Senate committee substitute makes the following changes to the 3rd edition.

Adds whereas clauses concerning the impact of the opioid epidemic in North Carolina.

Part III

Deletes the previous language of proposed GS 90-18.1(b) and now provides the following. Requires a physician assistant to personally consult with the supervising physician before prescribing a targeted controlled substance as defined in Article 5 of GS Chapter 90 when: (1) the patient is being treated by a facility that primarily engages in the treatment of pain by prescribing narcotic medications or advertises in any medium for any type of pain management services and (2) the therapeutic use of the targeted controlled substance will or is expected to exceed a period of 30 days. Requires the physician assistant to consult with the supervising physician at least once every 90 days when a targeted controlled substance prescribed in accordance with this subdivision is continuously prescribed to the same patient in order to verify that the prescription remains medically appropriate for the patient. Deletes the previous language of proposed GS 90-18.2(b), concerning nurse practitioners, and instead provides identical language as just described for proposed GS 90-18.1(b) concerning physician assistants, making the same requirements applicable for nurse practitioners. 

Amends the proposed new language in GS 90-106 concerning prescriptions and labeling. Adds two new exemptions to those set out in new subsection (a1), exempting a practitioner who orders a controlled substance to be administered in an outpatient dialysis facility as well as a person licensed to practice veterinary medicine pursuant to Article 11 of GS Chapter 90 from the requirement that practitioners electronically prescribe all targeted controlled substances. Adds to new subsection (a3), establishing immunity for a practitioner who acts in accordance with the limitation on prescriptions set forth in the subsection for acting in accordance with the subsection. Deletes proposed subsection (a4), concerning pain management agreement plans for extended therapeutic use of a targeted controlled substance. Makes conforming changes to the effective date provisions in Part VI.

Part V

Deletes the proposed changes to GS 90-113.73(b)(2), which make the required patient information that a dispenser must report for whom a controlled substance is dispensed also applicable to the owner of an animal to whom the controlled substance for the animal is dispensed. Also deletes proposed subdivision (b)(12), requiring the dispenser to report the name of a prescribing physician assistant or nurse practitioner's supervising physician. Adds to proposed subsection (e), prohibiting the assessment of any civil penalty upon a pharmacy acting in good faith that attempts to report the information required by the statute as amended. 

Provides that the effective date for the proposed changes to GS 90-113.73(e) (concerning penalties for failure to report)  are effective when the act becomes law (previously included in the provisions that become effective 30 days after the date the Chief Information Officer notifies the Revisor of Statutes that the CSRS database has the capability to record the described information).

Further amends GS 90-113.74, now amending subsection (c). Requires the administrator of a hospital emergency department or hospital acute care facility to provide the Department of Health and Human Services (Department) with a list of prescribers who are authorized to prescribe controlled substances for the purpose of providing medical care for patients of the hospital emergency department or hospital acute care facility and a list of delegates who are authorized to receive data on behalf of the providers listed. Requires the administrator to submit the lists to the Department by December 1 of the calendar year preceding the year during which the delegates are to receive data. Permits the administrator to provide updated lists at any time during the course of the year. Directs the Department to establish, within one week of receiving the initial or updated lists, all of the delegate accounts necessary to enable each delegate listed by the administrator of the hospital emergency department or hospital acute care facility to receive data on behalf of the listed prescribers. Adds that delegations made pursuant to this provision are valid during the calendar year for which submitted by the administrator. 

Modifies proposed GS 90-113.75B, concerning the annual report by the Department of Health and Human Services to the General Assembly and licensing boards. Amends the required content of the report to also include any other data deemed appropriate and requested by the North Carolina Board of Podiatry Examiners. 

Modifies the proposed changes to Section 12F.16(h) of SL 2015-241, deleting the requirement that the Department of Health and Human Services apply for grant funding from the National Association of Boards of Pharmacy to establish interstate connectivity for the Controlled Substances Reporting System (CSRS) as specified.

Modifies the proposed changes to Section 12F.16(i)(3) of SL 2015-241, deleting the requirement that the specified funds be used to establish interstate connectivity for the CSRS for the 2015-16 fiscal year. 

