State Budget Summary

SB 105 – 2021 Appropriations Act was signed into law by Governor Cooper on November 19, 2021. Highlights from the budget are included below, and additional information can also be found in the budget conference report released earlier last week.

In addition to the specific provisions summarized below, it is also important to note many of the changes NCMS opposed earlier this session, such as the SAVE Act and erosion of existing tort reform measures, were not included. The budget’s revisions to the Emergency Management Act also ensure the COVID-19 immunity provisions included in the COVID-19 Recovery Act remain in place.

 

State Budget Summary

 

Highlights of policy-related provisions include:

Joint Legislative Committee on Access to Healthcare and Medicaid Expansion

  • Creates a joint legislative committee tasked with considering ways access to health care and health insurance can be improved for North Carolinians.

Continue Medicaid Coverage for Pregnant Women for Twelve Months Postpartum

  • Allows pregnant women to remain eligible for coverage for 12 months postpartum effective April 1, 2022. This change will expire March 31, 2027.

Medicaid Reimbursement Contract for Residential Schools

  • Requires the Department of Public Instruction to enter into a contract with a third-party entity for any administrative services necessary to receive maximum reimbursement for medically necessary health care services for which payment is available under the NC Medicaid Program provided to eligible students attending the Governor Morehead School for the Blind, the Eastern North Carolina School for the Deaf, and the North Carolina School for the Deaf.

The North Carolina Collaboratory

  • Establishes the North Carolina Collaboratory to facilitate the dissemination of the policy and research expertise of The University of North Carolina and other higher education institutions within the State for practical use by the State and local governments.
  • Specifies the Collaboratory’s duties and powers.
  • Requires the Collaboratory to develop and deploy technologies to mitigate exposure to PFAS, including GenX, and health impacts from such exposure.

Virtual Behavioral Health Services Grant Program

  • Requires the Office of Rural Health to use certain funds to award competitive grants to hospitals to fund expanded telepsychiatry capabilities to respond to the COVID-19 public health emergency by allowing patients begin served in primary care settings to access hospital-based virtual psychiatric assessments and consultations.

Creation of the HCBS Fund

  • Establishes the HCBS Fund as a nonreverting special fund in the Division of Health Benefits consisting of the savings realized by DHB as a result of federal receipts arising from the enhanced federal medical assistance percentage for home and community-based services available to the State under the American Rescue Plan Act of 2021.

Waive Medicaid Provider Enrollment and Revalidation Fees

  • States that providers revalidating enrollment or enrolling in the NC Medicaid program or the NC Health Choice program shall not be charged the $100 fee above the federally required fee for the enrollment or revalidation.

Expand North Carolina Innovations Waiver Slots

  • Requires the Division of Health Benefits to amend the NC Innovations waiver to increase the number of slots by 1,000.

Modification of CON Exemption for Legacy Medical Care Facilities

  • Modifies the CON exemption for Legacy Medical Care Facilities by allowing a person seeking to operate a Legacy Medical Care Facility to request an additional extension of time by which the facility must be operational in order to be exempt from CON review and provides the procedure for making that request.

Temporary CON Exemption

  • Provides a temporary CON exemption a new general acute hospital in counties that meet certain specified criteria.

Adult Care Home Infection Prevention Requirements

  • Revises the requirements for adult care homes’ written infection prevention and control policy including certain specified standard and transmission-based precautions, reporting requirements, and strategies for addressing potential staffing issues.

Use of Opioid Settlement Funds

  • Establishes the Opioid Abatement Reserve in the General Fund to maintain funds received by the State as a beneficiary of the final consent judgment resolving the lawsuit against McKinsey and Company, Inc. and specifies how the funds shall be used to respond to the negative impacts of the opioid epidemic.

Emergency Management

  • Revises the Emergency Management Act to require a vote by the Council of State to extend a statewide emergency beyond 30 days by the Governor effective January 1, 2023.

