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Senate | May 29, 2013 | Committee Room | Health

Full MP3 Audio File

Speaker :Thank you very much for attending the senate health care committee meeting today. We will try to move through the agenda as expeditiously as possible. I would like to start off by making some introductions. We have a fine group of pages with us today from the senate and they come from all over our state. I am going to introduce them at this time and ask them to raise their hand so we can see you. First is Jasmine Jones from Nightdale – Jasmine stand up if you will, folks in the back may not be able to see you. Jasmine is sponsored by Senator Apodaka. Thank you for being with us. Elaine Kerny from Pinehurst. Elaine is a-wall. There she is in the back of the room. Elaine, we are glad to have you with us; you are sponsored by Senator Tillman; thanks for being with us. Antoinette Dyer, it is good to see you. She is from Raleigh and sponsored by Senator Nesbitt. Jana Simms from Autraville. Autraville, for those of you who may not know it, is in Sampson County. She is sponsored by Senator Jackson. Lily Turlington from Clinton. Lily is also sponsored by Senator Jackson. Andrew Distow – where is Andrew? Right at the back door. He is from Fayeteville and sponsored by Senator Meredith. Thomas Mcbrayer, who is over here against the wall. He is from Hickory and sponsored by Senator Allran, who is in the room. Thank you young folks for being here and helping us out this week. Our sergeant in arms, Ashley mckins, Steve Wilson, Ed Kessler, Billy Fritcher. We have four bills we are going to have on our calendar today. The first bill is senate bill 663. I believe we have a PCS for this bill. Senator Heist is going to present the PCS. Is there a motion to consider the PCS? Senator Stein moves that the PCS be before us. Senator Heist, you are recognized. Representative: Thank you Mr. Chairman and members of the committee. This bill originates with the DOJ settlement that we entered into a little more than a year ago. Following that, we established a blue commission for the interim to work and deal out some of the issues. A lot of the recommendations from the commission were met by the department of reporting. These are the remaining ones in the statute. The first thing that this does in beginning to reach those 2000 [xx] that were created, we created the tenant based rental assistance program. This is for the individuals that make that transition will provide assistance in addition to making sure that services are available in the community to move forward. Secondly, it establishes the community living fund within the housing finance agency that will provide for additional structures. One of the things we heard from the LMEMCO’s is that there were a lot of regions in the state and a lot of areas in the state that simply do not have the capacity right now to add individuals into a rental based assistance. So as that number grows we are adding funds, mainly from unspent funds coming over to that, to try to get higher numbers of units to meet that requirement. Finally, this bill also on recommendation, starts applying for the assisted technology reutilization program so that those can be claimed by another and utilized in the program. Assistive technologies is a broad area moving forward, and also allows those devices to be used after an evaluation, within a trial period, during that transition. If members have any questions, I will be glad to.. Speaker: Thank you Senator Heist. Senator Carner? Representative: Thank you Mr. Chair. I was on that commission and we were very thorough

And Really investigated and researched the questions possible answers. When you said that unspent funds for that trust, where are those what’s the source of those funds. [Speaker Changes] Traditionally within each year, [??] board we are looking this year the appropriation was about $10 billion to fill the slot. If those slots are not filled for the entire year or not utilized for the entire years those funds billed can build up every year and revert back to the state. It was the commission recommendation rather than risk not in compliance with the DOJ settlement that we would utilize that to expand our capacity. [Speaker Changes] Follow up Mr Chair [Speaker Changes] Yes Go ahead. [Speaker Changes] I am sorry appropriations from what line I don’t know we talking about [Speaker Changes] We do a specific appropriation passed in the last budget and the budget that the senate passed out as well that is consistent for the DOJ settlement. We have to by 2020 be at 2000 slots that kind of time line that we are kind of bumping up each year to get to that 2000. [Speaker Changes] Senator Wade [Speaker Changes] Appropriate time Mr Chair that I would like to move a favorable report [Speaker Changes] Lets hold that. See if there are any other questions. Senator McKissick. [Speaker Changes] This is kind of a follow up to the last item that you had mentioned. [??] what’s the phase in actually is for the units under this plan in terms of implementation to get to that 2000 units. How many units we are talking about each other perhaps transition