SB 361 — Healthy NC.

…"e. (14a) "Intermediate care facility for the mentally retarded" "Intermediate care facility for individuals with intellectual disabilities" means facilities licensed pursuant to Article 2 of Chapter 122C of the General Statutes for the purpose of providing health and habilitative services based on the developmental model and principles of normalization for persons with mental retardation, intellectual disabilities, autism, cerebral palsy, epilepsy or related conditions.

…A (16)health "Newcare institutionalfacility healthfinanced services"pursuant meansto anyChapter 131A of the following:General Statutes or receiving a certificate of need under Article 9 of Chapter 131E of the General Statutes." SECTION 2.(e) G.S.

…122C-23.1(e) d.reads as rewritten:

ThePage offering2 ofSenate dialysisBill services361-First orEdition homeGeneral healthAssembly servicesOf byNorth orCarolina onSession behalf2019 of"(e) As used in this section, "residential treatment facility" means a health"residential servicefacility" facilityas ifdefined thosein servicesand werelicensed under this Chapter, but not offeredsubject withinto theCertificate previousof 12Need monthsrequirements byunder orArticle on9 behalfof Chapter 131E of the facility.General Statutes.Chapter." SECTION 2.(f) G.S.

…131E-13(a)(1) r.reads as rewritten:

"(1) The conversioncorporation ofshall acontinue specialtyto ambulatoryprovide surgicalthe programsame or similar clinical hospital services to aits multispecialtypatients ambulatoryin surgicalmedical-surgery, programobstetrics, orpediatrics, outpatient and emergency treatment, including emergency services for the additionindigent, ofthat athe specialtyhospital facility provided prior to athe specialtylease, ambulatorysale, surgicalor program.conveyance.

…These u.services may be terminated only as prescribed by Certificate of Need Law prescribed in Article 9 of Chapter 131E of the General Statutes, or, if Certificate of Need Law is inapplicable, by review procedure designed to guarantee public participation pursuant to rules adopted by the Secretary of the Department of Health and Human Services." SECTION 2.(g) G.S.

Theconstruction,development,establishment,increase131E-136(4) inreads thenumber,as orrewritten: relocation of an operating room or gastrointestinal endoscopy room in a licensed health service facility, other than the relocation of an operating room or gastrointestinal endoscopy room within the same building or on the same grounds or to grounds not separated by more than a public right-of-way adjacent to the grounds where the operating room or gastrointestinal endoscopy room is currently located.

v."(4) "Home health agency" means a home care agencywhich is certified to receive Medicare and Medicaid reimbursement for providing nursing care, therapy, medical social services, and home health aide services on a part-time, intermittent basis as set out in G.S.

The131E-176(12), changeand inis designation,thereby inalso asubject licensed health service facility, of an operating room to aArticle gastrointestinal9 endoscopy room or change in designation of aChapter gastrointestinal131E.basis." endoscopyroomSECTION to2.(h) anG.S. operating room that results in a different number of each type of room than is reflected on the health service facility's license in effect as of January 1, 2005.

…."148-19.1 SECTIONreads 1.(b)as G.S.rewritten:

131E-177"§ reads148-19.1. as rewritten:

"§Exemption 131E-177.from licensure and certificate of need.licensure.

(a) Inpatient chemical dependency or substance abuse facilities that provide services exclusively to inmates of the Division of Adult Correction of the Department of Public Safety shall be exempt from licensure by the Department of Health and Human Services isunder designatedChapter State122C Healthof Planningthe andGeneral DevelopmentStatutes. Agency;

powersIf an inpatient chemical dependency or substance abuse facility provides services both to inmatesoftheDivision ofAdult Correction of the Department of Public Safety and duties.to members of the general public, the portion of the facility that serves inmates shall be exempt from licensure.

The(b) DepartmentAny ofperson Healthwho andcontracts Humanto Servicesprovide isinpatient designatedchemical asdependency or substance abuse services to inmates of the StateDivision Healthof PlanningAdult Correction of the Department of Public Safety may construct and Developmentoperate Agencya new chemical dependency or substance abuse facility for thethat Statepurpose without first obtaining a certificate of Northneed Carolina,from the Department of Health and isHuman empoweredServices pursuant to exerciseArticle the9 followingof powersChapter and131E duties:of the General Statutes.

PageHowever, 2a Senatenew Billfacility 361-Secondor Editionaddition Generaldeveloped Assemblyfor Ofthat Northpurpose Carolinawithout Sessiona 2019certificate (1)of Toneed establishshall standardsnot andbe criterialicensed orpursuant plansto requiredChapter to122C carryoutof the provisionsGeneral Statutes and purposesshall ofnot thisadmit Articleanyone andother tothan adoptinmates rulesunless pursuantthe toowner Chapteror 150Boperator offirst theobtains Generala Statutes,certificate toof carryneed." outSECTION the2.(i) purposesArticle and9 provisionsof Chapter 131E of thisthe Article;Article.General Statutes, G.S.