 

Highlights of budget-related provisions organized by category include:

Aging and Adult Services

  • Provides $15M in NR funds from the State Fiscal Recovery Fund for rapid rehousing services, activities to increase local capacity for services to prevent homelessness, and home improvements and home repairs for vulnerable seniors ages 60 and older.
  • Provides $3,585,000 in NR funds from the State Fiscal Recovery Fund for nutrition services for older adults in response to the COVID-19 pandemic.
  • Provides $125K in NR funds from the State Fiscal Recovery Fund for Hospice of Davidson County, North Carolina, Inc.
  • Provides $9.36M in recurring funds for the Home and Community Care Block Grant, which provides in-home and community-based services for older adults and their unpaid primary caregivers.
  • Provides $300K to Memory & Movement Charlotte to support individuals with Alzheimer’s Parkinson’s, and other forms of memory and movement disorder.
  • Provides $4M in recurring funds to increase support for the Key Rental Assistance Program to provide rental subsidies for eligible low-income, disabled individuals.

Central Management and Support

  • Provides $7.5M in NR funds for mobile units to support service delivery for the Camino Community Development Corporation, Inc., a nonprofit in Mecklenburg County that serves low-income families through primary care, behavioral health, and wellness services.
  • Provides $500K in NR funds for the city of Winston-Salem to create a hospital-based violence intervention program in response to the COVID-19 pandemic.
  • Provides $375,232 in NR funds for the Duke University Hospital-Based Violence Intervention Program in response to the COVID-19 pandemic.
  • Provides $250K in NR funds from the state fiscal recovery fund for Trellis Supportive Care, a nonprofit with offices in Davie, Forsyth, Stokes, and Rowan counties, to provide hospice and palliative care period.
  • Provides $15M in NR funds for a directed grant to the North Carolina Association of Free and Charitable Clinics to respond to the public health emergency by supporting member clinics.
  • Provides $10M in NR funds to the Office of Rural Health to establish a competitive grant program to support virtual behavioral health services.
  • Provides $1M in NR funds to Atrium Health, Inc., to respond to the public health emergency by providing school-based virtual health services to classrooms in Anson County and Winston-Salem/Forsyth County school districts.
  • Provides $1.5M in NR funds to the NC Statewide Telepsychiatry Program to respond to the public health emergency by providing virtual psychiatric assessments and consultations to patients using telemedicine technologies.
  • Provides $4,909,144 in NR funds for FY 2021-22 by budgeting receipts made available through the American Rescue Plan Act of 2021 for the federal Small Rural Hospital Improvement Program to support small rural hospitals in NC with COVID-19 testing and mitigation.
  • Provides $1.2M in NR funds for NC MedAssist for additional prescription assistance services for indigent and uninsured persons.
  • Provides $4M in NR funds for loan repayment incentives to recruit doctors, physician assistants, dentists, nurse practitioners, and certified nurse midwives to rural areas.
  • Provides $125K in NR funds to Ashe Memorial Hospital.
  • Provides $150K in NR funds to Cabarrus Public Health Interest.
  • Provides $250K in NR funds to Cumberland HealthNET, a collaborative network of community organizations with a primary focus of improving the health outcomes for the uninsured by linking them with a medical home and other needed health and community services.
  • Provides $250K in NR funds to the Free Clinic of Rockingham County, Inc.
  • Provides $300K to Davidson Medical Ministries, Inc., to support continued operations and facilitate healthcare services to those who are uninsured and/or unable to pay for medical services.
  • Provides $5M in NR funds to Atrium Health to support the development of a FQHC or FQHC look-alike in Cleveland County.
  • Provides $5M in NR funds to Healthreach Community Clinic, a free clinic that provides health services in Iredell County.
  • Provides $500K in NR funds to the Stedman-Wade Health Services Inc., a community health center in Cumberland County.
  • Provides $300K in NR funds to Surry Medical Ministries Foundation, Inc., in Mount Airy to support continued operations and facilitate healthcare services to those who are uninsured and/or unable to pay for medical services.
  • Provides $750K in NR funds to develop and implement a two-year pilot program in Cumberland County to provide health care and job training services to veterans.
  • Provides $1.5M in NR funds to the NCMS for the Foundation for Children with Neuroimmune Disorders to create a continuing medical education program for NC physicians for Pediatric Acute-onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
  • Provides $300K in NR funds to the North Carolina Healthcare Quality Alliance, Inc., a nonprofit that promotes and facilitates the improvement of health care delivery across the State.