over. I think its an excellent bill so I want to commend you for bringing it forward and something that we desperately need to do to make it happens as effectively as possible. What are we looking for in the terms of numbers if you know or perhaps the staff may be able to help us. [Speaker Changes] I believe right now somewhere around 100 slots and the increase was 350 slots a year that would get us up to that [Speaker Changes] I wonder if Miss Crosby might be able to answer that. I know at one time she was probably familiar with that or some one from your staff. Would you come forward to that. Who is that calling out? State your name and agency for the record [Speaker Changes] This is Jasket. I am the special advisor on ADA for the department of health and human services. For the first year it’s between 1 and 300 slots followed up for the next year by additional 150 slots and the following year its 718. It iterates up each year then. [Speaker Changes] That’s very helpful. Just really one thing. Are we looking looking at providing this housing for entities other those getting the assistance through state housing finance authority we are looking for any other types of entities that might be helping with this transitional housing. [Speaker Changes] It’s my understanding that individuals just not disqualified from other programs and other [??] doing toward these slots are focused not only just on tending assistance but making sure that the services are available to the individuals chooses to live. This is not a disqualification from other assistance program that might be available after. [Speaker Changes] Thank you Senator [Speaker Changes] Senator Stein [Speaker Changes] Thank you Mr Chairman. Senator Hise. Are the appropriations in section 3 are those appropriations all in the budget that was just passed or is this new money [Speaker Changes] These are the money that were included in the budget [Speaker Changes] Further Questions from the members of the committee. Senator Robinson. [Speaker Changes] Thank you Mr Chair and I apologize for not having read all of this. What are the requirements in terms of the housing? Are their specific requirements in this bill in terms of what the transitional housing has to be to meet specific kind of requirements? [Speaker Changes] I believe that any of the housing constructed under the housing finance program for individuals with disabilities as a whole would qualify for these programs. They can be single unit, stand alone as well as multi unit . The requirement is that they cannot exceed 20% of individuals within a particular area who can have their diagnosis known to the state whether they are in the program or not.

00:00 moving forward I know that we have members for the housing finance agency and others here that maybe able to speak to the physical requirements of a building to be qualified for disabilities doorways and others but those standards for ADA compliance are set forward so. okay [??]. yes go ahead senator Robinson. so I think Mr [??] just a few moments ago speaking to the physical requirements of the facilities for disability requirements. [??] with the housing finance agency Mr chair senator the physical standards for the units are all established and these units would be indistinguishable from other units that are occupied by other tenants 5 percent of the units in the development would be fully accessible so if an accessible unit was required one would be available but [??] large these are individuals these are tenants that lease in the market place without the need for special accommodations physical accommodations in the building. senator Robinson. yes one follow up Mr chair do we have commitment from the house and finance agency that they're going to work to make sure these individuals are placed equitably across the different housing areas. we have a requirement in the budget that the slots are distributed 50 percent are going to be divided equally among the LMEMCO's that are divided but the others are kind of hold slots that can be placed where we have availability within the state quite frankly a lot of the other [??] chairs just don't have the capacity right now to take on those whole amounts finance agency does a good job at spreading out the projects across the state and prioritizing those but the slots where we are funding are what is controlled by the department and not the finance agency. further questions from members of the committee thank you Mr [??] hearing none recognize senator Wade for a motion to approve the PCS and unfavorable as to the original bill all those in favor of the motion please say aye. aye. all opposed may say no the bill carries does it have a referral bill will be referred to senate for appropriations thank you senator Hise next on the agenda is house bill 492 representative Dollar's bill and I believe there is a PCS is there a motion to consider the PCS senator Wade moves that we consider the PCS which is before you thank you very much representative Dollar don't forget folks he's the chairman of the house appropriations committee so be very nice to him. you are too kind Mr chairman you are too kind actually this bill I