Bill Summaries: H1037 COVID-19 HEALTH CARE WORKING GROUP POLICY REC.

Tracking:
  • Summary date: Apr 29 2020 - More information

    House committee substitute to the 1st edition makes the following changes.

    Adds that Section 2.1 of the act is effective when it becomes law.

    Amends Section 3.1 by changing the date by which the plan for creating and maintaining a Strategic State Stockpile of personal protective equipment and testing supplies must be developed and submitted to the specified committee from June 1 to July 1, 2020.

    Adds new Section 3.2 that requires the Department of Health and Human Services and the Division of Emergency Management, during a public health emergency, to first consider companies based in the state that can provide mobile response units with capabilities to reach rural areas in the state. Specifies the types of operations that must be considered, including feeding operations and triage facilities. 

    Amends Section 4.3 by clarifying that following the consultation upon receiving a petition to authorize immunizing pharmacists to administer a recommended immunization or vaccine for COVID-19, if the State Health Director approves the petition, the State Health Director may issue a statewide standing order authorizing the administration of an immunization or vaccination for COVID-19 by immunizing pharmacists. The statewide standing order expires upon the adjournment of the next NCGA regular session. Makes conforming changes. Also adds that the following are immune from any civil or criminal liability for actions authorized by this section: (1) the State Health Director acting pursuant to this section and (2) any pharmacist who administers a COVID-19 immunization or vaccine pursuant to a statewide standing order issued under this section. 

    Amends Section 4.7 as follows. 

    Makes the following changes to proposed Article 1L, Emergency or Disaster Treatment Protection Act, of GS Chapter 90.

    Makes a technical change to the definition of COVID-19. Redefines the term health care facility to now mean any entity licensed pursuant to GS Chapters 122C (Mental Health, Developmental Disabilities, and Substance Abuse Act), 131D (Inspection and Licensing of Adult Care Home Facilities), or 131E (Health Care Facilities and Services), or Article 64 of GS Chapter 58 (Continuing Care Retirement Communities). Redefines the term health care provider to mean: (1) an individual licensed, certified, or otherwise authorized under GS Chapters 90 or 90B to provide health care services in the ordinary course of business or practice of a profession or in an approved education or training program; (2) a health care facility where health care services are provided to patients, residents, or others to whom such services are provided as allowed by law; (3) individuals licensed under GS Chapter 90 or practicing under waiver in accordance with GS 90-12.5; (4) any emergency medical services personnel as defined by statutory cross-reference; (5) any individual providing health care services within the scope of authority permitted by a COVID-19 emergency rule; (6) any individual who is employed as a health care facility administrator, executive, supervisor, board member, trustee, or other person in a managerial position or comparable role at a health care facility; (7) an agent or employee of a heath care facility that is licensed, certified, or otherwise authorized to provide health care services; (8) an officer or director of a health care facility; or (9) an agent or employee of a health care provider who is licensed, certified, or otherwise authorized to provide health care services. Modifies the definition of health care service to now mean treatment, clinical direction, supervision, management, or administrative or corporate service provided by a health care facility or a health care provider during the period of the COVID-19 emergency declaration, regardless of location in the state, where the services are rendered to provide testing, diagnosis, or treatment; dispense drugs, medical devices, medical appliances, or medical goods; or provide care to another individual, as previously described.

    Limits the scope of immunity provided in proposed GS 90-21.133 to civil immunity only, rather than both civil and criminal immunity. Makes conforming changes throughout and makes identical changes to the immunity provisions for volunteer organizations. Makes clarifying and organizational changes to the conditions specified for immunity to apply.

    Adds a severability clause and directs liberal construction of the Article.

    Changes the scope of the Article to now provide that the act applies to acts or omissions occurring during the time of Executive Order No. 116 issued on March 10, 2020, and any subsequent time period during which a gubernatorial state of emergency is declared to be in effect during calendar year 2020 in response to COVID-19 (previously, applied retroactively to all acts, omissions, or decisions on or after March 10, 2020, that serve as a basis to a claim).

    Adds new Section 4.8 amending GS 90-85.3A to include with the practice of pharmacy, the administration by pharmacists of diagnostic tests and antibody tests for Coronavirus Disease 2019 to patients if the test has been approved or authorized for emergency use by the US FDA. 