(2)130A-45.02(i), Adopt,143B-1292, amend,150B-2(8a)k., and repeal150B-21.1(6) suchare rulesrepealed. and regulations, consistent with the laws of this State, as may be required by the federal government for grants-in-aid for health service facilities and health planning which may be made available by the federal government.

SECTION 2.(j) This section shallbecomes beeffective liberallyJanuary construed1, in2020. order that the State and its citizens may benefit from such grants-in-aid;grants-in-aid.

(3)Subsection Define,(a) byof rule,this proceduressection forapplies submissionto ofcontested periodiccases reportsarising byon persons or healthafter serviceJanuary facilities1, subject2020. to agency review under this Article;Article.

(4)PART DevelopIII. With respect to healthservicefacilitiesplanning, all ofthe following:

a.PSYCHOLOGY INTERJURISDICTIONAL LICENSURE COMPACT SECTION 3.(a) Article 18A of Chapter 90 of the General Statutes, G.S.

Develop policy, criteria, and standards for health service facilities planning;

shall conduct planning.

b.

Conduct statewide registration and inventories of and make determinations of need for health service facilities, health services as specified in G.S.

131E-176(16)f., and equipment as specified in G.S.

131E-176(16)f1., which shall include consideration of adequate geographic location of equipment and services;

and develop services.

c.

Develop a State Medical Facilities Plan;Plan, provided, however, that the State Medical Facilities Plan shall not include policies or need determinations that limit the number of operating rooms or gastrointestinal endoscopy rooms.

(5) Implement, by rule, criteria for project review;review.

(6) Have the power to grant, deny, or withdraw a certificate of need and to impose such sanctions as are provided for by this Article;Article.

(7) Solicit, accept, hold andadministeronbehalfoftheStateanygrants ordevises of money, securities or property to the Department for use by the Department in the administration of this Article;

andArticle.

(8) Repealed by Session Laws 1987, c.

511, s.

1.

(9) Collect fees for submitting applications for certificates of need.

(10) The authority to review all records in any recording medium of any person or health service facility subject to agency review under this Article which pertain to construction and acquisition activities, staffing or costs and charges for patient care, including but not limited to, construction contracts, architectural contracts, consultant contracts, purchase orders, cancelled checks, accounting and financial records, debt instruments, loan and security agreements, staffing records, utilization statistics and any other records the Department deems to be reasonably necessary to determine compliance with this Article.

The Secretaryof Health and Human Services shall have final decision-making authoritywith regard to all functions described in this section." SECTION 1.(c) G.S.

131E-178(a) reads as rewritten:

"(a) No person shall offer or develop a new institutional health service without first obtaining a certificate of need from the Department;

provided, however, no person who provides gastrointestinal endoscopy procedures in one or more gastrointestinal endoscopy rooms located in a nonlicensed setting, shall be required to obtain a certificate of need to license that setting as an ambulatory surgical facility with the existing number of gastrointestinal endoscopy rooms, provided that:

Senate Bill 361-Second Edition Page 3 General Assembly Of North Carolina Session 2019 (1) The license application is postmarked for delivery to the Division of Health Service Regulation by December 31, 2006;

(2) Theapplicant verifies,byaffidavit submittedtotheDivision ofHealth Service Regulation within 60 days of the effective date of this act, that the facility is inoperationasoftheeffectivedateofthisactorthatthecompletedapplication for the building permit for the facility was submitted by the effective date of this act;

(3) The facility has been accredited by The Accreditation Association for Ambulatory Health Care, The Joint Commission on Accreditation of Healthcare Organizations, or The American Association for Accreditation of Ambulatory Surgical Facilities by the time the license application is postmarked for delivery to the Division of Health Service Regulation of the Department;

and (4) The license application includes a commitment and plan for serving indigent and medically underserved populations.

All other persons proposing to obtain a license to establish an ambulatory surgical facilityfor the provision of gastrointestinal endoscopy procedures shall be required to obtain a certificate of need.

The annual State Medical Facilities Plan shall not include policies or need determinations that limit the number of gastrointestinal endoscopy rooms that may be approved.Department." SECTION 1.(d) G.S.

131E-181 reads as rewritten:

"§ 131E-181.

Nature of certificate of need.

… (d) A recipient of a certificate of need shall complete the project authorized by the certificate of need within two years after the decision to issue the certificate of need becomes final.

If the recipient does not complete the project authorized by the certificate of need within this two-year time period, the certificate of need for the authorized project expires the day after the two-year time period ends.

A project authorized by a certificate of need is complete when the health service or the health service facilityfor which the certificate of need was issued is licensed and certified and is in material compliance with the representations made in the certificate of need application.

(e) TheDepartmentshallwithdrawacertificateofneed issuedtoanyrecipientthatceases operating the health service or health service facility included in that certificate of need for more than one year." SECTION 1.(e) G.S.

