HB 580 — Expand Day/Employment Options/Intellectual and Developmental Disabilities.

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2023 H 21 HOUSE BILL 580 Committee Substitute Favorable 6/6/23 Short Title:

Representatives Crawford, White, K.

Baker, and Hawkins (Primary Sponsors).

For a complete list of sponsors, refer to the North Carolina General Assembly web site.

Appropriations, if favorable, Rules, Calendar, and Operations of the House April 10, 2023 A BILL TO BE ENTITLED AN ACT TO EXPAND MEANINGFUL DAY AND EMPLOYMENT SERVICES OPTIONS FOR MEDICAID BENEFICIARIES WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES.

SECTION 1.(a) The Department of Health and Human ServicesServices, (DHHS)Division shallof studyHealth theBenefits feasibilityof(DHB), addingshall coveragedevelop of a new community-based Medicaid service,"in-lieu-of" service entitled "CommunityActivities"Community Activities and Employment Transitions" (CAET),(CAET) that provides individualized services and supports for individualsadults age 1618 or older with intellectual ordisabilities. developmental disabilities and that meets the criteria established in this subsection.

DHHSThis CAET service shall considerbe thecovered feasibilityofonly addingunder both (i) the coverageBH inIDD anytailored ofplans and (ii) the followingcombined ways:1915(b) and (c) waivers or an approved 1915(i) waiver.

(i)This bynew adding an "in-lieu-of" service offeredshall throughmeet theall 1115of waiver for Medicaid transformation, (ii) by adding or amending a 1915(i) home and community-based State Plan amendment to include the service,following orcriteria: (iii) by adding the service to any existing Medicaid waiver in this State.

(1) The new CAET service shall meetbe allmodeled after the nonresidential components of the followingservice criteria:entitled "Long-Term Community Supports" currently provided by VayaHealth andsimilarservices providedbyAllianceBehavioral Healthcare.

(1) The new service shall be modeled after (i) the nonresidential components of the service entitled "Long-Term Community Supports" currently provided by Vaya Health and (ii) similar services provided by Alliance Behavioral Healthcare that support a meaningful week when used either separately or with other available services.

(3) Services must originate from facilities that meet the homehome- and community-based services standards established by DHHSDHB and under federal law.

SECTION 1.(b) In studying the feasibilitydevelopment of athe new CAET service in accordance with subsection (a) of this section, DHHSDHB shall collaborate with the Marketing Association for Rehabilitation Centers (MARC), the North Carolina Association for Rehabilitation Facilities (NCARF), the North Carolina Association of Professional Supported Employment (NCAPSE), all LME/MCOs,LME/MCOs,and andotherappropriatestakeholders. other appropriate stakeholders.

Concurrent with thethedevelopment studyofthenew of the feasibility of a new CAET service, theDHB Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services (Commission) established under Part 4 of Article 3 of Chapter 143B oftheGeneral Statutes also shall collaborate with thosestakeholdersthose stakeholders to reviewanyrelevantreview any relevant rules, including 10A NCAC 27G .2301 through .2306.

TheDHB Commissionshall mayamendamend any relevant rules and, if necessary, may adopt additional rules to account for the numerous community-based activities and employment services that may be provided to Medicaid beneficiaries as part of athis new CAET"in-lieu-of" service.

*H580-v-2* General Assembly Of North Carolina Session 2023 SECTION 1.(c) Consistent with the authority granted under G.S.

108A-54(e), DHHSDHB may submit any State Plan amendments or waivers, or request other approval from the CentersforMedicareandCenters MedicaidServices,necessaryfortheimplementationofanynewCAETfor servicedeterminedtobefeasibleundersubsection(a)ofthissection.CoverageofthenewserviceMedicare mayand notMedicaid beginServices, earliernecessaryfor thanthe Januaryimplementation 1,of 2024.the new CAET service developed under subsection (a) of this section.

Coverage of the new service maynot begin earlier than January 1, 2024.

No later than AprilDecember 1, 2024,2023, DHHSDHB shall submit a report to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice detailing the following *H580-v-1* General Assembly Of North Carolina Session 2023 information related to anythe development of the new CAET service determinedin toaccordance bewith feasible under Section 1 of this act:

(1) TheThedefinition definitiondeveloped forforthe theCAETservice CAET service and anyanynewMedicaid new Medicaid clinical coverage policy or changes to an existing Medicaid clinical coverage policy.

(2) The anticipated annual cost to the State of adding the CAETproposed new service.

(3) Any legislative changes necessary infor orderthe toimplementation implementof the CAET service.

(5) Whether DHHSDHB is able to add coveragethis ofcoverage the CAET service pursuant to its authority under G.S.

108A-54(e) or whether appropriations in addition to those in Section 3 of this act are required prior to implementation.

If DHHSDHB intends to add coveragethis ofcoverage the CAET service pursuant to its authority under G.S.

There is appropriated from the General Fund to the Department of Health and Human ServicesServices, (DHHS)Division of Health Benefits (DHB), the sum of four million five hundred thousand dollars ($500,000)($4,500,000) in nonrecurringrecurring funds for the 2023-2024 fiscal year and the sum of nine million dollars ($9,000,000) in recurring funds for the 2024-2025 fiscal year to be used tofor supportthe implementation of the feasibilityCAET studyservice requireddeveloped byin accordance with Section 1(a)1 of this act.

ThereThese isfunds appropriatedshall fromprovide thea GeneralState Fundmatch tofor DHHSeight themillion sumseven ofhundred twothousand million dollars ($2,000,000)($8,700,000) in nonrecurringrecurring federal funds for the 2024-20252023-2024 fiscal year toand beusedthe fordraftingtherequestssum fortheauthoritiesorsupportsof neededseventeen million fourhundred thousand dollars($17,400,000)in recurringfederal funds forthe2024-2025 fiscal year, and those federal funds are appropriated to implementDHB anyproposedto newpay for costs associated with the implementation of the CAET service determineddeveloped toin beaccordance feasiblewith under Section 1 of this act.

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