think with one adjustment is it's in the PCS was in the budget bill that you all passed and just I'll just be quick about this this legislation is designed to help us address the issues that have risen regarding the special care units both the department as well as the general assembly have been working on this for a number of months we worked on this in the committee that chairman Hise and I coach here on the transitions to community living and I believe this is an agreed upon piece of legislation the one change and I apologize I don't think I have the latest PCS in front of me but there was a change toward the end just to clarify that the rates could go down the rates will actually will go down right now they're sort of artificially spiked and so there was a change in the PCS to a little different language than what we had on the house side but that's perfectly fine to reflect that those rates aren't gonna have to go down to. 05:00

The reality is the essence of the bill is to preserve our special care units, which as you know deal with Alzheimer's and dementia. And, there were other options that folks had looked at and the department had looked at, and those options just were not workable. We believe this is workable as I said it was in your budget bill, and I believe that if I understand, the Soucek-Hise has an amendment that's agreed to and Mister Chairmen obviously its your direction. [SPEAKER CHANGES] I recognize Senator Hise for an amendment. [SPEAKER CHANGES] I'd like to send forth an amendment. I think members should have copies. Moving forward, what this amendment does in its impact is set forth that the department shall, by August 15th submit to CMS the amendments the state finds necessary for this act, and that that amendment will have an effective date of July 1st so that it can be retroactive when its put into place. And moving forward so that we don't create a gap for individuals coming out. So this changes effective date and makes it finally effective when CMS approves but puts an effective date in that approval of July 1st. [SPEAKER CHANGES] Representative Dollar, you have comments on the amendment? [SPEAKER CHANGES] Oh, you bet I do. I think it's a great amendment, and it's a practical amendment, and I think it's line with what the department had requested. [SPEAKER CHANGES] The amendment that's before us, questions from members of the committee, Senator Rabin? Senator Rabin moves for favorable to accept the amendment. Are there any further questions? All those in favor of adopting the amendment please say Aye. All opposed No, and the amendment is adopted. The bill the PCS as amended is before you again, Representative Dollar. [SPEAKER CHANGES] Mister Chairman, I'd be happy to answer any questions. [SPEAKER CHANGES] Senator McKissick? [SPEAKER CHANGES] Sure. I was looking at Section 4A, and of course it talks about the department doing this annual report that would include the estimated number of medicaid recipients eligible for personal care services, estimated number of hours potential recipients would require, a copy of the draft medicaid state plan amendment, estimated timeline. Do we have any type of projections now, as to what these categories will look like when this data comes back. I mean, what perchance of the population that receives these services do we believe will be impacted, and do we have any idea what those projected costs might likely look like. It looks like we're going to be getting back information at some point, but going into this, are there any types of actuarially based projections or anecdotal projections that are just evidence based upon people looking at historical trends? [SPEAKER CHANGES] Well, I know that the department has been working on this, and of course in our discussions with the industry as well, they believe that they can fit what is needed within the available funds. And as we mentioned before, we know the actual rate itself will actually come down a little bit. The key here is the ability to actually assess an individuals acuity level so that you are providing greater service for those with higher acuity and lesser service with those with lower acuity. Which is something that I think general assembly particularly the last couple of years have been really trying to work on is to adjust our service because frankly, part of this goes back to the PCS and the perfect storm stuff, and I won't rehash all of that. There's a lot of history there, but you had services that weren't really matched up with the acuity of the individual, which created lots of problems. Volumes of problems. So this again is another refinement to get those things aligned, and it will fit within in the money. But Mister Chairman, I don't know if the department wants to try to further answer. [SPEAKER CHANGES] If there's some staff that might be able to provide a little more clarity or illumination. I appreciate that explanation. [SPEAKER CHANGES] Senator Hise might able to clarify. [SPEAKER CHANGES] And we may get some more as to who's in special care units. Just kinda the timeline on this for most know that last year is when we began the process of now doing U assessments for everyone.

