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Senate | May 1, 2013 | Committee Room | Health

Full MP3 Audio File

I'd like to introduce some pages who are with us today, Rayquon Anderson, Rayquon, good to see you, you're off over to my right, Rayquon is from Wilson County and his sponsor is Senator Bryant. Odom Williford, Odom is also off to my right. Odom is from Orange County and his sponsor is Senator Nesbitt and we're glad to have both of you gentlement with us today, and hope that this will be informative for you. Our Sergeant-at-Arms -- Sergeants-at-Arms, Ashley Meckins, Steve Wilson, Ed Kessler, Donna Blake, Billy Fritcher. And we're glad to have you gentlemen in doing your usual fine job with us. We have five bills on our agenda today, and the past couple of weeks we have run overtime, but we're not going to do that today because we do need to be out of here by 11:50. I would encourage the members who have questions or comments on the bills to keep them as brief as possible and do not try to fillibuster the bill to death please. First item up that we have today is Senate bill 557, Senator Hise, amend report date, NC Pre-K Funding Pilot. [SPEAKER CHANGES] Thank you, Mr. President, members of the Committee. Senate bill 557, for those who were here last term, is, in concept, something that you've all seen before. This was a budget provision in last year's budget. The reason I am rerunning it as a bill and changing the dates on it is this was a study that was never done by the department. In fact, at the time, the intern used -- the department used interns to model as though the study had been completed and submitted this results to the secretary to send to us as though we had done a pilot program, the secretary did not submit that as their final report, this is still information that we think is important, we think it's information we need if we're going to consider doing classroom funding as a whole, so this bill is before us today to again request that the department, under new management, would actually do the pilot program they were required to do previously. [SPEAKER CHANGES] You've read for questions, Senator Wade? [SPEAKER CHANGES] At the appropriate time I will move for a favorable response. [SPEAKER CHANGES] Senator Davis, from the west, did you want to speak first? I thought I saw your hand first. [SPEAKER CHANGES] [inaudible response] [SPEAKER CHANGES] Senator Davis of the east? [SPEAKER CHANGES] Thanks, Mr. Chair. My question is, Senator Hise, was there an official statement or anything shared on behalf of the department? I'm just trying to understand what took place. [SPEAKER CHANGES] I think, and staff might be able to speak to that better, I think that the report that came from the department stated that the survey had not been done, at least, that was the communication I had with the secretary at the time when she discovered what had occurred. So... [SPEAKER CHANGES] I think that's accurate, Senator Hise, further questions from members of the Comittee? Senator Rabin? [SPEAKER CHANGES] Thank you. I have to ask, Senator Hise, what action was taken against the people who sent the false information or tried to send the false information forward? [SPEAKER CHANGES] I've been assured by the secretary that action has been taken, and that's the limits, when you get into personnel, that I would have received on this matter. [SPEAKER CHANGES] Senator Davis from the east, for a second time? [SPEAKER CHANGES] Thanks, Mr. Chair. I'm just curious, were there any indications of complications with trying to conduct and deliver the report? I mean, this is just a little odd, it appears.