    Adds that for the duration of the COVID-19 emergency, a hospital, nursing home, or clinic with a valid State registration for controlled substances may temporarily dispense or use controlled substances at additional places of business by completing the specified registration process and providing all required information for any temporary overflow facility or satellite facility. Specifies that there is no registration fee for the emergency registration. Expires 60 days after Executive Order No. 116 is rescinded, or December 31, 2020, whichever is earlier. 

    Adds that all healthcare providers must receive and report to the Commission for Public Health and the Division of Public Health the results of any COVID-19 diagnostic test or antibody test performed on an individual before any non-emergency surgery or procedure. Requires DHHS to report this pre-procedure test result data on its website on a county-by-county basis, updated daily. 

    Amends Section 5.2 as follows. Clarifies that the waiver of the three-year fingerprinting requirements applies to current child care providers. Specifies that in accordance with federal guidance, all available State and federal name-based criminal background checks for prospective employees seeking employment in licensed child care must be completed (was, the federal requirements for fingerprint-based checks every five years is still applicable). Requires prospective employees to be issued a provisional qualification status. Requires that where only State and federal name-based checks were completed, that fingerprint-based checks be done within 60 days of Executive Order 116 being rescinded; if that is not done, then the prospective employee is disqualified until a finger-print based check is completed. Adds a requirement that the Division of Social Services is to temporarily waive any requirement to complete a fingerprint-based criminal history check pertaining to adoptions, foster care, or child care institutions. Requires, however, that in accordance with federal guidelines, name-based criminal background checks be completed, and in such situations where only name-based checks were completed, that fingerprint-based criminal history checks be completed within 60 days of Executive Order 116 being rescinded.

    Amends Section 5.7 to require the suspension of all biennial inspections in addition to annual inspections and regular monitoring requirements for the specified licensed facilities. Expands upon that list to also include those licensed under Articles 5 (Hospital Licensure Act), 6 (Health Care Facility Licensure Act), and 10 (Hospice Licensure Act) of GS Chapter 131E, as well as any provisions within any rules adopted under the specified chapters that pertain to DHHS or the Division of Health Service Regulation monitoring, inspection, or investigative requirements. Maintains the exceptions already listed in the section. Makes additional clarifying changes.

    Amends Section 6.1 by clarifying that the the first exams that can be conducted in the physical face-to-face presence of the commitment examiner or using telehealth apply to exams that are required by GS 122C-263 to determine whether the respondent will be involuntarily committed due to mental illness as well as those required by GS 122C-283(a) to determine whether the respondent will be involuntarily committed due to substance use disorder.


  • Summary date: Apr 28 2020 - More information

    Part I

    Sets forth definitions applicable to the act.

    Part II

    Affirms specified actions taken by the Governor and the Department of Health and Human Services (DHHS) in response to the COVID-19 emergency, as well as actions taken by health care licensing boards and health care teaching institutions to address the workforce supply challenges presented by the COVID-19 emergency. Defines COVID-19 emergency to mean the period beginning March 10, 2020, and ending on the date the Governor signs an executive order rescinding Executive Order 116, Declaration of a State of Emergency to Coordinate Response and Protective Actions to Prevent the Spread of COVID-19. Additionally, states legislative support for the following initiatives: (1) encouraging authorized administration of COVID-19 antibody tests, as defined, as soon as they become available in the State, with priority to workers essential to the provision of medical care, dental care, long-term care or child care; (2) pursuing any federally available waiver or program allowance regarding child welfare; and (3) providing ongoing flexibility to teaching institutions to ensure students seeking degrees in health care professions can complete necessary clinical hours.

    Part III

    Directs the Division of Public Health (DPH) and the Division of Health Service Regulation (DHSR) of DHHS, in conjunction with the NC Division of Emergency Management (DEM) of the Department of Public Safety, to develop and submit to the specified NCGA committees a plan for creating and maintaining a Strategic State Stockpile (Stockpile) of personal protective equipment (PPE) and testing supplies. Specifies the legislative intent for the Stockpile to be accessible by both public and private acute care providers, first responders, health care providers, long-term care providers, and non-health care entities, as those terms are defined in Part III of the act, that are located in the State for the purpose of addressing both COVID-19 pandemic and future public health emergencies. Details nine components that the plan must encompass, including (1) designation of agency oversight and the specified divisions’ roles and collaboration strategy; (2) recommendations for improvements to existing procurement, allocation, and distribution of PPE; (3) recommendations for how to increase the manufacture of PPE consistent with CDC guidelines; (4) identification of available locations to maintain the Stockpile; and (5) an estimated five-year budget. Allows DPH and DHSR to include any other component deemed appropriate in conjunction with DEM. Requires submission of the report by June 1, 2020.

