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House | June 10, 2015 | Committee Room | Health, Part 1

Full MP3 Audio File

Good morning ladies and gentleman this time will call the House Committee on Health to order. I'd like to begin by recognizing our sergeant at arms we have Mr. Young Bay, Mr. Bill Mars, and Mr. Jim Morland. Thank you gentleman for being with us this morning and for what you do for us everyday. We're also pleased to have some of our pages with us today, and if you would stand when I call your name and be recognized. We have Chris Bolton from Mecklenburg County sponsored by Representative Shepard, Carson Bets from Wake County sponsored by Representative Dohetry, Mathew Coppola for New Hanover county sponsored by Representative Davis Seth Cashion from Randolph county sponsored by Representative Hurley and Spencer Mangum Wake county, sponsored by Representative Robinson. Welcome to the House Health Committee, we hope you are having a good week here at the General Assembly. Ladies and Gentlemen we had two bills on our agenda today. The bulk of our time will be spend with House Bill 372, but we're going to begin with House Bill 714, Representative [xx] you are recognized to present your bill. Thank you Mr. Chairman, members of the committee House Bill 714 is build to license your behavior analyst the professional health care providers who actually provide the most common medically necessary treatment for autism. Members of committee may remember about four weeks ago I sent you a video of the training in process. This is, obviously we know what autism is behavior analysts are licensed in 23 states. Representative Gayda, My apologies. If I can interrupt your segment. Ladies and gentlemen there is a proposed committee substitute without objection we have the proposed committee substitute before the committee, there is no objection. Representative Gayda go ahead and proceed. Thank you Mr. Chairman, I apologize behavior analysts are licensed in 23 states but North Carolina is the only state in the country where these analysts do not practice independently, they require supervision by psychologists I would just simply state this the psychologist helped write this bill, we know of no opposition to this bill. This allows these people who have received masters degree education and passed the National Certification Board to practice their craft or their discipline in medicine without supervision. We know of no opposition to this bill and we request a favorable report today I happen to answer any questions. Members of the committee any questions or comments? Representative Adcock, Thank you Mr. Chairman, I had spoken with Representative Jim [xx] to just remind us what the education requirements are for a licensed behavior analyst. Representative Jeter. Thank Representative Adcock. They have to have a masters degree training in the discipline, and then they obviously to have experience in the field work, and then they actually have to pass the National Certification Test, board certification test. They have to be board certified as well so it's a significant level of training and expertise in education involved. Rep. Avila. Thank you Mr. Chair I guess my question will be what are the limitations of practice based on their education in terms of what are they not allowed to do if they don't if they don't have an upper level this is a question we always run into because their is always somebody higher up the ladder that's got a little bit more they can do a little bit more, what kind of issues do we have their with this? Ironically enough I'm sorry Mr. Chair ironically enough in this case you have people with PhD's in this level of training we were being supervised by physiologist who only have masters degree because of the supervisory laws that are currently exist in North Carolina we are the only state in the union that requires them to be supervised not practice independently even with their education and national birth board certification this is one of those rare occasions where people with more education and more training. I don't want to say that spiritually but a higher degree let's say, or actually being supervised with someone who doesn't have the same advanced degree so we feel like this correcting that imbalance. Representative Wardel. Thank you Mr. Chair I just wanted to ask bill sponsor a question is it possible for us to get one of those behavior analyst out here to analyze the general [xx]?  Representative [xx] you don't have to answer that question. You certainly man [xx] rhetorical but based on his jacket probably we need to. Representative [xx] you're recognized. Thank you Mr. Chair there is a programme evaluation division study that came out in December about the peliferation of boards and their licensing regulatory boards we're creating another one here. Is it not possible for whatever regulatory authority overseas psychologists [xx]