Directs the Department to conduct a study in consultation with the Office of the Attorney General and the NC Veterinary Medical Board on how to implement the provisions of the act pertaining to electronic prescriptions and the submission of data to the CSRS as they relate to the practice of veterinary medicine. Directs the Department to report to the Joint Legislative Oversight Committee on Health and Human Services no later than February 1, 2018.

Senate committee substitute makes the following changes to the 2nd edition.

Amends the long and short titles.

Provides that on the date when Medicaid capitated contracts with Prepaid Health Plans (PHPs) begin, all of the following shall occur: (1) PHPs shall manage all publicly funded behavioral health services currently managed by local management entities/managed care organizations (LME/MCOs) under contracts with the Department of Health and Human Services (DHHS), (2) LME/MCOs shall be dissolved, and (3) all remaining assets of LME/MCOs shall be transferred to DHHS to be used to satisfy the LME/MCO's liabilities and costs of PHP contracts. If there are insufficient funds, it is the Secretary's responsibility to satisfy LME/MCO liabilities.

Makes amendments to GS 122C-112.1 effective January 1, 2018, and applicable to contracts entered into on or after that date.

Deletes all amendments to the following laws: GS 122C-115.4(b) (regarding the primary functions of an LME); GS 122C-116 (Status of area authority; status of consolidated human services agency); GS 122C-118.1 (Structure of area board); GS 122C-124.2(c) (regarding the Secretary's responsibilities if the Secretary does not provide an LME/MCO with certification of compliance under that statute based upon the LME/MCO's failure to comply with certain requirements); GS 122C-121 (Area director); GS 122C-154 (Personnel); GS 126-11 (Local personnel system may be established; approval and monitoring; rules and regulations); and SL 2015-241, Section 12F.2(a) (directing DHHS to distribute at least one-twelfth of each LME/MCO's base budget at the beginning of the fiscal year).

Deletes provisions applying the compensation limitations of GS 122C-121 to currently employed area directors, regardless of when they were hired, as well as provisions directing LME/MCOs to submit copies of current employment agreements to the Secretary and the Office of State Human Resources.

Deletes proposed GS 122C-117(a2) (authorizing an area authority to subcontract certain managed care functions to other entities). Retains other amendments to that statute.

Deletes proposed GS 122C-147.3 (LME/MCO use of funds).

Amends GS 122C-124.1. Amends the caption to read Actions by the Secretary upon area authority or area director failure to comply or when area authority is not providing minimally adequate services. Deletes all references to county programs. Further directs the Secretary, upon the Secretary's determination that an area director has failed to comply with any requirement of State or federal law, rule, or regulation, or any requirement of the area authority's contract with the Department, or is doing any of the other currently listed things, to withhold funding for and assume control of the services as currently specified.

Amends GS 122C-151 (Responsibilities of those receiving appropriations). Directs area authorities to not use resources for any of five listed expenses, including alcohol and first-class airfare. Authorizes the Secretary to delay, reduce, or deny payment upon an area authority's failure to complete actions necessary for the memorandum of agreement (was, for the development of a specified memorandum of agreement), or other listed actions.

Applies the definitions of GS 122C-3 to the following section: Directs the Office of State Human Resources (OSHR), the Secretary of DHHS, and the LME/MCO area boards to revise and update the job description for area directors, as specified, by September 1, 2017. Directs OSHR to recommend to the State Human Resources Commission (Commission) a revision to the salary range for area directors, as specified, by December 1, 2017. Directs the Commission to revise the salary range for area directors based on the base of OSHR's recommendation by March 1, 2018. Makes the salary range for area directors, last updated in 2010, void. Prohibits LME/MCO area boards from authorizing any increase in the salaries of an area director until OSHR and the Commission complete a revision and update of the job description and salary range of area directors as directed. Does not prohibit an LME/MCO from authorizing a salary under GS 122C-121(a1) to be paid to an area director filling a vacant position after this act becomes law. Directs LME/MCO area boards to reestablish the salary for its area director upon completion of the revision and update by the OSHR and the Commission. Authorizes OSHR, after the date that the Commission revises the salary range for area directors, and until the LME/MCOs are dissolved under Section 1 of this act, to recommend adjustments to the salary range for area directors to the Commission. Provides requirements for forming such a recommendation.