    Part IV

    Enacts GS 90-28.5 to allow the NC Board of Dental Examiners to waive the requirements of Articles 2 and 16 of GS Chapter 90 (governing dentistry and dental hygiene services) in the event of a gubernatorial or local declaration of a state of emergency under specified state law, in order to permit the provision of dental and dental hygiene services to the public during the state of emergency.

    Amends GS 90-29 to expand the practice of dentistry to include the administration of diagnostic tests and antibody tests for coronavirus disease by dentists to patients. Conditions the authority on US FDA approval of the tests or authorization of the use of the tests for emergencies.

    Provides for a petition process for the State Health Director to authorize immunizing pharmacists to administer a COVID-19 immunization or vaccination by statewide standing order in the event the CDC recommends an immunization or vacations at a time when the NCGA is not in regular session. Allows for any person to submit a written petition to the State Health Director. Requires the State Health Director to approve or deny the petition within 30 days of receipt after consultation with specified entities representative of health care providers. Within ten days of approval of the petition, requires the State Health Director to further consult with the specified entities to develop a minimum standard screening questionnaire and safety procedures for written protocols for the recommended immunization or vaccination administration and submit them to the NC Board of Medicine, the NC Board of Nursing, the NC Board of Pharmacy, and the specified NCGA committee. Requires the Immunization Branch of DPH to develop and submit the questionnaire and recommended standards within the following ten days if the State Health Director fails to do so in the ten days after the petition’s approval. Specifies that administering pharmacists must meet the statutory requirements of immunizing pharmacists under GS 90-85.15B. Establishes that a statewide standing order by the State Health Director under this provision expires upon the adjournment of the next regular session of the NCGA.

    Authorizes licensed pharmacists to confirm the identity of any individual seeking dispensation of a prescription by the visual inspection of any form of government-issued photo ID for the duration of the COVID-19 emergency. Further, allows the pharmacist to confirm identity of known customers by referencing existing records. Requires pharmacists to review the patient’s information in the controlled substances reporting system for the preceding 12-month period before filling a Schedule II controlled substance prescription. Requires couriers to confirm the identity of a mail-ordered prescription recipient through the visual inspection of any form of government-issued photo ID. These provisions sunset on the earlier of 60 days after Executive Order 116 is rescinded, or December 31, 2020.

    Prohibits the NC Medical Board and the NC Board of Nursing from enforcing any provision of the Quality Improvement Plan Rules, as defined, to the extent that they (1) require quality improvement process meetings between providers, so long as the provider was practicing within the scope of his or her license prior to February 1, 2020, and continues to practice within that scope while the provisions are effective and (2) require monthly quality improvement process meetings between providers during the first six months of the practice arrangement. Additionally, prohibits the NC Medical Board and the NC Board of Nursing from enforcing any provision of the Quality Improvement Rules or the Application Fee Rules, as defined, to the extent they require an individual to fill out an application or pay a fee, so long as the individual is providing volunteer healthcare services within the scope of his or her license in response to the COVID-19 pandemic state of emergency. Finally, prohibits the NC Medical Board and the NC Board of Nursing from enforcing any provision of the Annual Review Rules for practice arrangements, as defined. These provisions sunset on the earlier of 60 days after Executive Order 116 is rescinded, or December 31, 2020.

    Directs the NC Area Health Education Center (NC AHEC) to study the issues that impact health care delivery and the health care workforce during a pandemic, consistent with NC AHEC’s mission, as described. Requires the study to focus on the impact of the COVID-19 pandemic, issues that need to be addressed in the aftermath of the pandemic, and plans that should be implemented in the event of a future health crisis. Requires the study to include input from higher education institutions that educate health care providers, as well as health care licensing boards, DHHS, the Department of Public Safety, geographically disbursed hospitals, and other specified health care facilities. Details 15 issues that the study must examine, at minimum, including (1) the adequacy of the health care workforce supply to respond to a pandemic in specified health care setting, (2) the adequacy of health care workforce training, (3) the impact of postponing or eliminating non-essential services and procedures on both the health care workforce and hospitals, (4) interruptions in the delivery of routine health care during the COVID-19 pandemic and the impact of the interruptions, and (5) the impact of telehealth on hospitals during the COVID-19 pandemic. Requires NC AHEC to report its findings and recommendations to the specified NCGA working group by November 15, 2020, and include a summary section. Allows NC AHEC to report subsequent study findings and recommendations to the specified NCGA committees.

