Part I

Declares the General Assembly’s intent to increase the hourly wage of direct care workers in the State to a minimum of $18 per hour. Requires the Department of Health and Human Services (DHHS), Division of Health Benefits (DHB) to provide a Medicaid rate increase to all of the following:

• Home and community-based providers enrolled in the Medicaid program. 
• Intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), including ICF/IID-level group homes.
• Providers who provide services to Medicaid beneficiaries receiving services through the North Carolina Innovations waiver program, the Community Alternatives Program for Children, or the Community Alternatives Program for Disabled Adults, and who are either (i) enrolled in the Medicaid program or (ii) approved financial managers or financial support agencies billing for personal care service or waiver service hours provided by direct care workers that are hired by employers of record or managing employers under consumer-directed or self-directed options in accordance with any of the listed Medicaid Clinical Coverage Policies in the act. 

Requires DHB to determine the definition of direct care worker to be applied, the amount of rate increases, how a provider or facility will use the increased rate and demonstrate compliance, including required documentation. Provides that any rate increase provided will be effective on the date approved by the Centers for Medicare and Medicaid Services (CMMS). Upon implementation of an applicable rate increase required by this section, DHB must adjust the per member per month (PMPM) capitation amount paid to LME/MCOs accordingly. All LME/MCOs will be required to implement the increase, and it shall also apply to BH IDD tailored plans. 

Appropriates $180 million (the State’s match for the $338 million in recurring federal funds) in recurring funds for 2024-25 from the General Fund to DHB to implement the above wage increase. Appropriates the federal funds to DHB for the same purpose. Effective July 1, 2024. 

Part II

Effective July 1, 2024, requires DHB to amend the NC innovations waiver to increase the number of slots under the waiver by a minimum of 1,000, made available upon approval by CMMS. Appropriates $35 million (the State’s match for the $66 million in recurring federal funds) in recurring funds for 2024-25 from the General Fund to DHB to implement the above slots increase. Appropriates the federal funds to DHB for the same purpose. Effective July 1, 2024.

Requires DHB to convene a workgroup of relevant stakeholder to develop a plan to satisfy the registry of unmet needs for the waiver within the next ten years. Requires DHG to submit a report containing the ten-year plan to the specified NCGA Committee by February 1, 2025. 

Part III

Amends GS 115C-391.1 to ban school personnel from physically restraining a student in a prone position. Requires a public school unit to request confirmation that parents have received the school’s policy on seclusion and restraint. Amends GS 115C-391.1(j)’s notice, consent, reporting and documentation provisions as follows. Requires school personnel to promptly notify the principal or designee of any use of mechanical restraint (currently, just prohibited uses of mechanical restraint), any use of physical restraint (currently, any use of physical restraint resulting in observable physical injury to a student), any use of seclusion (currently, any prohibited use of seclusion or seclusion that exceeds 10 minutes or the amount of time specified on their behavior intervention plan), and adds notification if the seclusion or restraint was used in a prohibited manner, caused observable physical injury to a student, or exceeded 10 minutes or the amount of time specified on a student's behavior intervention plan. Changes the time limit for promptly notify to by the end of the school day when the incident occurred (currently, end of the workday when the incident occurred but in no event later than the end of the following workday). Requires teachers to take at least one credit on the use of seclusion and restraint, including State policies, safe techniques, and trauma-informed practices as part of the licensure renewal. Applies beginning with the 2024-2025 school year. 

Part IV 

Requires DHHS’s Division of Mental Health, Developmental Disabilities and Substance Use Services (DHM) to convene a workgroup of relevant stakeholders to develop a five-year plan for monthly housing rental subsidies to be provided to individuals with intellectual or other developmental disabilities for use in integrated settings. Specifies that the plan must create 200 new monthly housing rental subsidies to be provided to individuals with intellectual or other developmental disabilities each year over the course of five years, resulting in the creation of a total of 1,000 monthly housing rental subsidies by the end of the five-year period. Directs that by no later than October 1, 2024, DHM must submit a report containing the five-year plan to the specified NCGA committees. 

Requires DHB to study the feasibility of adding coverage of a new Medicaid service, entitled "Community Activities and Employment Transitions" (CAET), that provides individualized services and supports for individuals age 16 or older with intellectual or other developmental disabilities and that meets the three specified criteria established in the subsection. Directs DHB to consider the feasibility of adding the coverage in any of the following ways: (i) by adding an "in-lieu-of" service offered through the 1115 waiver for Medicaid transformation, (ii) by adding or amending a 1915(i) home and community-based State Plan amendment to include the service, or (iii) by adding the service to any existing Medicaid waiver in this State. Requires DHB to collaborate with listed stakeholders. Requires the Commission for Mental Health, Developmental Disabilities, and Substance Abuse Services (Commission) to also collaborate with those stakeholders to review any relevant rules. Allows the Commission to amend any relevant rules and, if necessary, to adopt additional rules to account for the numerous community-based activities and employment services that may be provided to Medicaid beneficiaries as part of a new CAET service. Allows DHB to submit any State Plan waivers or amendments or request any other approval from CMMS necessary to implement any new CAET service. Specifies that Coverage of the new service cannot begin until on or after January 1, 2025. Requires DHB to submit a report the CAET service to the specified NCGA committee by no later than April 1, 2025. Effective July 1, 2024, appropriates $2 million from the General Fund to DHB in nonrecurring funds for the 2024-2025 fiscal year to be used to support the feasibility study and for drafting requests for the authorities or supports needed to implement any proposed new CAET service.  

Part V

Requires the Department of Transportation (DOT) to create an office within DOT to be known as the Office of Accessible Transportation and Mobility (Office).  Specifies the Office’s purpose, and requires all appropriate State and local agencies to coordinate with the Office. Requires the Office to consult with stakeholders. Requires DOT to submit a report on the Office’s mission and scope of responsibilities and include a five-year plan to guide the Office’s work to the specified NCGA committees by no later than March 31, 2025.