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House | May 25, 2016 | Chamber | House Session Health

Full MP3 Audio File

[BLANK_AUDIO] If you would take your seat we'll call our committee to order. Take a seat and we'll get started. [BLANK_AUDIO] Wlcome you to the health committee. Thank you for being here. [BLANK_AUDIO] Our sergeant at arms, Young/g Bay/g, Jim Moran, Joe Crook, and Will Crocker, Martha Gadison. Thank you for being here helping as well. We have a few house pages Brook Barnhill/g, Representative Mclrath/g, Natalie Tilly/g, Representative Sein, Weston Kreiger/g, Representative Johnson and Ethan Richie, Representative Richardson. Thank the pages for the work they do this week as well. We have two items, two bills before the Committee, we're actually gonna go out of order and take, both of these are Senate bills and we have Senator Pate with us who will talk about Senate Bill 734 The state was standing order we also have a number of the HSS staff and I think Doctor Williams he'd like for you to come up his will and participate in the presentation to the committee, so Senator Pate welcome and we are glad to have you to our house health committee and Senator Robinson I don't see her yet she may Join us as well, the Senate is working on their budget so they are tied up right now. >> Thank you very much Mr chairman it's a delight to be before my friends in the house as we present something which I think is a very important bill for your consideration that is Senate Bill 734 state wide standing order for Opial antagonist, Doctor Ranol Williams who is a public health director has done some heroic work in looking at what the opuloid epidemic is doing to people in our state, and I think he s taking a great step, a major step, I think we're maybe the second or third state in the union to do something of this nature that would save lives for people who are Overdosing on opuloids, and so without any further ado, I would like for D. Williams, with your permission Mr. Chair to explain the highlights of this bill and what his ideas are and I think that you will be pleasantly surprised and Hopefully inclined to support this bill, [UNKNOWN] for the presentation. Dr, Williams? >> Thank you Senator Pete, we will acknowledge Dr. Williams? >> Thank you Senator Pete, and chairman Lander, I very much thank you for letting me to come and speak today. As I've stated on previous occasions, when we look at the problems we're facing as a state and a nation with opuloids, it really is the kind of public health crisis that our time. Again we have many people dying from opuloid overdose in North Carolina, either guns or cars, and when you go out to the medical examiner which I do, right now, one out of four of our autopsy is for opuloid overdose and in some ways it's overwhelming our system, and when I go out there and observe the last two I've seen were very young people and so that's the genesis of this bill, it's an incredibly complex problem and multifactorial and therefore be the same, this part that I present to you is very bold, we will be the third state to do this, and that is under the standing order of the state health director which is me, using my DEA number, anyone in North Carolina could go and ask for [INAUDIBLE] which opuloid/g overdose and works almost instantaneously. And it really is a lifesaver. The example we always use is, it's like being a lifeguard at the beach. If you see someone who is drowning, you just go out and save them , and bring them in and then you can start further tings from that, unless you Then you really have lost the struggle life there. And so again I just thank our staff. They brought it far. I do think it's very bold. State health director's been around since 1877. This is the first time we'll ever have done anything like that. We don't come to you lightly but we think the magnitude of the problem meets the need and we think that it literally,