Amends SL 2015-245, as amended. Authorizes DHHS to adopt rules related to the activities listed in Section 4 of that session law (including the organization of the transformed Medicaid and NC Health Choice programs), and the regulation of PHPs, except that rules relating to PHP licensure under GS Chapter 58 or SL 2015-245, Section 6, are to be adopted by the Department of Insurance. Amends the definition ofprepaid health plan (PHP), requiring an entity not to be a provider-led entity to qualify as a commercial plan, and requiring a majority of a provider-led entity's governing body to have sufficient experience treating beneficiaries of the NC Medicaid program, as determined by the Secretary of DHHS (was, to have experience treating beneficiaries of the NC Medicaid program). Deletes the provision prohibiting capitated PHP contracts from covering behavioral health services for Medicaid recipients currently covered by LME/MCOs for four years after the date capitated contracts begin, and dental services, and prohibits capitated PHP contracts from covering the fabrication of eyeglasses. Provides that capitated PHP contracts do not cover recipients who are dually eligible for Medicaid and Medicare for two years after the date capitated contracts begin, recipients enrolled under the Medicaid Family Planning program, or recipients who are inmates of prisons. Deletes the provision directing the Division of Health Benefits to develop a long-term strategy to cover dual eligibles through capitated PHP contracts, and provides that enrollment of dually eligible recipients shall begin two years after the date capitated contracts begin, may be phased as described in a specified DHHS report, and shall be completed within two years after the date that dually eligible recipients are first enrolled with PHPs. Amends the number of required statewide capitated PHP contracts to be no less than three and no more than five. Amends the number of regional contracts to be up to 4 (was, up to 12). Directs PHPs to comply with 42 CFR 438 (was, GS Chapter 58, to the extent allowed by federal law and consistent with SL 2015-245), and deletes the provision stating that this requirement does not require PHP to cover services not covered by the Medicaid program. Deletes the provision instructing LMC/MCOs to continue to manage the behavioral health services currently covered for their enrollees for four years after the date capitated PHP contracts begin.

Amends SL 2015-245, Section 5, as amended. Amends the description of DHHS's role and responsibility during Medicaid transformation, requiring DHHS to (1) submit to CMS modifications to the currently required submissions, including to the demonstration waiver applications. Requires DHHS to provide notice under GS 108A-54.1A if it submits any modifications; (2) define regions (was, define six regions), as specified, to ensure effective delivery of healthcare; (3) further develop standardized contract terms for capitated PHP contracts that require PHPs and hospitals to negotiate mutually acceptable rates, methods, and terms of payment, and require negotiated payments to hospitals to not exceed 125% of the fee-for-service Medicaid rate unless specifically approved by DHHS; and (4) within 30 days of this bill becoming law, or upon CMS's approval of a waiver when a waiver is required, requiring providers enrolling or re-enrolling as a Medicaid or NC Health Choice provider to agree to accept 90% of the Medicaid fee-for-service rate for the services they provide to PHP enrollees if the provider has been offered a contract with a PHP but is not under a contract with that PHP, or if other conditions are met.

Amends GS 108A-54.1A (Amendments to Medicaid State Plan and Medicaid Waivers). Directs DHHS to notify the Joint Legislative Oversight Committee on Medicaid and NC Health Choice and the Fiscal Research Division of the submission of an amendment to the State Plan or a modification of a previously submitted amendment to the State Plan to the federal government, and of a determination that an amendment posted on its Web site will not be submitted to the federal government.

Amends GS 108D-1 (Definitions), GS 108D-12(a), GS 108D-13, GS 108D-14, and GS 108D-15, replacing the termmanaged care actionwithadverse benefit determination.

Further amends GS 108D-13 (LME/MCO level appeals). Requires a request for an LME/MCO level appeal of a notice of adverse benefit determination to be filed within 60 (was, 30) days of the mailing date of the adverse benefit determination. Directs the LME/MCO to resolve the appeal within 30 days (was, 45 days) of receiving the request for appeal. Requires, as an alternative to the requirement that an enrollee or network provider has exhausted the appeal procedures described in this statute or GS 108D-14, an enrollee to have been deemed to have exhausted the LME/MCO level appeals process under 42 CFR 438.408(c)(3), in order to file a request for a contested case hearing under GS 108D-15.