131E-183(a)(1) reads as rewritten:

"(1) The proposed project shall be consistent with applicable policies and need determinations in the State Medical Facilities Plan, the need determination of which constitutes a determinative limitation on the provision of any health service, health service facility, health service facility beds, dialysis stations, operating rooms, or home health offices that may be approved." SECTION 1.(f) G.S.

131E-184(c) reads as rewritten:

"(c) The Department shall exempt from certificate of need review any conversion of existing acute care beds to psychiatric beds provided:beds.

(1) The hospital proposing the conversion has executed a contract with the Department's Division of Mental Health, Developmental Disabilities, and Substance Abuse Services and/or one or more of the Area Mental Health, Developmental Disabilities, and Substance Abuse Authorities to provide psychiatric beds to patients referred by the contracting agency or agencies;

and (2) The total number of beds to be converted shall not be more than twice the number of beds for which the contract pursuant to subdivision (1) of this subsection shall provide." Page 4 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 SECTION 1.(g) G.S.

131E-184(e)(1) reads as rewritten:

"(1) The proposed capital expenditure would:

a.

Be used solely for the purpose of renovating, replacing on the same site, or expanding an existing:

1.

Nursing home facility, or 2.

Adult care home facility, orfacility;

and 3.

Intermediate care facility for the mentally retarded;

and b.

Not result in a change in bed capacity, as defined in G.S.

131E-176(5), ortheaddition ofahealth service facilityoranyothernewinstitutional health service other than that allowed in G.S.

131E-176(16)b." SECTION 1.(h) G.S.

131E-184 is amended by adding new subsections to read:

"(i) The Department shall exempt from certificate of need review the development, acquisition, construction, expansion, or replacement of a health service facility or health service that obtained certificate of need approval prior to October 1, 2019, as an ambulatory surgical facility, including an ambulatory surgical facility with one or more operating rooms or gastrointestinalendoscopyprocedurerooms;adiagnosticcenter;kidneydiseasetreatmentcenter, including freestanding dialysis units;

chemical dependency treatment facility;

intermediate care facility for individuals with intellectual disabilities;

psychiatric hospital;

or any other licensable facility, as defined in G.S.

122C-3(14)b.

(j) The Department shall exempt from certificate of need review the establishment of a home health agency by a continuing care retirement community licensed under Article 64 of Chapter 58 of the General Statutes to provide home health services to one or more residents of a continuing care retirement community who have entered into a contract with the continuing care retirement community to receive continuing care services with lodging.

A continuing care retirement communitythat seeks to providehomehealthservices to individuals whodo notreside at the continuing care retirement community pursuant to a contract to receive continuing care services with lodging shall be required to obtain a certificate of need as a home health agency prior to developing or offering home health services to any individual not a resident of the continuing care retirement community under a contract to receive continuing care services with lodging.

As used in this subsection, the terms "continuing care" and "lodging" are as defined in G.S.

58-64-1.

Nothing in this subsection shall be construed to exempt from the State's home health agency licensure and certification requirements a continuing care retirement community that has been exempted from certificate of need review for the provision of home health services to one or more residents pursuant to this subsection." SECTION 1.(i) G.S.

131E-184(j), as enacted by this section, applies to continuing care retirement communities engaged in the direct provision of home health services on or after October 1, 2019.

SECTION 1.(j) G.S.

131E-186(a) reads as rewritten:

"(a) Within the prescribed time limits in G.S.

131E-185, the Department shall issue a decisionto"approve,""approvewithconditions,"or"deny,"an application foranewinstitutional health service.

Approvals involving new or expanded nursing care or intermediate care for the mentally retarded bed capacity shall include a condition that specifies the earliest possible date the new institutional health service may be certified for participation in the Medicaid program.

The date shall be set far enough in advance to allow the Department to identify funds to pay for care in the new or expanded facility in its existing Medicaid budget or to include these funds in its State Medicaid budget request for the year in which Medicaid certification is expected." SECTION 1.(k) G.S.

131E-188 reads as rewritten:

"§ 131E-188.

Administrative and judicial review.

(a) After a decision of the Department to issue, deny or withdraw a certificate of need or exemption or to issue a certificate of need pursuant to a settlement agreement with an applicant to the extent permitted by law, any affected person, as defined in subsection (c) of this section, Senate Bill 361-Second Edition Page 5 General Assembly Of North Carolina Session 2019 shall be proponent of an application that was reviewed with the application for that certificate of need is entitled to a contested case hearing under Article 3 of Chapter 150B of the General Statutes.

A petition for a contested case shall be filed within 30 days after the Department makes its decision.

When a petition is filed, the Department shall send notification of the petition to the proponent of each application that was reviewed with the application for a certificate of need that is the subject of the petition.

Any affected person shall be entitled to intervene in a contested case.

A contested case shall be conducted in accordance with the following timetable:

(1) An administrative law judge or a hearing officer, as appropriate, shall be assigned within 15 days after a petition is filed.

(2) The parties shall complete discovery within 90 days after the assignment of the administrative law judge or hearing officer.