also have them take care of this as opposed to creating [xx] with new [xx] new regulatory regime. Representative Jeter Thank you Representative Bishop fro the question, the psychologist from and would just assume that this be separated out, this is a separate discipline, a separate level of training a special, a separate discipline. I think your point broader scheme of conserving licences boards across the medical spectrum has merit. Our real issue here is right now we have a gap in allowing this people to be treated because of the supervision requirement as I said North Carolina is the only state that does it, under current North Carolina statute this is always solution I think your question is probably a better conversation for broader discussion of how we get into regulatory reform on medical licensing board but I understand your question bur my understanding this is the best path very quickly to get. A follow though okay, Representative Pendleton. Yes Mr Chairman I have a question for Representative Trigger You are recognized How many are just is going to call some looking forward I can't tell how much is going to cost, how many employees they are going to have and that sort of thing Is set up a licence ship board I don't believe there is no physical note on this this is independent licensing board as if there is a point there is nine appointee the always fees that I know of is the podium of the board meeting which are nominal so there is no the board itself would be self funded by the behavior analyst as his medical board going Representative Bishop question. Follow up. Follow up. How are they going to operate without full time help? Representative Jeter. The behaviour analyst.. I mean the board they there are not going to have any full time employees to help them? The board is going to be set up and it's structure of the podium of the board members this are satisfied people is not in different than any of the other board we do, we know real major fiscal impact other than podium for board members themselves. representative Earl, you recognised. At the appropriate time, I would like to make a motion. Members other further comments, requests from the committee. Rep. Corny Thank you, I may have missed that somewhere, but just to clarify, the insurance coverage has all of that been worked out? The insurance coverage is at another bill that represented McGrady and I on. We decided specifically to separate this two issues, because we thought the licenses issue needed to go ahead and be moved ahead, so we didn't get into for lack of better work. The other issues dealing with Autism Insurance coverage this is just making sure these people can practise based on their training education certification. Representative Insko you're recognized. Thank you Mr. Chairman, I'm interested in the exemptions in page 10 and I guess I've a concern that there are other practitioners who are licensed under other boards that use some of these modalities and treatment and I'm assuming that that it has all been worked out and that wouldn't be a problem as long they were practicing under their own license. Everyone's been in the agreement with these including the governor's DHHS and everyone's that's been great. Thank you. Representative Penalton recognized for a second time.  Representative Jitrah if you please turn to page three line 33, it talks about employees. So they do have the ability to hire employees and I would think they have to have employees board, I don't know how we ever done without any staff, I was wondering how much this thing is going to cost.  I would refer back to line thirty five will no event shall stay and North California will be liable for expenses of board and excess of the income corrupt is miserable we believe that the fees associated with the licenser board and paying the fees will pay the fees. Obviously as we get into the financial discussions I'm sure I'm Sure that our senior appropriations chair will be happy to have that conversation, if and when we get to that point as of today we're not asking for anything. Further discussion further debate seeing none representative Oreo you are recognized for motion.  Thank you. I move that we give a favorable to the committee substitute and unfavorable to the original is it a referral? Yes. to finance.

Rep. Oral moves for a favorable report of the committee substitute for house bill 714 unfavorable to the original with referral to the finance committee all those in favor will signify by saying aye all oppose no the ayes have it congratulations representative Jeater Members of the committee we will go now to house bill 372, 2015 Medicaid modernization Rep. Dollar, Rep. Rampart you are recognized to present the bill. Ladies and gentlemen there is a proposed committee substitute without objection we will hear. Seeing no objection we will hear the proposed committee substitute representative Dollar you are recognized. Thank you Mr. Chairman and members of the committee I will make this a few brief opening remarks and then turn it over to the person that's actually been carry all the weight for many, many months working on all in this legislation and with that Mr. Chairman and members of the committee do let me take just a moment to thank Chairman Rampand for all of his hard work over a numbers of months working with members of both chambers, a wide range of stake holders and experts as well as its Administration to craft the registration that is before you today. There are a number of important achievements in this bill and let me just sort of give you the broader brush and Kem Lambert will get in to the details of the bill. The most important on my mind is bringing all of the stakeholders hold us together to hammer out a plan that will truly reform the medicaid program and I do want to thank on behalf of myself and Chairman Lam and others, all of the stakeholders that have been working so diligently together to come together and to hammer out this proposal that we have before us today and I'm sure that maybe someone will speak later provide greater budget certainty and long term cost savings which is one of the goals that we've had for some time very important as plan will improve long term health outcome for our citizens and that's really where you control cost. You control cost by changing behavior, and having better health outcomes that is what get you savings in the long run, this be a plan that is built on the strings of our state and those things include, position access for patients, we have a great access for the state, we need to preserve that award winning, primary care, medical home model, that so many agree is the basis for moving forward and taking care of an individual's medical needs. The success of our behavioral health public manage care organisations or demonstrate its strength or stability and a variety of programs actually from dental to skilled nursing to hospice cure in this day and according to US news and world report we have hospitals ranked near at the top national in almost every category of service. Truly we can build on this foundation a North Carolina solution that engages are tremendous resources that we have in this day. Now across the country, state after state has struggled with managing medicated is not easy. States are challenged to operate a Federal Healthcare Entitlement Programme and the truth is there's no one silver bullet. Anybody trying to sell one? Don't buy that. There's no simplistic solutions and North Carolina has had its shear challenges, but frankly a new day is dawning, and has dawned our administrate procedure and IT are being modernized we're working on those. Budgets have been trued up to address a series of long standing problems payments systems have significantly changed. We are working on those and leaders in government healthcare and advocacy have come together to help chart a new course. This new course will end the traditional FIFA service payment model, and move us to a system that pays for value and not simply the value of services and that's critical, a healthcare system that rewards providers based on the quality of healthcare outcomes for our patients and not simply the quality of procedures. Again I want to thank all of the provider groups for coming to the table and working together and be willing to compromise, to commit, to making our health system in North Carolina the best in the nation, and members with your help today, North Carolina can see is the unique opportunity that we have in this state, to build on our strengths and