation and transition services to individuals with SMI or SPMI who are currently residing in institutional settings.
"§ 122C‑20.9.  In‑reach activities for supportive housing.
The Department shall have ongoing responsibility for developing and distributing a list of potentially eligible program participants for each LME/MCO by catchment area. Upon receipt of this information, each LME/MCO shall have ongoing responsibility for prioritizing the list of individuals to whom it will provide in‑reach activities in order to (i) arrange an in‑person meeting with potentially eligible participants to determine their eligibility and level of interest and (ii) report back to the Department on the LME/MCO's recommended list of program participants on a monthly basis. Upon receipt of an LME/MCO's recommended list of program participants, the Department shall make a final determination of eligibility.
"§ 122C‑20.10.  Allocation of supportive housing slots to LME/MCOs.
The Department shall annually determine the number of housing slots to be allocated to each LME/MCO as follows:
(1)	Each year, the Department shall distribute at least fifty percent (50%) of the housing slots available through this program equally among all LME/MCOs.
(2)	The Department shall award additional housing slots to LME/MCOs based on local need, as determined by the information provided on a monthly basis by LME/MCOs to the Department in accordance with G.S. 122C‑20.9.
"§ 122C‑20.11.  Transition of program participants into housing slots.
The LME/MCO shall develop a written transition plan for each individual determined to be eligible and interested in participating in the North Carolina Supportive Housing Program. The transition plan shall identify at least all of the following:
(1)	Available housing slots that meet the individual's needs.
(2)	Any transition services that will be necessary for the individual, including, but not limited to, a one‑time transition stability payment, not to exceed two thousand dollars ($2,000) per individual, for up‑front move‑in costs approved by the Department or the housing subsidy administrator.
(3)	Solutions to potential barriers to the individual's successful transition to community‑based supported housing.
(4)	The individual's assistive technology needs, as determined by an assessment conducted in accordance with G.S. 168‑18.3.
(5)	Any other information the Department deems necessary for the individual program participant's successful transition into community‑based supported housing.
"§ 122C‑20.12.  Transition services.
LME/MCOs shall provide individualized transition services to program participants within their respective catchment areas for the 90‑day period following the individual's transition into a housing slot provided through the program.
"§ 122C‑20.13.  Tenancy support services.
The Department or the housing subsidy administrator shall provide ongoing tenancy support services to program participants.
"§ 122C‑20.14.  Approval of landlords and housing units.
The Department shall develop an application process for owners of housing units seeking to participate in the program as landlords. The application process shall, at a minimum, include an inspection of the owners' available housing units and a requirement that owners complete training on the North Carolina Supportive Housing Program prior to being approved as landlords.
"§ 122C‑20.15.  Rules to implement NC Supportive Housing Program.
The Commission on Mental Health, Developmental Disabilities, and Substance Abuse Services may adopt any temporary rules necessary to implement this section.
"§ 122C‑20.16.  Annual reporting on NC Supportive Housing Program.
(a)	Annually, on April 1, each LME/MCO shall report to the Department on the number of individuals within the catchment area who transitioned into housing slots available through the North Carolina Supportive Housing Program during the preceding calendar year. The report shall include a breakdown of all funds expended by the LME/MCO for transitioning these individuals into the housing slots.
(b)	Annually, on July 1, the Department shall report to the General Assembly on the effectiveness of the North Carolina Supportive Housing Program established in this section.
"§ 122C‑20.17.  Department not obligated to provide unlimited number of housing slots.
Nothing in this section shall be construed to require the Department to provide housing slots to individuals beyond the number that can be supported by funds appropriated by the General Assembly for this purpose."
SECTION 2.(b)  By no later than July 30, 2013, each LME/MCO shall transition at least 15 eligible individuals to community‑based supported housing slots available through the North Carolina Supportive Housing Program established under G.S. 122C‑20.5.
SECTION 2.(c)  There is appropriated from the General Fund to the Transitions to Communing Living Housing Budget established in G.S. 122E‑3A, the sum of three million eight hundred thirty‑five thousand two hundred eighty dollars ($3,835,280) for the 2013‑2014 fiscal year and the sum of five million eight hundred seventy‑six thousand dollars ($5,876,000) for the 2014‑2015 fiscal year. These funds shall be used as follows:
(1)	The sum of one million seven hundred forty‑five thousand two hundred eighty dollars ($1,745,280) for fiscal year 2013‑2014 and the sum of three million one hundred twenty thousand thirty‑seven dollars ($3,120,037) for fiscal year 2014‑2015 shall be used to establish and operate the North Carolina Supportive Housing Program authorized in G.S. 122C‑20.5.