(3) The hearing at which sworn testimonyis taken and evidence is presented shall be held within 45 days after the end of the discovery period.

(4) The administrative law judge or hearing officer shall make a final decision within 75 days after the hearing.

(5) Repealed by Session Laws 2011-398, s.

46, as amended by Session Laws 2011-326, s.

23, effective January 1, 2012, and applicable to contested cases commenced on or after that date.

The administrative law judge or hearing officer assigned to a case may extend the deadlines in subdivisions (2) through (4) so long as the administrative law judge or hearing officer makes a final decision in the case within 270 days after the petition is filed.

… (b) Any affected person who was a party in a contested case hearing shall be entitled to judicial review of all or any portion of any final decision in the following manner.

The appeal shall be to the Court of Appeals as provided in G.S.

7A-29(a).

The procedure for the appeal shall be as provided bythe rules of appellate procedure.

The appeal of the final decision shall be taken within 30 days of the receipt of the written notice of final decision, and notice of appeal shall be filed with the Office of Administrative Hearings and served on the Department and all other affected persons who were parties to the contested hearing.

The Court of Appeals, in an action for judicial review brought under this section, shall award all costs of such action, including reasonable attorney's fees to the prevailing party.

For the purpose of this subsection, reasonable attorney's fees include attorney's fees incurred during the administrative review portion of the contested case arising under Article 3 of Chapter 150B of the General Statutes.

(b1) Before filing an appeal of a final decision granting a certificate of need, the affected person appellant shall deposit a bond with the Clerk of the Court of Appeals.

The bond requirements of this subsection shall not apply to any appeal filed by the Department.

(1) The bond shall be secured by cash or its equivalent in an amount equal to five percent (5%) of the cost of the proposed new institutional health service that is the subject of the appeal, but may not be less than five thousand dollars ($5,000) and may not exceed fifty thousand dollars ($50,000);

provided that the applicant who received approval of the certificate of need may petition the Court of Appeals for a higher bond amount for the payment of such costs and damages as may be awarded pursuant to subdivision (2) of this subsection.

This amount shall be determined by the Court in its discretion, not to exceed three hundred thousand dollars ($300,000).

five hundred thousand dollars ($500,000).

A holder of a certificate of need who is appealing onlya condition in the certificate is not required to file a bond under this subsection.

… (c) The term "affected persons" includes:

the applicant;

any individual residing within the service area or the geographic area served or to be served by the applicant;

any individual Page 6 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 who regularly uses health service facilities within that geographic area or the service area;

any person who provides services, similar to the services under review, to individuals residing within the service area or the geographic area proposed to be served by the applicant;

any person who, prior to receipt by the agency of the proposal being reviewed, has provided written notice to the agency of an intention to provide similar services in the future to individuals residing within the service area or the geographic area to be served by the applicant;

third party payers who reimburse health service facilities for services in the service area in which the project is proposed to be located;

and any agency which establishes rates for health service facilities or HMOs located in the service area in which the project is proposed to be located." SECTION 1.(l) G.S.

131E-147 is amended by adding a new subsection to read:

"(f) The Department shall not issue or renew a license to operate an ambulatory surgical facility developed, acquired, or replaced on or after October 1, 2019, unless the application includes all of the following:

(1) A commitment that the Medicare allowable amount for self-pay and Medicaid surgical cases minus all revenue collected from self-pay and Medicaid surgical cases shall be at least four percent (4%) of the total revenue collected for all surgical cases performed in the facility or proposed facility.

(2) For each year of operation, a commitment to report to the Department the total number of cases by each of the following payer categories:

a.

Self-pay surgical cases.

b.

Medicaid surgical cases.

c.

Medicare surgical cases.

d.

Commercial insurance surgical cases.

e.

Managed care surgical cases.

f.

Other surgical cases.

(3) A commitment to report utilization and payment data for services provided by the ambulatorysurgical facilityto the statewide data processor, as required by G.S.

131E-214.2." SECTION 1.(m) G.S.

131E-175(11) and (12) are repealed.

SECTION 1.(n) This section becomes effective October 1, 2019.

PART II.

PSYCHOLOGY INTERJURISDICTIONAL LICENSURE COMPACT SECTION 2.(a) Article 18A of Chapter 90 of the General Statutes, G.S.

SECTION 2.(b)3.(b) Chapter 90 of the General Statutes is amended by adding a new Article to read:

Senate Bill 361-First Edition Page 3 General Assembly Of North Carolina Session 2019 (1) Increase public access to professional psychological services by allowing for telepsychological practice across state lines as well as temporary in-person, face-to-face services into a state which the psychologist is not licensed to practice psychology.

Senate Bill 361-Second Edition Page 7 General Assembly Of North Carolina Session 2019 (5) Promote compliance with the laws governing psychological practice in each Compact State.

Page 4 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 (12) E.Passport.

If the Page 8 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 psychologist is licensed in more than one Compact State and is practicing under the Temporary Authorization to Practice, the Home State is any Compact State where the psychologist is licensed.

or Senate Bill 361-First Edition Page 5 General Assembly Of North Carolina Session 2019 b.