Further amends GS 108D-14 (Expedited LME/MCO level appeals) to require an LME/MCO to resolve a granted expedited appeal no later than 72 hours (was, three working days) after receiving the request for an expedited appeal. Provides the same alternative requirement to request a contested case hearing as is provided in GS 108D-13.

Further amends GS 108D-15 (Contested case hearings on disputed managed care actions). Requires a request for an appeal to be sent no later than 120 (was, 30) days after the mailing date of the notice of resolution.

Makes the act effective when it becomes law, except as otherwise provided.

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

Makes organizational changes.

Part I. Discretionary Economic Development Fund Modifications

Deletes the proposed changes to GS 143B-431.01 (Department of Commerce contracting of functions).

Deletes the proposed changes to GS 143B-437.51(5), amending the definition of eligible person. Instead, amends the term high-yield project as the term is used in Part 2G of Article 10 concerning the Job Development Investment Grant Program (Program). Currently, high-yield project means a project for which the agreement requires that a business invest at least $500 million in private funds and create at least 1,750 eligible positions. Expands this definition to encompass projects where the agreement requires that a business invest at least $500 million in private funds and create at least 1,750 eligible positions for projects located in a high-growth area, at least 1,600 positions for projects located in a development tier three area, at least 1,200 positions for projects located in a development tier two area, or at least 800 positions for projects located in a development tier one area. Specifies that the location with the highest designation determines the job creation requirements due under this provision if a project will be located in more than one area. Also adds the term high-growth area, and defines the term to mean the classification assigned to an area pursuant to GS 143B-437.08 (Development tier designation). Effective July 1, 2017, and applies to agreements entered into on or after that date (previous changes to GS 143B-437.51 were effective January 1, 2017, and applied to awards made on or after that date).

Changes the effective date provided for the changes made to GS 143B-437.52(a) to July 1, 2017 (was, January 1, 2017), and makes the changes applicable to agreements entered into on or after that date (was, awards made on or after that date).

Deletes the proposed changes to GS 143B-437.52(c), concerning award limitations. Now sets the maximum amount of total annual liability for grants awarded in any single calendar year under the Program, including amounts transferred to the Utility Account pursuant to GS 143B-437.61, at $20 million (was, set at $20 million for a year in which no grants are awarded for a high yield project and $35 million for a year in which a grant is awarded for a high yield project; previously, limited the maximum liability provisions to projects not wholly located in development tier one areas). Adds new language establishing that this maximum liability provision does not apply to high-yield projects or to projects located wholly within a development tier one area. Effective January 1, 2017, and applies to liability for grants awarded on or after that date (previous changes were effective when the act becomes law and applicable to grants awarded on or after that date). 

Amends GS 143B-437.55(b), concerning the grant application fee. Changes the current blanket fee of $10,000 to now set the following fees: $10,000 for projects that are not high-yield projects and located in a development tier three area, $5,000 for projects located in a development tier two area, and $1,000 for projects located in a development tier one area. Sets the fee for high-yield projects at $10,000. Specifies that the locations with the highest development tier area designation determines the fee if a project will be located in more than one development tier area. Effective July 1, 2017, and applies to applications filed on or after that date. 

Deletes the proposed changes to GS 143B-437.56(d), which added that for any eligible position located in a county designated as an attainment area, 70% of the annual grant is payable to the business and 30% is payable to the Industrial Development Fund Utility Account (Utility Account). Instead, adds new language providing that for any eligible position created for a high-yield project in years in which the business receives the enhanced percentage pursuant to subsection (a1) of the statute, irrespective of the location of the project, 95% of the annual grant approved for disbursement must be payable to the business and 5% must be payable to the Utility Account pursuant to GS 143B-437.61. Makes conforming changes to delete existing language exempting high-yield projects from the provisions of subsection (d) in years in which the business receives the enhanced percentage pursuant to subsection (a1) of the statute. Effective July 1, 2017, and applies to grants awarded on or after that date (previous changes were effective January 1, 2017, and applicable to awards made on or after that date).

Amends GS 143B-437.58(a), eliminating the minimum filing fee on the annual payroll report required of businesses awarded grants and instead sets the fee at .03% of an amount equal to the grant less the amount to be transferred pursuant to GS 143B-437.61 (currently, is the greater of $2,500 or .03% of an amount equal to the grant less the amount to be transferred). Effective July 1, 2017, and applies to annual payroll reports submitted on or after that date.