…there’s some results come back for that, but such a high percentage of those cases are going through the appeal process right now. Specifically how that’s going to come out in the end, when you have an appeal process for special care units that cuts it off at 80 anyway, because that’s the new majority. So trying to get a sense of this is kind of a moving situation right now until we can get through this process through the appeals that are going on, and expanded back up to the 130 hours that was kind of cut off previously from the 80 to 130. Knowing where individuals fall in is kind of a difficult process. That’s why we’re looking for that reporting in August. [SPEAKER CHANGES] Quick follow up, Mr. Chair? And thank you Senator Hise and Representative Dollar. I appreciate those explanations. It would be great if we had more definitive data. Is there anybody from the department that could shed anything else upon it? I see the direction we’re moving, and I understand it is a moving target. I just didn’t know if we had any idea now as to what we might be, rather than simply waiting to August. [SPEAKER CHANGES] Ma’am if you’ll introduce yourself and who you represent please. [SPEAKER CHANGES] I’m Sabrina Lee from the Department of Health and Human Services Division of Medical Assistants. Based on the transition data that we have from the first round of PCS assessments, we know that today 3,399 individuals are currently receiving PCS services living in special care units. Of that, approximately 86% were assessed as needing hands-on assistance with 5 qualifying ADLs, which is the highest level of acuity that we assess. So based on that, we are looking at the stratification of the data to project numbers in terms of how many people would qualify for that 130 hours. Keeping in mind, this program requires comparability. So in addition to individuals living in special care units, individuals living in an in-home setting would also have the opportunity to be assessed as needing more than 80 hours. So we have actually two cohorts that would be involved in the expansion of ours. [SPEAKER CHANGES] Excellent. That really provides some great insight. Representative Dollar it looks like you’re getting ready to say something else for me. It looks like we’re talking about 86% of that 3400 folks. [SPEAKER CHANGES] Thank you Senator McKissick. I’m going to ask Senator Dollar if he’ll further explain, and then we’ll go to a couple of other questions. [SPEAKER CHANGES] I was just going to add that there is an independent assessment that is in the legislation, because the assessments that were done for PCS last year didn’t contemplate above 80 hours. And we also ask in there that those assessments be done by someone who is experienced with this population, which will be helpful to us. [SPEAKER CHANGES] Thank you very much. Senator Kinnaird? [SPEAKER CHANGES] Thank you. I’d like to hear from the people who represent the special care units. I think I see Evelyn Hawthorne back there. Mr. Chair if she could just speak to the bill? [SPEAKER CHANGES] Ms. Hawthorne if you’ll come forward and speak just briefly to the bill, please. We do need to move along. [SPEAKER CHANGES] Good morning members. Mr. Chairman thank you for recognizing me. My name is Evelyn Hawthorne. I represent the North Carolina Assisted Living Association. The Association is part of the North Carolina Alliance for Alzheimer’s Care, and there are other representatives in the room with that group. We appreciate Representative Dollar’s leadership, Senator Hise’s leadership, and Senator Pate’s leadership on this sticky issue that we’ve been dealing with forever it seems. We have not seen the PCS. We have not seen the amendments. We appreciate the fine tuning of the bill, but suggest that there are some other issues that still need to be addressed, and would appreciate the opportunity to continue to work with the members on those issues, the members and the staff. In particular, we’re very concerned that the language in the bill before, I don’t know exactly what the amendments do, but the bill appears to disallow some of the very care that these residents need, by language in the bill. In terms of what would qualify them for the elevated level of hours. If you look at…