Senate Bill 361-Second Edition Page 9 General Assembly Of North Carolina Session 2019 (28) Temporary Authorization to Practice.

(3) Notifies the Commission, in compliance with the terms herein, of any adverse action orsignificant investigatoryinformation regardingalicensedregardingalicensedindividual; individual;

Page 6 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 (4) Requires an Identity History Summary of all applicants at initial licensure, including the use of the results of fingerprints or other biometric data checks compliant with the requirements of the Federal Bureau of Investigation (FBI), or other designee with similar authority, no later than 10 years after activation of the Compact;

90-270.162, to practice telepsychology in other Compact States Page 10 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 (Receiving States) in which the psychologist is not licensed, under the Authority to Practice Interjurisdictional Telepsychology as provided in the Compact.

Senate Bill 361-First Edition Page 7 General Assembly Of North Carolina Session 2019 (4) Have no history of adverse action that violate the Rules of the Commission;

and Senate Bill 361-Second Edition Page 11 General Assembly Of North Carolina Session 2019 (8) Meet other criteria as defined by the Rules of the Commission.

Page 8 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 d.

Page 12 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 i.

A Home State may take adverse Senate Bill 361-First Edition Page 9 General Assembly Of North Carolina Session 2019 action against a psychologist based on an adverse action taken by a Distant State regarding temporary in-person, face-to-face practice.

Senate Bill 361-Second Edition Page 13 General Assembly Of North Carolina Session 2019 (2) In the event discipline is reported on a psychologist, the psychologist will not be eligible for telepsychology or temporary in-person, face-to-face practice in accordance with the Rules of the Commission.

Page 10 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 (2) Issuecease and desist and/orinjunctiverelieforders to revoke apsychologist's Authority to Practice Interjurisdictional Telepsychology and/or Temporary Authorization to Practice.

Page 14 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 All information provided to the Commission or distributed byCompact States pursuant to the psychologist shall be confidential, filed under seal, and used for investigatory or disciplinary matters.

Senate Bill 361-First Edition Page 11 General Assembly Of North Carolina Session 2019 (2) Venue is proper and judicial proceedings by or against the Commission shall be brought solely and exclusively in a court of competent jurisdiction where theprincipal officeoftheCommissionislocated.TheCommissionmaywaive venue and jurisdictional defenses to the extent it adopts or consents to participate in alternative dispute resolution proceedings.

Senate Bill 361-Second Edition Page 15 General Assembly Of North Carolina Session 2019 a.

Page 12 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 h.

The Commission shall keep minutes which fully and clearly describe all matters discussed in a meeting and shall provide a full and accurate summary of Page 16 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 actions taken, of any person participating in the meeting, and the reasons therefore, including a description of the views expressed.

As soon as practicable, the Commission must make public a copyof the vote to close the meetingmeetingrevealingthe revealingthe vote of each Commissioner with no proxy votes allowed;

Senate Bill 361-First Edition Page 13 General Assembly Of North Carolina Session 2019 (8) The Commission shall publish its Bylaws in a convenient form and file a copy thereof and a copy of any amendment thereto with the appropriate agency or officer in each of the Compact States;

Senate Bill 361-Second Edition Page 17 General Assembly Of North Carolina Session 2019 (3) To purchase and maintain insurance and bonds;

Page 14 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 b.

Page 18 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 c.

– (1) The members, officers, Executive Director, employees, and representatives of the Commission shall be immune from suit and liability, either personally or in their official capacity, for any claim for damage to or loss of property or personal injury or other civil liability caused by or arising out of any actual or alleged act, error, or omission that occurred, or that the person against whom Senate Bill 361-First Edition Page 15 General Assembly Of North Carolina Session 2019 the claim is made had a reasonable basis for believing occurred within the scope of Commission employment, duties, or responsibilities, provided that nothing in this subdivision shall be construed to protect any such person from suit and/or liability for any damage, loss, injury, or liability caused by the intentional or willful or wanton misconduct of that person.

Senate Bill 361-Second Edition Page 19 General Assembly Of North Carolina Session 2019 (3) The Commission shall indemnify and hold harmless any member, officer, Executive Director, employee, or representative of the Commission for the amount of any settlement or judgment obtained against that person arising out of any actual or alleged act, error, or omission that occurred within the scope of employment, duties, or responsibilities, or that such person had a reasonable basis for believing occurred within the scope of Commission employment, duties, or responsibilities, provided that the actual or alleged act, error, or omission did not result from the intentional or willful or wanton misconduct of that person.

and (4) Themannerin whichinterestedpersonsmaysubmit noticetonotice to the Commission of their intention to attend the public hearing and any written comments.

(g) The Commission shall grant an opportunityopportunityfor for a public hearingbefore it adopts a rule or amendment if a hearing is requested by:

Page 16 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 (1) At least 25 persons who submit comments independently of each other;

This subsection shall not Page 20 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 preclude the Commission from makinga transcript or recordingof the hearing if it so chooses.