(2)	The sum of one million four hundred forty thousand dollars ($1,440,000) for fiscal year 2013‑2014 and the sum of one million five hundred forty thousand dollars ($1,540,000) for fiscal year 2014‑2015 shall be used for program administration for the North Carolina Supportive Housing Program authorized in G.S. 122C‑20.5.
(3)	The sum of six hundred fifty thousand dollars ($650,000) for fiscal year 2013‑2014 and the sum of one million two hundred sixteen thousand dollars ($1,216,000) for fiscal year 2014‑2015 shall be used to provide one‑time transition stability funds, not to exceed two thousand dollars ($2,000) per individual, to cover the cost of up‑front move‑in costs for individuals placed in housing slots available through the North Carolina Supportive Housing Program authorized in G.S. 122C‑20.5.
SECTION 3.  Chapter 122E of the General Statutes is amended by adding a new section to read:
"§ 122E‑3A.  Transitions to Community Living Housing Budget.
(a)	Definitions. – The following definitions apply in this section:
(1)	Catchment area. – As defined in G.S. 122C‑3.
(2)	Individuals with disabilities. – Individuals with severe mental illness, as defined in G.S. 122C‑20.5, and severe and persistent mental illness, as defined in G.S. 122C‑20.5.
(3)	Targeted units. – Units within Low Income Housing Tax Credit developments that are specifically designed to facilitate the inclusion of individuals with disabilities.
(4)	Transitions to Community Living Fund. – The Fund established in Section 10.23A.(d) of S.L. 2012‑142.
(b)	Creation and Source of Funds. – The Transitions to Community Living Housing Budget is established within the Transitions to Community Living Fund to pay for the transition of individuals with disabilities from institutional settings to integrated, community‑based supported housing. Any unexpended, unencumbered balance of the amount appropriated in Section 10.23A(e) of S.L. 2012‑142 at the end of each fiscal year, including the end of the 2012‑2013 fiscal year, shall not revert and shall remain available in the Transitions to Community Living Housing Budget.
(c)	Use of Funds. – The North Carolina Housing Finance Agency, in consultation with the Department of Health and Human Services, shall be responsible for administering the Transitions to Community Living Housing Budget. The funds in the Transitions to Community Living Housing Budget shall be available for expenditure only upon an act of appropriation by the General Assembly and only for the following purposes:
(1)	To provide community‑based supported housing in integrated settings appropriate for individuals with disabilities.
(2)	To support housing projects in which the percentage of targeted units is at least fifteen percent (15%). Priority for funding shall be given to targeted units located in catchment areas identified by the Department of Health and Human Services, in consultation with the North Carolina Housing Finance Agency and LME/MCOs, as having the greatest need for targeted units.
(d)	Sunset. – The Transitions to Community Living Fund terminates on June 30, 2020, and any balance remaining on that date shall revert to the General Fund."
SECTION 4.(a)  Chapter 168 of the General Statutes is amended by adding a new Article to read:
"Article 2A.
"Assistive Technology for Individuals Transitioning Into Community Living.
"§ 168‑18.  Definitions.
The following definitions apply in this Article:
(1)	Assistive technology device or ATD. – Any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve the functional capacities of individuals with disabilities. This term includes durable medical equipment.
(2)	Assistive technology services. – A device, service, strategy, or practice used to increase or improve functional capabilities of individuals with disabilities.
(3)	Department. – North Carolina Department of Health and Human Services.
(4)	Durable medical equipment or DME. – Equipment that meets all of the following criteria:
a.	Can withstand repeated use.
b.	Is primarily and customarily used to serve a medical purpose.
c.	Generally is not useful to a person in the absence of an illness or injury.
d.	Is appropriate for use in the home.
(5)	Individuals with disabilities. – Individuals with severe mental illness, as defined in G.S. 122C‑20.5, severe and persistent mental illness, as defined in G.S. 122C‑20.5, or intellectual or developmental disabilities who are transitioning from institutional settings to integrated, community‑based settings.