based on our work with first responders in which last year we saved more lives than we had lives lost from overdoses. I'm making this available to anyone who has a loved one or who has a friend and to have available nearby that literally people will find themselves in a situation with our first responders, but for that drug, the person will die. So thank you very much for your consideration. >> Thank you Dr. Williams. We do have a few questions, we'll start with Representative Murphy. >> Thank you chairman. Dr. Williams can you just point out the fact [INAUDIBLE] if this drug is administered in error, in other words someone is not overdosed, that there are There are no side effects, this one does not cause anyone to have any illness, it only works on people who have overdosed from an opuloid/g but if they are unresponsive from some other situation, it's not going to make it any worse, if you could speak to that. >> Thank you Representative Murphy, and again as physicians we'll always take a look at the risks versus the benefits of anything and certainly this is a drug, but we think to your point that this drug opuloids/g act on receptors in the brain and this simply just knocks the drug off the receptor and so in that case it's not gonna hurt anybody that has another issue. So we feel very good about that. >> Representative Inscor >> Thank you Mr. Chairman, I have two questions. One is how will you know that this is available, how do we educate the public, and how much does it cost? >> Representative Inscor that's a great question. The cost is so noble, it won't be the first time really we have this some state local health directories have already put in standing orders and some pharmacies have already issued that on their own under the guidance of our medical director but this will be a statewide roll out so as were just talking this morning, we think we have to be very purposeful about making sure pharmacies are aware of it. We've worked with the North Carolina medical society, the North Carolina Medical Board, and the North Carolina Pharmacy Board collaborated to come up with this initiative so we will work with them and then again as far as the cost, it varies for medicaid. You can either get a nasal spray or you just get into the [INAUDIBLE] or you can do an injection, and the price for that range is for about $75 to about $110. >> Follow up. >> Just to follow up, are there any data that are available from other states that have done this, about how effective it is? >> Yes ma'am. We will be the third state in the country to do this, the first state to do this to do this was in October, so we really are recognized nationally as a thought leader. And so one of our great hopes is that this will spread around the country. So we don't have any early data about how this particular program. Now we have it from our first responders in which we had more reversals last year than deaths but this widespread dissemination. And again to your point, some people won't go get this drug cuz they don't wanna go to the doctor. Some doctors go wait a minute, I'm giving you a drug to give to somebody else. That kinda is off-putting to them, and we just want to eliminate all those barriers. >> Representative Avila. >> At the appropriate time for a motion. >> Okay, Representative Blackwell. [BLANK_AUDIO] Okay, Representative Adcock. >> Well Representative Avila beat me to it cuz I was gonna make a motion at the appropriate time. I would like to make a comment and that is to your last point Dr. Williams about first responders. What this bill allows us to do is actually expand our community of first responders. So it's brilliant in that regard and we just cannot even hope to save these lives in the long run if we don't save them in the short run. So I commend you and your department [INAUDIBLE] and I'm glad that I'm so sorry we couldn't be first. >> Thank you Representative [INAUDIBLE] >> Okay we'l go back to Representative Abar/g for a motion and this one does have a referral to J1. >> I move for a favorable report for senate bill 734 with a serial referral to J1. >> Okay, all those in favor say aye. >> Aye. >> Any opposed, no. Senator To Pate it does pass looks like it's unanimous, appreciate your efforts on this you and Doctor Williams and the staff so we will move this from our committee over to J1. >>Thank you very much members of the committee Mr chair. >> In exchange for that you know you have to be much kinder to us on the budget coming back from the Senate >> [LAUGH] [LAUGH] We will see okay Senate Bill 838 and Senator Heiss is tied

up in the budget preparations so Representative Dollar will be presenting that we do have a PCS on in the motion except PCS. All those in favor say aye? >> Aye. >> Okay, Representative Dollar. >> Thank you Mr chairman members of the committee what this bill is it's essentially a technical, a cleanup bill and several modifications that can do us Principally from the department in order to facilitate the submission of the 1115 waiver, the Medicaid reform, innovation waiver that will be sent to the CMS, center for Medicaid and Medicare Submitted to them next Wednesday, June 1st, so what this bill does is, this goes back to our original bill from last year as well as a couple of other items and make some conforming changes and clarifications based on what that submission is going to To be next weekend if you have any questions or you'll probably need to refer them to staff, let's get your support. >> [UNKNOWN] >> Thank you Mr, Chairman, thank you [UNKNOWN] for bringing this forward. Could you explain the impact of page/g Page 3 line 17 which would be C. >> Page 3 line, which line? I'm sorry >> 17. >> 17? [BLANK_AUDIO] I'll have, i'll let staff. >> Let's call in staff Calling department someone from the department. >> Mr. Chairman his [INAUDIBLE] I'm a deputy secretary for medical assistance in DHHS. And essentially this really allows us to exclude this group for manage care because there is such a small group of folks when they come on their services are time limited it's a group of folks that we wind up paying for anyway, so it's really just to exclude them from their captivate payment. >> Further questions Representative Blackwell. >> Thank you Mr. chairman representative Dollar could you comment on page two and I'm for a their is a change in the line which they used to say that behavioral health will be excluded. Until four years after the day [INAUDIBLE] contracts began and now it is changing to say for at least four years I've read that to say basically we are guaranteeing it won't be for four years and it could be a lot longer but can you sort of give us an idea of what's going on there. Is it just as I've said ? Are we simply sorta trying to make that potential move a little fuzzier? >> Representative Don/g? >> Thank you Mr. Chairman. Yes, representative Blackwell, if you look up in lines, especially in line 6 you see some additional language there for [INAUDIBLE] shall not cover and that is really sort of a technical clarifying change and because those words were placed at that point it may, most of Of line 39 redundant. Now I think in the Bill as it had come over, it was reading local management entities, LME MCOs, until four years after the day capitulated/g contracts begin. This version, the house version, the PCS, we put in the language for it at least four years so that does leave it open as you suggest. >> Representative Hager? >> Thank you and I apologize [UNKNOWN] I think sometimes health jargon is more confusing than engineering Legal jargon is. Could you just explain here in page three which be line 2030, there's a lot of presumptions there and I'm not sure what all that means. >> Representative Dollar if we can call staff, we can call them. Mr. Richards again? >> I think he could best answer, >> Okay, Mr Richards? >> The [UNKNOWN] And essentially there are some people that we allow to be determined on presumptability because they show up in the hospital and they get the medicaid services.