    Enacts new Article 1L, Emergency or Disaster Treatment Protection Act, in GS Chapter 90. Provides for the Article’s short title and purpose, and sets forth nine defined terms. Grants civil and criminal immunity to any health care facility, health care provider, or entity that holds legal responsibility for the acts or omission of a health care professional for any harm or damages alleged to have been sustained as a result of an act or omission in the course of arranging for or providing health care services, as defined. Conditions the immunity granted on three conditions: (1) that the health care facility, health care provider, or entity is arranging for or providing health care services pursuant to a COVID-19 emergency rule, as defined, or otherwise in accordance with applicable laws at the time of the COVID-19 emergency declaration, as defined; (2) the act or omission occurs in the one of three specified ways by the health care facility, health care provider, or entity; and (3) the arrangement for or the provision of health care services is made in good faith. Limits the described immunity to exclude acts or omissions that constitute willful or intentional criminal misconduct, gross negligence, reckless misconduct, or intentional inflection of harm; specifies that acts or omissions resulting from a resource or staffing shortage are not willful, intentional, or the like. Provides for similar immunity provisions for volunteer organizations, as defined. Applies retroactively to all acts, omissions, or decisions on or after March 10, 2020, that serve as a basis to a claim.

    Part V

    Amends GS 90-414.4(a1)(2) to extend the date by which all providers of Medicaid and State-funded care services, unless specifically excepted, must begin submitting demographic and clinical data to the State’s Health Information Exchange (HIE) network from June 1, 2020, to October 1, 2020. Makes conforming changes to GS 90-414.4(a2).

    Directs the Division of Child Development and Early Education of DHHS to temporarily waive the requirements that all child care providers complete a fingerprint-based criminal history check every three years. Specifies that the every five-year federal requirement remains applicable. Sunsets the provision on the earlier of 60 days after Executive Order 116 is rescinded, or December 31, 2020.

    Authorizes the Division of Health Benefits (DHB) of DHHS to provide Medicaid coverage described in identified federal law, which covers COVID-19 testing for certain uninsured individuals during the period in which there is a declared nationwide public health emergency as a result of COVID-19.

    Authorizes DHB to provide temporary, targeted Medicaid coverage to individuals with incomes up to 200% of the federal poverty level, as requested by DHHS in the 1115 waiver application submitted on March 27, 2020. Allows DHB to implement CMS approved temporary coverage that is different than that requested in the waiver so long as the coverage is for a limited period related to the declared nationwide public health emergency due to COVID-19; the coverage is limited to only prevention, testing, or treatment of COVID-19; and the income level to qualify for the coverage does not exceed 200% of the federal poverty level. Authorizes DHB to provide this coverage retroactively to the earliest date allowable.

    States the legislative intent to adhere to all federal requirements for obtaining enhanced federal Medicaid funding under the Families First Coronavirus Response Act, as amended, for the period required under the Act and during which there is a declared nationwide public health emergency as a result of COVID-19. Directs DHB to adhere to and implement all federal law and regulation necessary for receipt of the enhanced federal Medicaid funding, and states that federal law and regulation applicable to the NC Medicaid program or the NC Health Choice program supersede and preempt any conflicting state law during the period in which such nationwide public health emergency is declared for COVID-19.

    Sets forth eligibility parameters for the Disabled Adult Child Passalong authorized under the Social Security Act for the Medicaid program to include only: (1) that the adult is currently entitled to and received federal Retirement, Survivors, and Disability Insurance (RSDI) benefits as a disabled adult child on a parent’s record, (2) that the adult is blind or has a disability that began before age 22, (3) that the adult would currently be eligible for Supplemental Security Income (SSI) or State-County Special Assistance if the current RSDI benefit is disregarded, and (4) that eligibility  based on former receipt of State-County Special Assistance or SSI requires the adult to currently reside in an adult care home.