(l) Upon determination that an emergency exists, the Commission may consider and adopt an emergencyrule without priornotice, opportunityfor comment, or hearing,providedthathearing, providedthat the usual rule-making procedures provided in the Compact and in this section shall be retroactively applied to the rule as soon as reasonably possible, in no event later than 90 days after the effective date of the rule.

(m) The Commission or an authorized committee of the Commission maydirect revisions to a previouslyadopted rule or amendment for purposes of correctingcorrectingtypographical typographical errors, errors in format, errors in consistency, or grammatical errors.

– Senate Bill 361-First Edition Page 17 General Assembly Of North Carolina Session 2019 (1) The executive, legislative, and judicial branches of state government in each Compact State shall enforce this Compact and take all actions necessary and appropriate to effectuate the Compact's purposes and intent.

– Senate Bill 361-Second Edition Page 21 General Assembly Of North Carolina Session 2019 (1) If the Commission determines that a Compact State has defaulted in the performance of its obligations or responsibilities under this Compact or the promulgated rules, the Commission shall:

TheprevailingTheprevailingmembershall membershall beawarded all costs of such litigation, including reasonable attorneys' fees.

– Page 18 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 (1) The Commission, in the reasonable exercise of its discretion, shall enforce the provisions and Rules of this Compact.

Page 22 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 (a) The Compact shall come into effect on the date on which the Compact is enacted into law in the seventh Compact State.

If this Compact shall beheld contraryto the constitutionconstitutionofanystatememberthereto, ofanystatememberthereto, theCompact shall remain in full force and effect as to the remaining Compact States." SECTION 2.(c)3.(c) Subsections (a) and (b) of this section become effective when at least seven states have enacted the PsychologyInterjurisdictional Compact (PSYPACT) set forth ininsubsection subsection (b) ofthis section.

PART III.IV.

ALLOW LICENSED MARRIAGE AND FAMILY THERAPISTS TO CONDUCT FIRST-LEVEL EXAMINATIONS FOR INVOLUNTARY COMMITMENT AND CREATE FEES SECTION 3.(a)4.(a) G.S.

Senate Bill 361-First Edition Page 19 General Assembly Of North Carolina Session 2019 "§ 122C-263.1.

To certify a licensed clinical social worker, a master's or higher level degree nurse practitioner, a licensed professional counsellor, a licensed marriage and family therapist, or a physician's assistant to Senate Bill 361-Second Edition Page 23 General Assembly Of North Carolina Session 2019 conduct the first examinations described in G.S.

…." SECTION 3.(b)4.(b) G.S.This section is effective October 1, 2019.

90-270.54PART readsV. as rewritten:

"§PROGRAM 90-270.54.FOR ALL-INCLUSIVE CARE FOR THE ELDERLY REGULATORY CHANGES SECTION 5.(a) G.S.

Requirements131E-138 forreads licensure as arewritten: marriage and family therapist.

…"§ (a1)131E-138. The Board shall issue a license to conduct first examinations pursuant to G.S.

122C-263.1Licensure torequirements. applicants who meet the criteria for licensure in subsection (a) of this subsection and who pay a one-time, ten dollar ($10.00) fee.

…."(a) SECTIONNo 3.(c)Except G.S.as provided in subsection (f1) of this section, no person or governmental unit shall operate a home care agency without a license obtained from the Department.

90-270.57Nothing readsin asthis rewritten:Part shall be construed to extend or modifythe licensing of individual health professionals by the licensing boards for their professions or to create any new professional license category.

"§… 90-270.57.(f1) Exceptions to Licensure.

Fees.– If home care services are provided to a participant of the Program for All-Inclusive Care for the Elderly through an organization that has a valid Program for All-Inclusive Care for the Elderly agreement with the Centers for Medicare and Medicaid Services and the Division of Health Benefits of the Department of Health and Human Service, then the entity providing the home care services shall not be required to hold a license under this section.

(a)…." InSECTION order5.(b) toG.S. fund the Board's activities under this Article, the Board may charge and collect fees not exceeding the following:

…131D-2.1 (10)reads Applicationas torewritten: perform first examinations pursuant to G.S.

122C-263.1"§ 10.00.131D-2.1.

InDefinitions. addition to the examination fee provided in subdivision (1) of this subsection, the Board may charge and collect from each applicant for license examination the cost of processing test results and the cost of test materials.

(b)As Theused Boardin maythis establishArticle: fees for the actual cost of (i) document duplication services, (ii) materials, and (iii) returned bank items as allowed by law.

All… feesPage listed20 inSenate subsectionBill (a)361-First ofEdition thisGeneral sectionAssembly shallOf beNorth nonrefundable."Carolina SECTIONSession 3.(d)2019 This(3) sectionAdult iscare effectivehome. October 1, 2019.