Amends GS 143B-437.62, extending the sunset of the Job Development Investment Grant Program to January 1, 2025 (was, January 1, 2019).

Deletes the proposed changes to GS 143B-437.72, amending the provisions that must be included in an agreement between a local government and a grantee business, and the State and local governments.

Part II. Development Tier Designations

Deletes the proposed changes to GS 143B-437.08 (Development tier designation). Amends subsection (b), which sets out the development factors which the Secretary of Commerce (Secretary) must annually assign to each county. Modifies the first factor to now be the ratio of employment to population for the civilian population aged 25 to 64  for the most recent five-year period for which data are available (was, the average rate of unemployment for the most recent 12 months for which data is available). Modifies the second factor to now be average annual wage for the most recent 12 months for which data is available (was, medium household income). Eliminates the third factor concerning growth in population. Maintains the fourth factor as it currently exists, concerning the adjusted assessed property value per capita. Makes conforming changes to subsection (d) concerning the data used in measuring the development factors. Adds new subsection (c1), requiring the Secretary to determine each county's performance against statewide values for the three development factors, as amended by this act. Requires the Secretary to separately designate any county with performance greater than all of the statewide indicators as a high-growth area, effective for the calendar year following the designation. Eliminates the adjustments set out in subsections (e) and (f), and makes conforming changes to subsection (c). Maintains the existing exceptions for two-county industrial parks, and certain multijurisdictional industrial parks set out in subsections (g) and (h). Eliminates the exception for Eco-Industrial Parks set out in subsection (j). Maintains the reporting requirements set out in subsection (k). Makes technical changes. 

Further amends GS 143B-472.127, concerning the administration of economic development grants or loans awarded by the Rural Infrastructure Authority. Makes organizational changes and adds to existing language, providing that local governments that receive grants or loans from the Rural Infrastructure Authority must be located in either a development tier one or tier two area, or a rural census tract in a development tier three area that is not a high-growth area (currently, does not require the rural census tract in a development tier three area to also not be a high-growth area to receive grants or loans under the program). 

Part III. Improve Project Impact

Modifies proposed GS 143B-437.07(d), requiring the Department of Commerce (Department) to create an annual report on the performance of each county underperforming the statewide value in one or more economic indicators set out in GS 143B-437.08 (was, required to create a plan for improvement of each county underperforming). Requires the Department to provide the applicable portion of the report to each county and offer assistance to each county upon request regarding improving performance relative to the statewide values identified. Makes changes to the annual progress report to be submitted to the Joint Legislative Oversight Committee on Economic Development and Global Engagement consistent with the modifications made to GS 143B-437.08. Makes conforming changes to delete the provision concerning required consultation and specific data to be used in the initial plan for improvement that is now eliminated.

Part IV. Rural Assistance 

Eliminates the previous provisions requiring the Department of Commerce (Department) to gather information and report for each Collaboration for Prosperity Zone as previously specified. Instead, directs the Department to study methods to support data-driven analysis and assistance for each Collaboration for Prosperity Zone and each labor market area within a Prosperity Zone, including publication of available facilities for commercial development and potential uses of the facilities. Requires the Department of Commerce to report to the Joint Legislative Economic Development and Global Engagement Oversight Committee by January 1, 2018.

Part V. Use of Economic Development Tiers and Rankings

Changes the date by which all entities must elect whether to continue or discontinue the use of the development tier designations from July 1, 2017, to January 1, 2018, for the specified purposes. Adds the Joint Legislative Economic Development and Global Engagement Oversight Committee to the entities to which any entity electing to discontinue using the tiers must report on the criteria designed to replace the tiers by October 1, 2017.

Adds a new provision requiring each entity electing to continue the use of the development tier designations to report by October 1, 2017, on the analysis that supports the continued use, including an analysis of how targeted programs match the use of the tier designations, to the Fiscal Research Division, the Joint Legislative Economic Development and Global Engagement Oversight Committee, and to their respective joint oversight committees.

Directs the Joint Legislative Economic Development and Global Engagement Oversight Committee to study and make legislative recommendations to the 2018 Regular Session of the General Assembly on seven specified matters, including studying the NCWorks Apprenticeship program.