Child Development and Early Education

  • Provides $1,208,000 in NR funds to Ready for School, Ready for Life, a nonprofit in Guilford County that provides children and their families with resources for healthy development.
  • Provides $500K in NR funds to Child Development Center, Inc., a nonprofit in New Hanover County that provides services to preschool age children with special needs.
  • Provides $500K in NR funds to Reach Out and Read, a nonprofit that works with pediatricians to provide books to children.

Health Benefits

  • Provides funding for an additional 1,000 individuals with intellectual and developmental disabilities to access services through the State’s Medicaid Innovations waiver. The State share of costs, $3.9M in FY 2021-22 and $25.9M in FY 2022-23, will be paid from the HCBS Fund.
  • Provides funding for at least 114 additional slots in the Community Alternatives Program for Disabled Adults Medicaid waiver. The State share of funding, $500K in FY 2021-22 and $1M in FY 2022-23 will be transferred from the HCBS Fund.
  • Provides funding to add more slots to the following Medicaid waiver programs as determined by DHBL Innovations, Community Alternatives Programs, and Traumatic Brain Injury.
  • Provides funding to increase the Medicaid reimbursement rates to HCBS providers for the purpose of increase direct care worker wages.
  • Increases the Medicaid reimbursement rate for private duty nursing services to $11.25 per 15 minutes.
  • Provides funding for approximately 1,900 new Medicaid recipients eligible due to State-County Special Assistance In-Home program changes.
  • Increases funding for the Transitions to Community Living Initiative, which supports eligible Medicaid beneficiaries with mental illness in transitioning from institutions to community settings.
  • Provides funding for a wage increase for direct care workers employed by intermediate care facilities for individuals with intellectual disabilities.
  • Increases Medicaid beneficiary copayments to $4, effective July 1, 2022.
  • Provides funds for the run out of Medicaid and NC Health Choice fee-for-service claims associated with beneficiaries enrolled in managed care.
  • Provides funding for projected changes in Medicaid enrollment, enrollment mix, utilization, prices, and federal match rate, as well as the transition to managed care on July 1, 2021.
  • Provides funds to support the transition to Medicaid managed care and the Healthy Opportunities pilot program.
  • Provides funds to extend Medicaid benefits for the pregnant women eligibility category from 60 days postpartum to 12 months postpartum, effective April 1, 2022 through March 21, 2027.
  • Provides funds to allow the parents of children temporarily placed into the child welfare system to retain Medicaid eligibility if the parent is making reasonable efforts to comply with the court-reunification plan.
  • Budgets additional requirements and receipts to support the authorization for charter schools to certify public expenditures.

Health Service Regulation

  • Provides $3M in NR funds for an adult care home accreditation pilot program to be administered by the Cecil G. Sheps Center for Health Service Research.
  • Provides $420K in NR funds to New Hanover Regional Medical Center for the Community Paramedicine Program, which brings some medical services directly to the patient in their home, avoiding duplicate services and unnecessary trips to the hospital.

