A BILL TO BE ENTITLED
AN ACT TO DIRECT THE STATE BOARD OF EDUCATION TO RECOMMEND A SCHOOL NURSE STAFFING STANDARD AND DEVELOP AN IMPLEMENTATION PLAN TO MEET THAT STANDARD, TO DIRECT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND THE DEPARTMENT OF PUBLIC INSTRUCTION TO DEVELOP A PLAN TO CONSOLIDATE CERTAIN SCHOOL‑BASED NURSING FUNDING PROGRAMS, to require the department of health and human services to examine medicaid rates for school‑based nursing services, and to establish medicaid REIMBURSEMENT FOR school‑based nursing services documented on 504 plans and individual health plans, AS RECOMMENDED BY THE JOINT LEGISLATIVE PROGRAM EVALUATION OVERSIGHT COMMITTEE.
The General Assembly of North Carolina enacts:
SECTION 1.  No later than January 15, 2020, the State Board of Education, in consultation with the Department of Health and Human Services and the Department of Public Instruction, shall study school‑based nursing services provided in the State and submit to the Joint Legislative Education Oversight Committee and the Joint Legislative Oversight Committee on Health and Human Services a report containing (i) a recommended staffing standard of school nurses to students or student populations considered necessary to meet the health needs of students and (ii) an implementation plan for achieving the recommended staffing standard. The report shall also include at least all of the following information:
(1)	The extent to which school‑based nursing services currently offered are meeting the health needs of students and the extent to which school‑based nursing services would meet the health needs of projected student populations.
(2)	The prevalence and effect of permitting unlicensed assistive personnel to provide student care in the absence of a nurse.
(3)	The school‑based nursing staffing standard currently recommended by the National Association of School Nurses.
(4)	A model for the distribution of State funding for school‑based nursing services, including factors to consider when determining statewide funding priorities, in lieu of awards based on specific criteria, given the base level of funding provided.
(5)	An estimate of the amount of State funding needed to implement the recommended staffing standard.
(6)	A suggested time line to achieve the recommended staffing standard.
(7)	Any other information the State Board deems relevant.
SECTION 2.  No later than May 1, 2020, the Department of Health and Human Services (DHHS) and the Department of Public Instruction (DPI) shall jointly develop and submit to the Joint Legislative Oversight Committee on Health and Human Services and the Joint Legislative Education Oversight Committee a proposed plan to (i) consolidate the School Nurse Funding Initiative and funding for school‑based nursing services through the Child and Family Support Team Initiative into a single program, based on an acuity model, and (ii) allocate funds for school‑based nursing services from the consolidated program beginning in the 2020‑2021 fiscal year. DHHS and DPI shall not implement the proposed consolidation plan except as directed by an act of the General Assembly. The proposed consolidation plan shall include at least all of the following information:
(1)	A memorandum of understanding describing how DHHS and DPI would communicate and interact to oversee and operate the consolidated program.
(2)	Recommendations as to which department should have primary or total responsibility for the program, including information about any potential fiscal or staffing impacts resulting from consolidation.
(3)	Recommendations for implementing an acuity model, i.e., a nurse allocation model based on differentiated needs, for funding school‑based nursing services at the statewide level. These recommendations should include factors, weights, and data sources suggested for developing the statewide acuity model.
(4)	An estimate of the frequency with which the State should reevaluate the allocation of funding for school‑based nursing services based on the statewide acuity model.
(5)	Recommendations for promoting the development of a local acuity model in each local school administrative unit.
(6)	Any other information DHHS and DPI deem relevant to the successful implementation of their proposed consolidation plan.
SECTION 3.  No later than December 1, 2018, the Department of Health and Human Services shall report to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice and the Fiscal Research Division regarding the results of an examination of the rates paid for school‑based nursing services provided to Medicaid recipients. The examination shall include consultation with the Division of Public Health School Health Consultant Team, the Department of Public Instruction, and representatives from Local Education Agencies. The examination shall include a consideration of an increase in school‑based nursing services Medicaid rates, whether an increase would encourage Local Education Agencies to submit for Medicaid reimbursement when applicable, and whether an increase in the rate paid for school‑based nursing services would require an increase in the rate paid for any other Medicaid services, whether provided in schools or any other setting.
SECTION 4.(a)  No later than October 1, 2018, the Department of Health and Human Services shall submit to the Centers for Medicare and Medicaid Services any State Plan amendment or any waiver necessary to establish Medicaid reimbursement for school‑based nursing services that are documented on a recipient's 504 Plan or Individual Health Plan.
SECTION 4.(b)  No later than December 1, 2018, the Department of Health and Human Services shall report to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice and the Fiscal Research Division regarding the status of the State Plan amendment submitted under subsection (a) of this section.
SECTION 5.  This act is effective when it becomes law.