Sections– 3(b)An assisted living residence in which the housing management provides 24-hour scheduled and 3(c)unscheduled applypersonal care services to applicationstwo submittedor onmore residents, either directly or afterfor thatscheduled date.needs, through formal written agreement with licensed home care or hospice agencies.

PARTagencies IV.or with a Program for All-Inclusive Care for the Elderly organizationthathasavalidprogram agreementwiththeCentersforMedicare and Medicaid Services and the Division of Health Benefits of the Department of Health and Human Services.

ELIMINATESome REDUNDANCYlicensed INadult ADULTcare CAREhomes HOMEprovide INSPECTIONSsupervision SECTIONto 4.persons with cognitive impairments whose decisions, if made independently, may jeopardize the safety or well-being of themselves or others and therefore require supervision.

Medication in an adult care home may be administered by designated trained staff.

Adult care homes that provide care to two to six unrelated residents are commonlycalled familycare homes.

… (5) Assisted living residence.

– Any group housing and services program for two or more unrelated adults, by whatever name it is called, that makes available, at a minimum, one meal a day and housekeeping services and provides personal care services directlyor through a formal written agreement with one or more licensed home care or hospice agencies.

agencies, or with a Program for All-Inclusive Care for the Elderly organization that has a valid program agreement with the Centers for Medicare and Medicaid Services and the Division of Health Benefits of the Department of Health and Human Services.

The Department may allow nursing service exceptions on a case-by-case basis.

Settings in which services are delivered may include self-contained apartment units or single or shared room units with private or area baths.

Assisted living residences are to be distinguished from nursing homes subject to provisions of G.S.

131E-102.

There are three types of assisted living residences:

adult carehomes,adult carehomesthat serveonlyelderlypersons, and multiunit assisted housing with services.

As used in this section, "elderly person" means:

a.

Any person who has attained the age of 55 years or older and requires assistance with activities of daily living, housing, and services, or b.

Anyadult who has a primarydiagnosis of Alzheimer's disease or other form of dementia who requires assistance with activities of daily living, housing, and services provided by a licensed Alzheimer's and dementia care unit.

… (10) Multiunit assisted housing with services.

– An assisted living residence in which hands-on personal care services and nursing services which that are arranged by housing management are provided through an individualized written care plan by a licensed home care or hospice agency through an individualized written care plan.

or by a Program for All-Inclusive Care for the Elderly organization that has a valid program agreement with the Centers for Medicare and Medicaid Services and the Division of Health Benefits of the Department of Health and Human Services.

The housing management has a financial interest or financial affiliation or formal written agreement which that makes personal care services accessible and available through at least one licensed home care or hospice agency.

agency or through a Program for All-Inclusive Care for the Elderly organization that has a valid program agreement with the Centers for Medicare and Medicaid Services and the Senate Bill 361-First Edition Page 21 General Assembly Of North Carolina Session 2019 Division of Health Benefits of the Department of Health and Human Services.

The resident has a choice of any provider, and the housing management may not combine charges for housing and personal care services.

All residents, or their compensatory agents, must be capable, through informed consent, of entering into a contract and must not be in need of 24-hour supervision.

Assistance with self-administration of medications may be provided by appropriately trained staff when delegated by a licensed nurse according to the home care agency's or the Program for All-Inclusive Care for the Elderly organization's established plan of care.

Multiunit assisted housing with services programs arerequiredto register annuallywith theDivision ofHealth Service Regulation.

Multiunit assisted housing with services programs are required to provide a disclosure statement to the Division of Health Service Regulation.

The disclosure statement is required to be a part of the annual rental contract that includes a description of all of the following requirements:

a.

Emergency response system;system.

b.

Charges for services offered;offered.

c.

Limitations of tenancy;tenancy.

d.

Limitations of services;services.

e.

Resident responsibilities;responsibilities.

f.

Financial/legal relationship between housing management and home care or hospice agencies;agencies or Program for All-Inclusive Care for the Elderly organizations.

g.

A listing of all home care or hospice agencies and other community services in the area;area.

h.

An appeals process;

andprocess.

i.

Procedures for required initial and annual resident screening and referrals for services.

Continuing care retirement communities, subject to regulation by the Department of Insurance under Chapter 58 of the General Statutes, and temporary family health care structures, as defined in G.S.

160A-383.5, are exempt from the regulatory requirements for multiunit assisted housing with services programs.

…." SECTION 5.(c) G.S.

131D-2.2(b) reads as rewritten:

"(b) Multiunit Assisted Housing With Services.

– Except when a physician certifies that appropriate care can be provided on a temporary basis to meet the resident's needs and prevent unnecessary relocation, multiunit assisted housing with services shall not care for individuals with any of the following conditions or care needs:

(1) Ventilator dependency;dependency.

(2) Dermal ulcers III and IV, except those stage III ulcers which are determined by an independent physician to be healing;healing.

(3) Intravenous therapyor injections directlyinto the vein, except for intermittent intravenous therapy managed by a home care or hospice agency licensed in this State;State.