What we don't wanna do is put them in capitation cuz we would wind up, frankly the ability to manage that in a capitated system would be very difficult. So these things are, we're paying for these services anyway but what we're trying to do is make sure when we go go to a manage care system, what we don't do is put a burden care agencies for people I can't account for. >> Thank you Mr. Chairman. >> Thank you Representative Hager. Representative Insko? >> Thank you Mr. Chairman, on page six line 24, I'm just curious about what GS 114, 2.3, and 147-17A what put does that cover, and that will be a staff question. Staff question Mr Richard, do you see the section? >> Is probably Legal staff probably, page six line 24 it just exhibits the secretary from certain >> We are looking at it, they are looking at it [BLANK_AUDIO] Mr Richards, do you wanna try that? I'm going to try it so I think the legal council is going to be better at this I don't think I can get to this sites as quickly as they can, they've looked it up I think they are prepared to respond. Okay you'll take it. >> This is Jenifer Hillman with the Legislative Analysis Division I've pulled up GS114-2.3 and this requires written permission from the Attorney General prior to employing private counsel. >> Is that helpful? >> Mr. Chairman if I might add, I think - >> Representative Dollar. >> I think the principle aim here Is that they are going to need substantial legal council legal support as they move this waiver forward and there is no question that they are going to need specialized private council or they won't be able to move the 1115 through the process. Representative Adcock. >> Thank you Mr. Chair. This is probably a staff question. Page 3, line 19 and in the stem it says except for the following categories and D says, medically needy Medicaid recipients. I always think of Medicaid recipients generally as medically needy. Could someone define that for us. Medically needy Medicaid recipient. >> Mr. Richards. >> This is Dave Richards with DHHS again. And it's very specific category inside of the Medicaid program, so it is an exemption. The same thing we're trying to do is exempt people that incaputation/g would not That makes sense because of the ability to find to manage that decapitated system. I can get you the detail on that category if you like. >> Follow up? >> That would be fine, I would assume that would mean like extremely medically fragile or something like that. >> I would not as well that this bill is as a result of the Medicaid oversight committee that met It during the all session, these items were vetted and then came out of the review of that committee as well. So there is a lot of talk in review each of these items as we went through them in the over site committee. >> Other questions, representative Insak/g? >> Thank you. On page also line 29 and 30 , if the secretary establishes alternative procedures of review and contracts, I assume that the contracts are referring to the contracts that we'll have with the managed care companies? Representative Dollar. >> That's correct and these are the contracts that are going through the new division of health benefits. >> Other questions? We don't need a motion to accept this does have a referral to serial referral to preparations I move approval I knew it was referred to the next committee. >> To appropriations. Reports the PCS. >> However stated. >> Okay, we will incorporate that in your motion, however stated. All those in favor say aye? >> Aye. >> Any oppose? No. It does pass and it will be moved from here on to appropriations.

Thank you committee >> Thank you very much Representative Dollar/g. Next week the health committee will meet June 1, we are likely to meet at 9 o'clock, the agency will be reviewing the waiver that will be submitted to the federal government. So next week will be a very important meeting for you to attend and then following that will be an announcement and a signing ceremony to Actually announce the completion of the waiver and submitting that to the federal government. So our meeting next week will be moved up to accommodate the governess schedule and the signing ceremony. >> Representative Dollar [BLANK_AUDIO] He's asking about [INAUDIBLE] >> Okay. A correction that does not need a referral to preparation, thanks for catching that. That was a note I was given So we will correct you motion to exclude referral to preparations because it is important we get this out before the waiver is submitted this next week. Representative Insko. >> Do you know when we will have access to the waiver language? Staff, Mr. Richardson. >> Representative Insko, we won't be able to share that language until we submit because of the obviously sensitivities of that but as soon as we're ready to submit we'll have it available for everyone. >> We have Set aside about an hour and a half, two hours so there'll be a lot of review and detail of that waiver request. If no other business the committee is adjourned