If you look at the need for supervision and queuing those sort of non hands on care that is especially these residences need to have in order to qualify for the elevated level of hours. But it is especially forbidden in terms of what would be allowable in terms of services. I would differ Mr chairman if you would write to Charles Marshall who is an attorney with the [??] we could get in to that further . But that is the gist the crux of what we are concerned about. Would be happy to answer any questions. [Speaker Changes] Mr Chair, could we hear from the Attorney please? [Speaker Changes] Yes. Do come forward Sir and introduce yourselves and Please represent and Please keep the remarks as short as possible. [Speaker Changes] Charles Marshall. I am an attorney representing Carolina Assisted living, who is a provider, specializes in special care units. All I would like to do is to let know as Miss Flakland said from the policy perspective. Thank Rep Dollar and in particular Senate Hise and the staff because as a lawyer what I had done is try to address this thorny issue about we are giving a 130 hours in addition to the 50 which is so desperately needed and I think the bill sponsor for that. That’s the critical step here. The only fear I have seen as an Attorney is that the department is doing the assessment for 130 and it turns out that the assessment comes back saying they do need to be prompt in Queuing and that’s what all [??] need. And that’s usually what drive the number of hours up side. If they need that don’t want the department to get stuck in a position all of a sudden, they can’t authorize that level of hours the 110, 120, 130 because of the prohibition of non [??] care. I would feel that the department can work that out with CMS in those type of conversations where it is concerned about the statutory prohibitions that might tie their hands from the [??] being able to access the 130 hour issue. In particular I have had conversations about comparability. I can’t speak speak for CMS obviously or any Federal regulator But it would appear to me that if all all summer residence has a demonstrated need for particular type of non hands on care that they are to be able to have that even if others that didn’t have that same need don’t. But we are still providing comparable services to people with comparable needs. The needs being dementia related needs that other residence may not have. Again I appreciate since that is specifically for working with us on those thorny issues. Just want to raise this issue, because we didn’t want a situation where the 130 hours which is so critical is there. And If they are not able to access, it has to come back to the legislature and say there is a issue with the type of care [Speaker Changes] Mr Chairman [Speaker Changes] I think Rep Dollar might have a remark to make. [Speaker Changes] Just a brief comment if I don’t say this right things, then Senator Hise can correct me. Certainly the issue that we are going to continue to take a look at moving forward by by a concern we have and has been raised earlier and some of the questions were with respect to costs. And this has to stay within the funds we have available . Frankly we just can’t blow this budget up but adding things could substantially potentially increase cost until we are very sure about what the numbers are moving forward. [Speaker Changes] Senator Harrington [Speaker Changes] I would like to ask whether we would continue to work on this as this moves. Because I think this is a very serious concern especially as the population ages and we have more and more people with dementia. [Speaker Changes] Senator Hise [Speaker Changes] Thank you Mr Chairman. I just want to speak real briefly on what we are doing with hands on and it’s not that we will fulfill the services needs but under comparability and issues the only way to get a waiver for a particular diagnosis was through our waiver. And CMS is required that if we do our waiver for these groups that the units have to meet home and committee by standards . You just can’t carve out Medicaid under entitlement a particular diagnosis. You have to open out to every one. So hands on available for this population and its available for everyone on Medicaid offered assistance. We have done an evaluation that says can they shower themselves but did not include they can be told to shower themselves. In going through that process, we literally had the Federal Government come back  

And say to do this with special care units required that we couldn’t lock the facilities, couldn’t be locked. They had to have access to a kitchen. They had to choose their own roommates and visitation. Some of the most insane ideas for a special care unit I think that’s ever been suggested in moving forward. So that’s what we’re trying to do is not open up a comparability issue with everyone else under Medicaid that’s coming forward. And this is where I think we feel comfortable that we can step to right now and get those other hours out there as the federal government comes to its senses at some later point maybe we can consider something differently. [SPEAKER CHANGES] I just have to say, amen. The federal government has constrained us mightily in terms of trying to come up with a solution to this issue. [SPEAKER CHANGES] Senator Rabin, did you have a comment? [SPEAKER CHANGES] Yeah, I was just wondering, based on the language it seems to me that it’s any kind of disability were talking about, not just dementia. Anything that’s covered by Medicaid where you can meet those five criteria. True? [SPEAKER CHANGES] Kind of yes and no. But, it’s individuals who would