Mental Health/Developmental Disabilities/Substance Abuse Services

  • Provides $12.6M in NR funds for FY 2021-22 from the State Fiscal Recovery Fund to LME/MCOs for temporary funding assistance for intermediate care facilities for individuals with intellectual disabilities services on a per diem basis.
  • Provides $25M in NR funds for FY 2021-22 from the State Fiscal Recovery Fund for Forsyth and Mecklenburg Counties for crisis behavioral health joint partnerships with local hospital systems, local behavioral health crisis centers, local emergency services providers, and LME/MCOS.
  • Provides $25M in NR funds for FY 2021-22 from the State Fiscal Recovery Fund to replace the Incident Response Improvement System.
  • Provides $500K in NR funds for FY 2021-22 from the State Fiscal Recovery Fund for Brynn Marr Hospital, Inc.
  • Provides $3.2M in recurring funds to provide additional funding for TBI services.
  • Provides $1.2M in NR funds to continue specified adult and pediatric TBI pilot programs.
  • Provides $200K in NR funds to Mt. Olive Family Medicine Center, Inc., to support its Concussion Clinic and provide concussion education, baseline testing, and post-concussion assessment and care to schools and adolescent athletes in eastern North Carolina.
  • Provides $3M in NR funds for a behavioral health urgent care pilot program at Dix Crisis Intervention Center in Onslow County.
  • Provides $50M to support technology upgrades and electronic health record system development at State-operated healthcare facilities to enhance services and patient safety.
  • Provides $20M in recurring funds to incentivize the development of Medicaid services to support the needs of recipients living in community-based group homes, to establish new rate models and methodologies, to increase the payments to LME/MCOs to facilitate the transition to a more appropriate and sustainable service funding model, and to continue the existing funding and rate structure to offset loss of bridge funding.
  • Provides $500K in NR funds for Partners Health Management to address the needs of individuals in Surry County struggling with addiction.
  • Provides $10M in NR funds to Hope Alive, Inc., a nonprofit in Robeson County, for substance use disorder treatment and recovery services.
  • Provides $200K in NR funds to Aces for Autism, a nonprofit in Pitt County, to serve individuals with autism spectrum disorder.
  • Provides $50K in NR funds to Anchor Holds, Inc., a nonprofit in Nash County, to provide services to individuals with substance use disorder.
  • Provides $500K in NR funds to Wilkes Recovery Revolution, Inc., to address the needs of individuals struggling with addiction.
  • Provides $100K in NR funds to Fellowship Hall, Inc., a nonprofit drug and alcohol recovery center in Greensboro.
  • Provides $100K in NR funds to Reality Ministries, Inc., a nonprofit in Durham, that serves individuals with developmental disabilities.
  • Provides $112,437 in NR funds to Ground 40 Ministries, a nonprofit in Union County that provides substance abuse treatment services.
  • Provides $200K in NR funds to Dew4Him Ministries, Inc., a nonprofit in Wake County that provides substance abuse treatment and services to women.
  • Provides $21.4K in NR funds to Living Free Ministries, Inc., a nonprofit in Alamance County that provides substance abuse treatment and recovery services.
  • Provides $250K in NR funds to The Enrichment Center, a nonprofit in Winston-Salem that provides services for adults with intellectual and developmental disabilities.
  • Provides funding from the Dorothea Dix Hospital Property Funds to Johnston Health Enterprises, Inc., Good Hope Hospital, and Harnett Health System, Inc., to construct mental health treatment beds.

Public Health

  • Provides funds for health departments to expand communicable disease surveillance, detection, control and prevention activities to address COVID-19 and other communicable disease-related challenges impacted by the pandemic.
  • Provides $150M in NR funds from the State Fiscal Recovery Fund to support lead and asbestos remediation in public schools and child care facilities.
  • Provides $1.2M in NR funds and $1.2M in recurring funds to the Communicable Disease Branch for communicable disease prevention efforts including support for lab testing, connecting patients who test positive for a communicable disease to appropriate health care provider treatment options, and other efforts to prevent Hepatitis C, HIV, and other communicable diseases.
  • Provides $200K in NR funds to Cabarrus Women’s Center for services and to purchase ultrasound equipment.
  • Provides $50K in NR funds for the Pregnancy Resources Center or Cleveland County.
  • Provides $6.4M in NR funds to the Human Coalition for a statewide expansion of the Continuum of Care Pilot Project which provides care coordination and medical support to women experiencing crisis pregnancies.
  • Provides $3M to Nurse-Family Partnership to provide support for first-time parents.
  • Provides $62,340,758 in federal receipts from the COVID-19 Cooperative Agreement for Emergency Response/Public Health Crisis Response to establish, expand, train, and sustain a State and local public health workforce.
  • Budgets $20,230,000 in federal receipts from the American Rescue Plan Act of 2021 to provide resources for confinement facilities to address COVID-19.
  • Budgets $1,439,232 in federal receipts from the American Rescue Plan Act of 2021 to provide resources to support COVID-19 testing and mitigation in homeless service sites, encampments, and other congregate settings.
  • Budgets $14,144,928 in federal receipts from the American Rescue Plan Act of 2021 to provide resources to support the Nursing Home and Long-term Care Facility Strike Team and Infrastructure Project.
  • Budgets $27,361,745 in federal receipts to support Disease Intervention Specialists, training and retention, and technological advances to address COVID-19 and other infectious diseases.
  • Budgets $102,468,748 in federal receipts from the American Rescue Plan COVID-19 Vaccination Supplement to support statewide vaccination efforts.
  • Budgets $142,473 from the federal Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement to support public health laboratory preparedness.
  • Provides $21M from the North Carolina settlement with Juul Labs, Inc., to the Division of Public Health for tobacco and nicotine dependence prevention and cessation activities targeted at youth and young adults.