    Directs DHSR and local departments of social services to suspend all annual inspection and regular monitoring requirements for licensed facilities under Article 2 of GS Chapter 122C, concerning facilities for the mentally ill, the developmentally disabled, and substance abusers; and Articles 1 and 3 of GS Chapter 131D, concerning adult care homes, or any rules adopted thereunder. However, authorizes DSHR to conduct inspections and regular monitoring as it deems necessary to avoid serious injury, harm, impairment, or death to employees, residents, or patients of the facilities, or if directed by CMS. Directs DHSR to review the compliance history of all of the facilities licensed under Article 2 of GS Chapter 122C and Article 1 of GS Chapter 131D that were determined to be in violation, assessed penalties, or placed on probation within the six-month period preceding the beginning of the COVID-19 emergency. Specifically requires DHSR to review compliance history for noncompliance with CDC guidelines regarding infection control or the proper use of PPE. Directs DHSR to require employees of such identified facilities to undergo immediate training by DHSR about infection control and the proper use of PPE. Allows DHSR to conduct the training online, by videoconference, or as DHSR deems appropriate. Sunsets the provisions on the earlier of 60 days after Executive Order 116 is rescinded, or December 31, 2020.

    Authorizes the Division of Social Services (DSS) of DHHS to temporarily waive the 72-hour requirement of preservice training before child welfare services staff assumes direct client contact responsibilities. Allows DSS to use online training as an acceptable equivalent in meeting preservice training requirements. Sunsets the provisions on the earlier of 60 days after Executive Order 116 is rescinded, or December 31, 2020.

    Part VI

    Allows the first examination for involuntary commitment due to substance use disorder under GS 122C-283 to be conducted face-to-face or utilizing telehealth equipment and procedures. Defines telehealth to mean the use of two-way real-time interactive audio and video where the respondent and the commitment examiner can hear and see each other. Requires the commitment examiner who examines a respondent by telehealth to be satisfied to a reasonable medical certainty that the determinations made pursuant to state law would not be different if the examination were conducted face-to-face; otherwise the examiner must note that the examination was not satisfactorily accomplished whereby the respondent must be taken for a face-to-face commitment examination.

    Similarly, allows the second examination for involuntary commitment due to mental illness under GS 122C-266 or due to substance use disorder under GS 122C-285 to be conducted face-to-face or utilizing telehealth equipment and procedures, so long as the commitment examiner who examines a respondent by telehealth is satisfied to a reasonable medical certainty that the determinations made pursuant to the relevant state law would not be different if the examination were conducted face-to-face; otherwise the examiner must note that the examination was not satisfactorily accomplished whereby the respondent must be taken for a face-to-face commitment examination with a physician (for commitment due to mental illness, and commitment due to substance use disorder if the initial examination was performed by a qualified professional) or a qualified professional (for commitment due to substance use disorder). Sunsets the provisions on the earlier of 60 days after Executive Order 116 is rescinded, or December 31, 2020.

    Enacts GS 58-50-310 to set forth seven provisions applicable to health benefit plans offered in the state from March 10, 2020, through the date Executive Order 116 expires or is rescinded, as well as the period of any subsequent state of emergency gubernatorially declared in the 2020 calendar year in response to COVID-19 through 30 days after that subsequent state of emergency expires or is extended. Defines health benefit plan by statutory cross-reference. Among others, the parameters provided include requirements for health benefit plans to provide coverage and reimbursement for virtual health care, as defined, including mental and behavioral health care; coverage and reimbursement for physical therapy, occupational therapy, and speech therapy delivered through telehealth; and reimbursement of providers for a covered health care service delivered by telehealth at a level no less than the reimbursement for the service had it been provided in-person. Prohibits requiring prior authorization for telehealth services or virtual healthcare services, and allows requiring a deductible, copayment, or coinsurance for a covered health care service delivered by telehealth by a preferred or contracted provider to a covered individual. Makes the new statute applicable to the State Health Plan for Teachers and State Employees. Sunsets the statute on December 31, 2020.

    Encourages CMS to provide reimbursement for health care delivered through audio-only communication under the Medicaid program to increase access to health care for older adults.

    Part VII

    Includes a severability clause.

    Part VIII

    Includes a standard effective date provision.


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