(6)	Professional assistive technology consultant. – An individual who is certified as an assistive technology practitioner by an accrediting body approved by the Secretary or an individual who is employed by the Department as an assistive technology consultant.
(7)	Secretary. – Secretary of the North Carolina Department of Health and Human Services.
"§ 168‑18.1.  Department to establish assistive technology reutilization program for individuals with disabilities transitioning into integrated, community‑based settings.
The Department shall expand the North Carolina Assistive Technology Program to include an assistive technology reutilization program. The purpose of the assistive technology reutilization program is for the Department to (i) retrieve ATDs purchased with State funds, including durable medical equipment purchased through the State Medicaid Program, from consumers who no longer utilize the ATDs and (ii) catalogue, refurbish, sanitize, store, and reassign the ATDs to individuals with disabilities.
"§ 168‑18.2.  Preference for the assistive technology reutilization program.
Prior to purchasing a new ATD for an individual with a disability, each Division within the Department and each LME/MCO shall determine if a suitable refurbished ATD is available through the assistive technology reutilization program authorized in G.S. 168‑18. If available, the Division or LME/MCO shall provide the refurbished ATD to the individual in lieu of purchasing, or facilitating the purchase of, a new ATD; provided, however, the Division or an LME/MCO may purchase a new ATD for an individual with a disability if the cost of transporting the refurbished ATD to the individual would outweigh the cost of purchasing a new ATD. The Division or LME/MCO shall provide each recipient of a new or refurbished ATD with information about the assistive technology reutilization program.
"§ 168‑18.3.  Outreach and training on assistive technology.
The Department and LME/MCOs shall provide or arrange for outreach and training on assistive technology devices for individuals with disabilities and professionals working with these individuals. This outreach and training shall be conducted by individuals who are knowledgeable about assistive technology and local community services and supports and shall, at a minimum, include general information about the assistive technology reutilization program, ATDs, how to include ATDs in the transition planning process, and various statewide resources for accessing assistive technology services, ATD demonstrations, and ATD loans.
"§ 168‑18.4.  Assessment of assistive technology needs.
The Department or an LME/MCO, as appropriate, shall arrange for each individual with a disability within its catchment area to undergo at least two assistive technology assessments by a professional assistive technology consultant, one during the planning phase of the individual's transition to an integrated, community‑based setting and a second upon the individual's transition into that setting. The assistive technology assessment conducted during the transition planning phase shall be included in the individual's transition plan developed in accordance with G.S. 122C‑20.11. The purpose of the assistive technology assessment is to determine the individual's specific assistive technology needs based on functional ability, environment, the tasks to be completed with the assistive technology, and available technology options. The assistive technology assessment shall cover the individual's home, independent living environment, employment setting, or all three, as needed.
"§ 168‑18.5.  Assistive technology device demonstrations and loans.
The Department or an LME/MCO, as appropriate, shall arrange for individuals with disabilities to access ATDs through the North Carolina Assistive Technology Program for trial and demonstration during the planning phase of the individual's transition into an integrated, community‑based setting. The purpose of the trial and demonstration is to ensure that the selected ATDs are the best match for the individual considering the individual's functional ability, the environment, and the tasks to be completed with the assistive technology. LME/MCOs may fulfill the requirements of this section by providing hands‑on, online, or remote demonstrations of ATDs, or by arranging for loans of ATDs to individuals with disabilities during the planning phase of the individual's transition.
"§ 168‑18.6.  Disposal of assistive technology devices and durable medical equipment.
The Department shall transfer to the Department of Administration donations of assistive technology devices that are deemed unfit for reuse or reassignment under the assistive technology reutilization program. The Department of Administration shall dispose of these donations as State surplus property."
SECTION 4.(b)  There is appropriated from the General Fund to the Transitions to Communing Living Housing Budget established in G.S. 122E‑3A, the sum of two hundred thousand dollars ($200,000) for the 2013‑2014 fiscal year and the sum of one hundred fifty thousand dollars ($150,000) for the 2014‑2015 fiscal year. These funds shall be used to pay for assistive technology assessments for individuals with disabilities who are transitioning from institutional settings to integrated, based settings in order to identify the assistive technology devices that are the best match for the individual considering the environment, task, and ability of the user.
SECTION 5.  Sections 2(c) and 4(b) of this act become effective July 1, 2013. The remainder of this act is effective when it becomes law.