Social Services

  • Provides $300K in NR funds to implement a child welfare and behavioral health pilot project to provide easier access to comprehensive health and trauma-related services for children in foster care.
  • Provides $50K in NR funds to the Greater High Point Food Alliance.
  • Provides $250K in NR funds to A Touch of the Father’s Love, Inc., a nonprofit ministry and food pantry in Nash County.
  • Provides $10K in NR funds to The Pastor’s Pantry, a nonprofit in Davidson County that provides monthly groceries for low-income seniors and supplies emergency food for low-income individuals and families.
  • Provides $10K in NR funds to the West Davidson Food Pantry.
  • Budgets $17,105,002 in NR funds from the supplemental Low Income Household Water Assistance Program funding provided by the American Rescue Plan Act.

Vocational Rehabilitation Services

  • Provides $300K in NR funds to the National Multiple Sclerosis Society to provide home modification services and home modification assistance grants to help NC residents with MS to remain in their homes.
  • Provides $800K in NR funds to purchase equipment in order to maintain a statewide inventory of up-to-date assistive technology equipment to be used for assessments, training, and short-term equipment loans.

Capital

  • Provides $75.25M in NR funds for the construction of a new Brody School of Medicine.
  • Provides $46.75M in NR funds for the renovation of Carrington Hall Nursing School.
  • Provides $11.37M in NR funds for the construction of a health science center at UNCP.
  • Provides $4M to Fayetteville Technical Community College to renovate and convert an existing facility into a nursing school.
  • Provides $350K in NR funds to the Alleghany Memorial Hospital Foundation for capital improvements at Alleghany Memorial Hospital.
  • Provides $15M in NR funds to Cape Fear Valley Health System to address rural health disparities through development of the Medical Education & Research Center.
  • Provides $1,129,519 in NR funds to Good Hope Hospital in Harnett County for the construction of mental health treatment beds.
  • Provides $10M in NR funds to Granville Health Center for capital improvements.
  • Provides $6,579,519 in NR funds to Harnett Health System, Inc. for the construction of mental health treatment beds at Betsy Johnson Hospital.
  • Provides $3M in NR funds to Holly Hill hospital for capital improvements.
  • Provides $10M in NR funds to Stokes County for capital improvements to the hospital.
  • Provides $4M in NR funds to the American Healthcare Systems Foundation, Inc. for the construction of mental health treatment beds.
  • Provides $300K in NR funds to UNC Rockingham Healthcare for capital improvements.
  • Provides $3M in NR funds to WakeBrook UNC Healthcare for capital improvements.
  • Provides $3.23M in NR funds to Burke County for the construction of a new substance abuse treatment facility.
  • Provides $30M in NR funds to Cabarrus County for a new regional behavioral health crisis service center.
  • Provides $1M in NR funds to Gateway of Hope Addiction Recovery Center for a new treatment facility.
  • Provides $10.5M in NR funds to Mountain Area Health Education Center for the construction of a new parking deck.
  • Provides $21.6M to Wake Forest Baptist Health for a new regional autopsy center.

Community College System

  • Allocates $15M in NR funds to improve broadband access for 25 rural community colleges.
  • Provides $500K in NR funds for a pilot program to expand career opportunities for students with intellectual and developmental disabilities.

Public Instruction

  • Provides $25M to establish the Children with Disabilities Reserve for the FY 2021-22 school year.
  • Reflects the transfer of 362 school psychologist positions from the Instructional Support Allotment and provides funding sufficient to hire an additional 115 school psychologist positions.
  • Provides $13,175,727 in recurring funds to support an increase in the funding cap for the Children with Disabilities Allotment.
  • Provides $2,824,616 in recurring funds for FY 2021-22 and FY 2022-23 and $175,384 in NR funds for FY 2021-22 for the new Transportation Reserve Fund for Homeless and Foster Children.
  • Provides $250K in NR funds for FY 2021-22 to fund grants to schools for feminine hygiene products for students.