be…What we cannot do is we cannot discriminate between residential setting. So, you have to be comparable in the areas. Now this is in a particular area, but you do have to have comparability, whether the individual is in an in home setting or is in a residential setting. And that’s what we struggle with, not only on this issue but a range of similar issues. [SPEAKER CHANGES] Follow up a little bit please sir. [SPEAKER CHANGES] Yes. [SPEAKER CHANGES] The recipient has a medical condition disability or cognitive impairment and demonstrates unmet needs and so on, that’s the language. What I’m concerned about and where I’m going is, we’re talking about costs that could mount in the future that we need to account for. And if in the modeling we’re accounting for some of the things that could happen i.e. when seventeen or nineteen billion dollars of Tricare money goes into Medicaid and we start getting ?? patients who have disabilities who might need this kind of care, are we adding them in our modeling or accounting for those things somehow? [SPEAKER CHANGES] Well this just applies to the state’s portion, the Medicaid portion, of what we’re going at the state. Because obviously, as you know, the Tricare and Medicare, we don’t have any involvement in that. [SPEAKER CHANGES] But are the residents of the state who are receiving state Medicaid…There’s a great number, nearly a million, nearest I can tell, of potential retired military that stay here. And if that transfer of funds happens and they’re forced into Medicaid then they’re forced into this system, the way I understand it. Which could be I’m confused on it. I just want to throw it out as part of the modeling idea, if you’re going to account for stuff in the future to think out that way. [SPEAKER CHANGES] Senator Wade. [SPEAKER CHANGES] At the appropriate time Mr. Chair I’d like to move for a favorable response. [SPEAKER CHANGES] Senator Robinson has a question then we’ll get back to Senator Wade. [SPEAKER CHANGES] Yes, just one question Mr. Chair. When you talk about the reduced cost do we have any idea of what is the cost now? What would that cost be reduced, or is that fluctuating depending on level of services or whatever? [SPEAKER CHANGES] The rate will be reduced. I’ve got a couple of rate figures in my mind but I might quote the wrong one. But it’s kind of elevated with what Senator Hise explained previously. It’s sort of artificially elevated right now so it is going to be allowed to come down. Which, everybody in the industry knows this. It’s going to be coming back down to somewhere close to where it was. [SPEAKER CHANGES] Can staff answer… [SPEAKER CHANGES] Let’s ask Mrs. Denise Thomas. [SPEAKER CHANGES] Denise Thomas, fiscal research. The rate will be reduced from, I believe it’s, thirteen twelve per fifteen minutes to fourteen dollars and seven. I’m sorry, to fourteen dollars and seven cents per fifteen minute unit. I’m sorry, per hour. Just a minute, let me pull up the spreadsheet. [SPEAKER CHANGES] I think it’s fourteen twelve if I’m not mistaken. Something like that. [SPEAKER CHANGES] Fourteen o

Senator Wade, recognize you for a motion. [SPEAKER CHANGES] Move for a favorable report. [SPEAKER CHANGES] Senator Wade moves for a favorable report to the PCS, unfavorable to the original Bill, with a re-referral to appropriations based budget, as amended. All those in favor please say aye. All opposed may say no. The Bill carries. Thank you very much, Representative Dollar. [SPEAKER CHANGES] Thank you, Mr. Chairman, and members of the Committee. [SPEAKER CHANGES] Next on the agenda is House Bill 399. Representative Burr, who also is Co-Chair of the House Appropriations Committee, is going to present this Bill, and be very nice to him as well. [SPEAKER CHANGES] Thank you, Mr. Chairman. House Bill 399 is amending all pertaining to the Department of Health and Human Services as it is an agency Bill, and the Bill's making changes to the statutes pertaining to child abuse, neglect and dependency, Medicaid and public health. Some of these are basically a requirement in order for the state to be eligible for grants. Some are requirement that are needed to be changed in order to meet federal regulations that have been established. The Department has been working with stakeholders on this. There have been a few issues we have tried to iron out. I do think, Mr. Chairman, there's an Amendment that will correct one more issue. It's going to be sent forward? [SPEAKER CHANGES] Yes. We had the Amendment prepared, and we will send it out at this time. Senator Wade, wait until we get the Bill out before everyone. [SPEAKER CHANGES] Everyone have a copy of the Amendment? Senator Wade, you're recognized to explain the Amendment. [SPEAKER CHANGES] It's a very simple Amendment. It just allows 10 days for a hospital to file the birth certificate, instead of 5. Sometimes they need a little extra time. There's DNA testing sometime, and sometimes you have to