Conference Report – Quick Summary!

May 30, 2022

The text below is the “explanatory” language for each item – which necessarily leaves out some of the detail:

• Item 283 – #1c:  This amendment directs the Secretary of Health and Human Resources to establish a workgroup to evaluate the current structure of the Department of Behavioral Health and Developmental Services. Funding is also provided to include a feasibility analysis to transform the Catawba Hospital Campus to provide a continuum of services for the treatment and recovery of individuals with substance use disorder and behavioral health care needs.
• Item 285 – #1c: This amendment delays the implementation of rate setting for private day special education services until July 1, 2023. In addition, it directs the Office of Children’s Services to use the available first year funding to determine any fiscal impact that may result from the implementation of rate setting for private day special education services on July 1, 2023.
• Item 304 – #2c: This amendment adds $38.7 million the first year and $44.1 million the second year from the general fund and $40.6 million the first year and $46.5 million the second year from matching federal Medicaid and other nongeneral funds to rebase the Medicaid rates for DD waiver services that were not included in the House Bill 30, as introduced, including services provided in Group Homes serving 5 to 12 persons, Group Day Support, Group Supported Employment, Workplace Assistance, Community Guide, DD Case Management and Benefits Planning. The amendment also adds language setting out the appropriation for the Developmental Disability (DD) waiver rebasing totaling $377.0 million from the general fund (GF) and $390.6 million from federal Medicaid matching funds and other nongeneral funds over the biennium. Language also provides the Department of Medical Assistance Services (DMAS) with the authority to update the rates based on recent rebasing estimates after a review of the model assumptions is conducted and reported, no later than July 1, 2022. Language further clarifies that the rates shall be reflective of Tiered payments contained in the rebasing model. It is the intent of the General Assembly that in the enrolling of this act, funding included in this item shall be allocated among appropriate items within the Department of Medical Assistance Services.  Note: The services included in HB30 were Group Homes (4 or fewer), Sponsored, Supported Living, Independent Living, In-Home, Community Engagement,  Community Coaching, Therapeutic Consult, and PD and Skilled Nursing.  
• Item 304 – #7c:  This amendment reflects a delay in adding developmental disability waiver slots. The introduced budget includes 600 new slots each year. This amendment reflects maintaining 600 slots in the second year. The COVID-19 pandemic and resulting labor shortages have resulted in significant provider disruption. A companion amendment in this item provides rate increases to stabilize the provider network. After the provider network is stabilized and capacity exists to absorb additional slots, the General Assembly may consider adding the additional slots in the 2023 Session.
• Item 304 – #11c:  This amendment provides $43.4 million the first year and $42.5 million the second year from the general fund and $47.2 million the first year and $46.6 million the second year in federal Medicaid matching funds to increase on July 1, 2022, the Medicaid reimbursement rates for personal care, respite and companion services by 7.5% for consumer-directed and agency-directed attendants.
• Item 304 – #13c:   This item increases rates for peer recovery and family support services,  effective July 1, 2022, from $6.50 to $13.00 per 15 minutes for individuals and from $2.70 to $5.40 per 15 minutes for groups.
• Item 304 – #19c:  This amendment provides $40.5 million from the general fund and $76.5 million from nongeneral funds the first year and $37.0 million from the general fund and $67.3 million from nongeneral funds the second year to increase the five percent dental rate increase included in the introduced budget to 30 percent. This amendment accelerates the dental rate increase to July 1, 2022.
• Item 304 – #22c: This amendment adds funding and language to continue the temporary fiscal year 2021 12.5% rate increase that was provided to most Medicaid home and community based providers with exceptions for developmental disability waiver services and personal care, respite, and companion care services. In the first year, the state share will be funded from American Rescue Plan Act (ARPA) funds.  Note this includes: (i) adult day health care; (ii) consumer-directed facilitation services; (iii) crisis supervision, crisis stabilization and crisis support services; (v) transition coordinator services; (vi) mental health and early intervention case management services; and (vii) community behavioral health and habilitation services.
• Item 304 – #23c: This amendment adds language to extend the provision of Medicaid reimbursement of parents or spouses of Medicaid eligible minor children to provide personal care/personal assistance services that have been available during the pandemic through a Medicaid Appendix K waiver and approved by the federal government. Language also provides authority to the agency to promulgate emergency regulations to continue parents/spouses as personal care/personal assistance providers.
• Item 310 – #1c: This amendment removes the carryforward language related to the settlement agreement with the United States Department of Justice.  Any balances at year end will be discretionary and subject to the Governor’s authority for reappropriation of year end balances. In addition, the Department of Behavioral Health and Developmental Services is directed to report quarterly on its compliance with the provisions of the settlement agreement.
• Item 311 – #2c:  This amendment eliminates 11 new positions added in the introduced budget. The positions include eight for the Division of Licensing, one Behavioral Health on-call administrator, one administrative position for crisis services and one for administering marijuana prevention efforts. The reduced appropriation and positions will be allocated to the appropriate items upon enrolling of the budget bill.
• Item 311 – #3c: This amendment provides $2.5 million from the general fund each year for the Department of Behavioral Health and Developmental Services (DBHDS) and partners to provide technical assistance to school divisions seeking guidance on integrating mental health services, and to make grants to school divisions to contract for community-based mental health services for students from public or private community-based providers. These funds can enhance the current school-based mental health services by offering more flexible clinical capacity for service and programming needs that are beyond the scope of school-based personnel. The funds can also be used to continue new programs and interventions supported by federal recovery funds. The pilot programs will report back to DBHDS and the Behavioral Health Commission on the success factors for integrating behavioral health in education settings and identify funding recommendations and resources needed to continue these efforts.
• Item 311 – #4c: This amendment directs the Department of Behavioral Health and Developmental Services to, in any fiscal year that new developmental disability waiver slots are authorized, allocate such slots to the Community Services Boards and a Behavioral Health Authority by the first day of the fiscal year, so that the slots can be assigned to eligible individuals on the Priority One waiting list to access services as soon as possible. In fiscal year 2022 the department delayed the allocation of 890 waiver slots pending a review of individuals on the waiting list, which resulted in a nearly seven-month delay in releasing the slots.
• Item 311 – #6c: This amendment eliminates $1.0 million the first year from the general fund for a study of the behavioral health system.
• Item 311 – #7c: Effective July 1, 2023, this amendment transfers the authority and oversight of all rate setting for Developmental Disability waiver services from the Department for Behavioral Health and Developmental Services to the Department of Medical Assistance Services, which is the more appropriate agency to oversee Medicaid rate setting.
• Item 311 – #9c: This amendment directs the Department of Behavioral Health and Developmental Services to collect information from Community Services Boards and the Behavioral Health Authority on employee compensation to assist in developing a proposal to address compensation issues to be considered in the 2023 Session.