Conference report adopted by both the House and Senate recommends the following changes to 4th edition to reconcile matters in controversy. Amends GS 122C-118.1 to permit a board of county commissioners in a multicounty area with a catchment population of at least 1.25 million to appoint members of the area board in a manner other than that set out in statute, subject to approval from the Secretary, by January 1, 2013. Extends to October 1, 2013 (was, July 1, 2013) the date by which all area boards must meet the requirements of GS 122C-118.1.

House committee substitute makes the following changes to 2nd edition.
Deletes all provisions of the previous edition and replaces them with AN ACT TO MAKE CHANGES IN GOVERNANCE OF LOCAL MANAGEMENT ENTITIES WITH RESPECT TO THE IMPLEMENTATION OF STATEWIDE EXPANSION OF THE 1915(B)/(C) MEDICAID WAIVER.
Amends GS 122C-115(a) (concerning duties of counties) to clarify that a county must provide mental health, developmental disabilities, and substance abuse services in accordance with statewide restructuring of services delivery under a 1915(b)/(c) Medicaid Waiver. Amends GS 122C-116(a) to remove condition that a single county area authority is a department of the county in which the authority is located. Makes conforming changes. Rewrites GS 122C-118.1 (structure of area authority boards) to provide that an area board must have between 11 and 21 voting members (rather than 11 to 25, and up to 30 in certain multicounty authorities) appointed by the board or boards of county commissioners. Modifies the qualifications for board members and requires members to live in the catchment area. Prohibits registered lobbyists from serving on area authority boards. Directs all area boards to meet the revised requirements by July 1, 2013. Makes clarifying changes to GS 122C-119.1, requiring annual training for board members, and directs the NC Department of Health and Human Services (DHHS), the UNC School of Government, and local management entities (LMEs) to develop the training course.
Provides that no member on the Consumer and Family Advisory Committees may serve more than three (rather than two) consecutive terms under GS 122C-170(b). Authorizes area authorities to add one or more counties to their catchment area if a majority of the existing member counties agree.
Prohibits DHHS from approving a county’s request to withdraw from a multicounty area authority operating under a 1915(b)/(c) Medicaid waiver beginning July 1, 2012, and extending for two years. Requires a process for county disengagement, as detailed, by January 1, 2014. Makes a conforming change to GS 122C-112.1 (duties of Secretary).
Amends GS 122C-147(c) (concerning area authority property) to provide that the area authority (rather than the county) has title to real property purchased for the authority’s use. Amends GS 122C-117 (powers and duties of area authority) to grant authorities the power to borrow money with approval of the Local Government Commission and removes approval requirement for the director appointment. Also modifies the delivery procedure for the authority’s quarterly report. Amends GS 122C-115.2, allowing the Secretary to waive any provisions of the LME business plan requirements that are inconsistent with contracts between DHHS and the area authority. Enacts new GS 122C-126.1 to provide that all competitive health information is confidential and not a public record, with the exception of contracts of area authorities. Sets out the procedure for area authorities to follow after a request for disclosure.
Amends GS 122C-121(a1) to allow the area director a salary in excess of the salary ranges established by the State Personnel Commission, upon approval from the Director of the Office of State Personnel. Makes conforming changes to GS 126-5(a) and GS 122C-154 (allowing area authority employees a higher salary).
Repeals GS 122C-122 (public guardians) and directs any successor guardian to try to continue existing contracts if in the best interest of the incompetent person. Amends GS 35A-1213 (qualifications of guardians for incompetent persons) to add that individuals contracting to provide services to LMEs may not serve as guardians for individuals receiving those services unless the person is the ward’s parent. Requires corporations appointed as guardians to meet specified conditions. Makes a clarifying change, and modifies the definition of disinterested public agent in GS 35A-1202. Makes clarifying changes to GS 35A-1292 (resignation of guardian). Amends SL 2011-264 (statewide expansion of 1915(b)(c) waiver) to clarify that local management entities (LMEs) must manage the waiver, and makes other clarifying changes.

Senate committee substitute makes the following changes to 1st edition.
Adds new subsection (e1) to GS 90-18.1 providing that a physician assistant who completes a medical certification for a death certificate is deemed to have been authorized to complete the certification by the physician assistant’s supervising physician. Directs that the supervising physician is to be responsible for authorizing the completion of the medical certification. Amends GS 130A-115(c) to permit the use of an electronic or facsimile signature of the physician, physician assistant, or nurse practitioner without specific approval by the state registrar. Provides that electronic signature has the same meaning as in GS 66-58.2 or GS 66-312 (was, same meaning as in GS 66-58.2). Makes conforming changes to GS 130A-115(c) and (d) to include physicians assistants. Effective October 1, 2011, and applies to certifications signed on or after that date. Makes conforming changes to the title to better reflect the bill’s content as amended.