locate the other parent, so they've asked to extend it to 10 days, so they don't have to put in a birth certificate that's not completely filled out and get it returned, and I would appreciate your support on this Amendment. [SPEAKER CHANGES] Comment on the Amendment, Representative Burr? [SPEAKER CHANGES] Thank you, Mr. Chairman. My understanding is the Department is okay with the Amendment, I'm fine with it, and we'd certainly ask for your support. [SPEAKER CHANGES] Senator Davis? [SPEAKER CHANGES] Thanks, Mr. Chair. I just have a question regarding the Amendment itself. Would there be a need to bring Section A and B in a Line, or was everyone okay with--I think it's 5 and 10 days, and I think this was part of the ambiguity before. [SPEAKER CHANGES] Senator Wade? [SPEAKER CHANGES] We don't have the whole statute, and I'm told that that only refers to live births not at a hospital or a medical facility, but Staff can answer that if you'd like for them. [SPEAKER CHANGES] Yes. Amy Jo Johnson from our Staff can answer the question, I believe. [SPEAKER CHANGES] Certainly. In the original Bill, you see the A being changed form 10 to 5 days. The current law for A is already 10, so we didn't need to put that back into the Amendment. We're just changing B, changing that from 5 to 10, so both will now match at 10 days. [SPEAKER CHANGES] Mr. Chair, I think this is a great Amendment, and I do move for adoption of that Amendment. [SPEAKER CHANGES] Further questions? Seeing none--well, it's Senator Wade's Amendment, so Senator Wade has already moved for the adoption of the Amendment. All those in favor of adopting the Amendment please say aye. All opposed may say no. The Amendment is adopted. The Bill is back before you. Representative Burr. [SPEAKER CHANGES] I have nothing further, unless there are questions. We're happy to take those. I'd be happy to have either Staff or the Department address any questions. Mr. Chairman? [SPEAKER CHANGES] Seeing none, Senator Rabin, you are recognized for a motion. [SPEAKER CHANGES] I move for a favorable. [SPEAKER CHANGES] Senator Rabin moves for a favorable report to the Bill, as amended. It will be rolled into a PCS and it will go to the Floor. All those in favor say aye. All opposed may say no. The Motion carries. The Bill, as amended, is approved. Thank you very much.

House Bill 459. Representative Dollar is going to present this bill, and the PCS to this bill has been pulled and we will discuss the original bill, so get the original bill out, House Bill 459, Representative Dollar. [SPEAKER CHANGES]Thank you Mr. Chair, and members of the committee, I'll try to be very brief. This is a bill supported by the department, or at least they support it on the House side, and what we are looking to do here it try to break down a number of silos we have out there and deal with chronic care issues, both within the Medicare program, and in the state health plan, in a more coordinated fashion, just as the bill sets forward. The main portion of the bill on page 2 directs those 2 organizations to come up with a plan that would be reported back, obviously, to the General Assembly assessing financial impact in the magnitude of chronic health care issues to the state with specific chronic illnesses outlined there. Assessments of the benefit drive of wellness programs and the like, and assessment of that. Some discussion of coordinating our activities across a number of major divisions and agencies in state government and have them pull together a plan, obviously as planned, and many aspects of it would potentially be brought back to the General Assembly for any action that would be required on our part. But if you put all these, just as the where is clauses, you put all these particular chronic diseases together, they account for essentially 70% of the deaths in the United States, and a roughly equivalent number here in North Carolina. So, I think this is a bill that helps move us forward in terms of taking down silos, and being more holistic in our approach, and not only getting a better bang for our buck, long term, but also looking to try to have better coordinated health care in North Carolina, particularly for the state as a whole, but particularly as it relates to our state health plan and our Medicaid program. And I know of no, Mr. Chairman, members of the committee, I know of no opposition to this. [SPEAKER CHANGES]Thank you Representative Dollar. Are there questions from members of the committee? Senator Woodard, I recognize you for a motion. Senator Woodard has recommended that we move for the adoption of House Bill 459, with a re-referral to appropriations based budget. Any further discussion? Seeing none, all those in favor please say aye. [SPEAKER CHANGES]Aye. [SPEAKER CHANGES]All those opposed may say no, and the bill is adopted. Thank you very much for your attention, the meeting is now adjourned. [SPEAKER CHANGES]Thank you Mr. Chairman, members of the committee,