(4) Airborne infectious disease in a communicable state that requires isolation of the individual or requires special precautions by the caretaker to prevent transmission of the disease, including diseases such as tuberculosis and excluding infections such as the common cold;cold.

(5) Psychotropic medications without appropriate diagnosis and treatment plans;plans.

(6) Nasogastric tubes;tubes.

Page 22 Senate Bill 361-First Edition General Assembly Of North Carolina Session 2019 (7) Gastric tubes, except when the individual is capable of independently feeding himself or herself and caring for the tube, or as managed by a home care or hospice agency licensed in this State;State.

(8) Individuals requiring continuous licensed nursing care;care.

(9) Individuals whose physician certifies that placement is no longer appropriate;appropriate.

(10) Unless the individual's independent physician determines otherwise, otherwise or the individual is enrolled in the Program of All-Inclusive Care for the Elderly, individuals who require maximum physical assistance as documented by a uniform assessment instrument and who meet Medicaid nursing facility level-of-care criteria as defined in the State Plan for Medical Assistance.

Maximum physical assistance means that an individual has a ratingoftotal dependencein fourormoreofthesevenactivitiesofdailyliving as documented on a uniform assessment instrument;instrument.

(11) Individuals whosehealthneedscannotbemetinthespecificmultiunitassisted housing with services as determined by the residence;

andresidence.

(12) Such other medical and functional care needs as the Medical Care Commission determines cannot be properly met in multiunit assisted housing with services." SECTION 5.(d) G.S.

131D-2.2(d) reads as rewritten:

"(d) Obtaining Services.

– The resident of an assisted living facility has the right to obtain services at the resident's own expense from providers other than the housing management.

This subsection shall not be construed to relieve the resident of the resident's contractual obligation to pay the housing management for any services covered by the contract between the resident and housing management.

The resident of an assisted living facility has the right to select as the resident's health care provider the Program for All-Inclusive Care for the Elderly without jeopardizing residency in the assisted living facility." SECTION 5.(e) G.S.

131D-2.16 reads as rewritten:

"§ 131D-2.16.

Rules.

Except as otherwise provided in this Article, the Medical Care Commission shall adopt rules necessary to carry out this Article.

The Commission has the authority, in adopting rules, to specify the limitation of nursing services provided by assisted living residences.

In developing rules, the Commission shall consider the need to ensure comparable quality of services provided to residents, whether these services are provided directly by a licensed assisted living provider, licensed home care agency, a Program for All-Inclusive Care for the Elderly organization that has a valid program agreement with the Centers for Medicare and Medicaid Services and the Division of Health Benefits of the Department of Health and Human Services, or hospice.

In adult care homes, living arrangements where residents require supervision due to cognitive impairments, rules shall beadoptedto ensurethatsupervision is appropriate and adequateto meet the special needs of these residents.

Rule-making authority under this section is in addition to that conferred under G.S.

131D-4.3 and G.S.

131D-4.5." SECTION 5.(f) G.S.

131D-6 reads as rewritten:

"§ 131D-6.

Certification of adult day care programs;

purpose;

definition;

penalty.

… (d) The All of the following programs are exempted from the provisions of this section:

(1) Those that care for three people or less;less.

(2) Those that care for two or more persons, all of whom are related by blood or marriage to the operator of the facility;facility.

(3) Those that are required by other statutes to be licensed by the Department of Health and Human Services.

Senate Bill 361-First Edition Page 23 General Assembly Of North Carolina Session 2019 (4) Program for All-Inclusive Care for the Elderly organizations that have a valid program agreement with the Centers for Medicare and Medicaid Services and the Division of Health Benefits of the Department of Health and Human Services when providing services to participants in the program." SECTION 5.(g) This act is effective October 1, 2019.

7 PART VI.

ELIMINATE REDUNDANCY IN ADULT CARE HOME INSPECTIONS SECTION 6.

– TheDepartment shall ensure thatadultthat adult carehomes required to be licensed by this Article are monitored for licensure compliance on a regular basis.

Page 24 Senate Bill 361-Second Edition General Assembly Of North Carolina Session 2019 If the annual inspection of an adult care home is conducted separately from the inspection required every two years to determine compliance with physical plant and life-safety requirements, the Division of Health Service Regulation shall not cite, as part of the annual inspection, any violation of law that overlaps with an area addressed by the physical plant and life-safety inspection, unless failure to address the violation during the annual inspection would pose a risk to resident health or safety.

Nothingin this section prevents a licensing inspector from referring a concern about physical plant and life-safety requirements to the section within the Division of Health Service Regulation that conducts physical plant and life-safety inspections." PART V.VII.

SEVERABILITY CLAUSE AND EFFECTIVE DATE SECTION 5.(a)7.(a) If any section or provision of this act is declared unconstitutional or invalid by the courts, it does not affect the validity of this act as a whole or any part other than the part declared to be unconstitutional or invalid.

SECTION 5.(b)7.(b) Except as otherwise provided, this act is effective when it becomes law.

Page 24 Senate Bill 361-Second361-First Edition Page 25