University of North Carolina

  • Provides $6M in recurring funds to the Wake Forest Institute for Regenerative Medicine.
  • Allocates $30M in NR funds to the North Carolina Policy Collaboratory to award research grants to monitor, assess, and address the public health and economic impacts of the COVID-19 pandemic.
  • Allocates $20M in NR funds to the Collaboratory for a water and sewer project that establishes the Innovative Highly Treated Wastewater Pilot Program.
  • Allocated $18M in NR funds to the Vice Chancellor for Research at UNC Chapel Hill for the Rapidly Emerging Antiviral Drug Development Initiative to advance development of therapeutics for the COVID-19 pandemic.
  • Provides $9.2M in recurring funds for the UNC School of Medicine’s Asheville Campus.
  • Allocates $1.5M in NR funds from DHHS for an adult care home accreditation pilot program to be administered by the Cecil G. Sheps Center for Health Services Research.
  • Provides $9.6M in recurring funds to SR AHEC to support additional residencies in the SR AHEC service areas.
  • Provides $5.9M in recurring funds to support the residency program at the Brody School of Medicine at ECU.
  • Provides $500K in NR funds to Appalachian State University for the Rural Medical Resource Initiative.
  • Allocated $500K in NR funds to the University of North Carolina at Pembroke for the operation of mobile medical units in rural and at-risk communities to respond to the impacts of the COVID-19 pandemic.

Agriculture, Natural, and Economic Resources

  • Provides $40M in NR funds to be distributed equally to the six food banks in the State to meet the increased demand caused by the COVID-19 pandemic.
  • Provides $10M in NR funds to Golden L.E.A.F. to grant funds to assist nonprofit organizations in becoming partner agencies with food banks and serving food security needs in their communities.
  • Provides $5M in NR funds to Reinvestment Partners for its Produce Prescription Program.
  • Provides $2M in NR funds to the Division of Workforce Solutions for a program that helps individuals battling substance abuse enter and stay in the workforce.
  • Provides $487,275 in recurring funds to establish an Emerging Compounds Unit within the Division of Water Resources.
  • Provides $400K in NR funds for the Waste Detection Elimination Program to identify and remediate groundwater contamination caused by straight pipes and failing septic systems.

Justice and Public Safety

  • Provides $4M in recurring funds to support competitive grants to sheriffs’ offices to assist in expanding, maintaining, or establishing medication-assisted treatment of non-opioid, long-acting, injectable medication regimes as treatment for alcohol and/or opioid dependence as part of reentry programming in county jails.
  • Provides $500K in NR funds to the Alamance County Sherriff’s Office to support the Stepping Up Initiative in developing a diversion center where nonviolent suspects with mental illness can receive necessary services.
  • Provides $750K in NR funds to continue the implementation of a pilot project to establish a Quick Response Team to address the needs of opiate and heroin overdose victims.
  • Budgets $8M of receipts from the Substance Abuse Prevention and Treatment Block Grant to expand the MAT Community Supervision pilot program to at least 5 tier one or tier two counties with the highest need.

General Government

  • Provides $11.7M in NR funds for the North Carolina Pandemic Recovery Office to continue operations through the end of FY 2022-23.
  • Provides $400K in NR funds for outreach, training, and other suicide prevention activities to veterans and active duty military personnel.
  • Provides $29,995,000 in NR funds to match a potential federal grant to construct a new nursing facility in Wake County.
  • Budgets patient receipts to provide funds for the opening of a new veterans nursing facility in Kernersville, NC.

Information Technology

  • Provides federal broadband funds for competitive grants to providers to expand broadband availability in rural areas.
  • Provides funds from the Coronavirus Capital Projects Fund for competitive grants to expand broadband availability in rural areas.
  • Provides federal broadband funds to issue targeted grants addressing local infrastructure needs and connective unserved and underserved households.
  • Provides funds for an awareness and digital literacy campaign.
  • Provides funds for the preparation of statewide broadband maps.
  • Provides $8.5M for the hardware and infrastructure costs associated with the growth of the HealthConnex system.
 
 

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