This month's end this was a choice not to further questions from members of the committee's Senator McCain said yes to follow a listener Davis is quick to say was a conscious choice and eventually ignored a directive on the shelves; this data into game four in the issue and we said that policy be absolutely just ignored in one big problem with capability are Staffing Resources that in turn that into the model the study is if it had been for this Internet, but Wilson again today in the many years and turns in the area to model and forecasts of the study had heard that some of that is to report as clearly disappointed, be honest with you that when it's an advantage, and the little did we mention some stewardship and responsibility and understanding when we issue to refuse a matter of policy this time they should be collecting available to us getting anything be done thank you for bringing 4 to 7 ,(SPEAKER CHANGES) wishes to follow 528 I just can't conceive of us going to the trouble of doing another bill was the first one was in complied with and we think that was OK are, by this would like to know what that happened as to the plywood for the man that they can set this is being done under different administration to the questions from Minnesota committed as the motion will forfeit a lot of people have sent away the believed was something going too well follow the coming two will make a motion lumps in the way you recognize this rough ride will record to the latest move from several record among senate bill 557 , losing favor say I want to hold those same and some of my secondary wood for the presentation by sunny Chan the senate bill 486 peruses education and awareness center court a miscarriage in a modest goals for the short answer rarely an educational notice what we're asking are requesting is that the hospital's star in the delivery and new lead babies, a vice their mothers, and need to get bad that the gap vaccination which is that the condensation for tetanus could vary in this case really ugly up the no on peruses this is a recommendations come from the center for disease control's its improved and recommended by the American academy of pediatrics were asking for this Wetherill reason for bringing to the darlings attention right now telling greater born a busy by the pediatrician to play within 24 hours and right now we've had an increase in the occurrence of combo of the call for which is what peruses will address is so as your support for this bill questions from members of the commission for signing that has chaired by Billy innocence other good idea, many sense of what the hell for the status today, and I would assume that happened in the west that most attentive as than we were seeing about 20 of 30% decline some people not getting back think as a require anyone could do it so those that aren't not in favor of back saying their children will require basis for friendly reminder that because the college will kick off?? (SPEAKER CHANGES) nothing or make sure we remind them to the command, but that the giants and wonder if this is denomination seven P fresh and that tells you have Tennessee taken ADM and intellect and sell excess not redundant stores at the point now I think they can I speak from that person was praised the light is a board certified pediatrician for 21 years in what happens this is a reminder hospital also when the babies born to some other reminder pediatrician that they can go right away and hospitals have to 75 to do all we are couple weeks by Joel month before the baby scene that pediatrician's office the company owned decision followed this analogy of annexing in a skillet is simply tell the mother facts correct to remind them of the ejection has been courageous thing that could just a second neighbors taken as chairman of beds that convert the turntable report please too low for a couple questions center Robinson but I guess one and two are supporting can N senator mike, let the way you also happens all the ??..........

doesn't happen and it's important to do it at the hospital because sometimes it does take awhile before that mother gets that baby and for some of them, they aren't getting directly to a pediatrician and I know that. So it's important to have that education up front that you outta have that vaccine because whooping cough can be passed on so I commend you for that. [SPEAKER CHANGES] Thank you and I think that's important to know because you get what, if I pronounce this correctly but, ?? infections. So the infections occur within the hospital and they're passed on, it's contagious, so that's the rationale for doing this. [SPEAKER CHANGES] Further questions from members of the committee? Seeing none. Recognized Senator Davis for motion. [SPEAKER CHANGES] Move for favorable report, Mr. Karen? [SPEAKER CHANGES] You've heard the motion, all those in favor please say aye. Opposed no. Motion carries the bill, will go to the senate for ??. [SPEAKER CHANGES] Thank you. [SPEAKER CHANGES] Thank you Senator Tarp. [SPEAKER CHANGES] Next is Senate Bill 488: Amend Nursing Home Administrator Act Fees, Senator Tucker. And there is a PCS to this bill. We need motion to consider it a PCS for Senator Wade. All those in favor say aye. All opposed no. The PCS before you, go ahead Senator Tucker. [SPEAKER CHANGES] Mr. Chair, there is also an amendment I think that all the members have. [SPEAKER CHANGES] Yes, wait just one second. Yes, an amendment, go ahead, who's amendment is this? Is this a staff amendment? [SPEAKER CHANGES] Mine [SPEAKER CHANGES] Go ahead and explain the amendment. [SPEAKER CHANGES] Mr. Chair. [SPEAKER CHANGES] Senator Conaird [SPEAKER CHANGES] I moved this politically correct amendment. [SPEAKER CHANGES] Senator Tucker, are you sure this is your amendment? Senator Conaird has graciously recommended the adoption of the passage of the amendment. All those in favor, please say aye. All opposed no. Now the bill is before you, the PCS. Senator Tucker. [SPEAKER CHANGES] Thank you Mr. Chair. I corrected that last night when I was reading 'cause I knew that Senator Conaird would be here or Senator Robinson and I did not want the wrath of those two. This is Amend of Nursing Home Administrator Act and Fees. The statues on the nursing homes have not been changed since 1969 and there's been no increase in fees. It does, since 2004, it does increase the fees and also it requires for a four year degree to manage or be licensed to manage a nursing home. There are folks that don't have a four year degree that will be grandfathered and those who are in transitional periods now training with a two year degree, this won't take affect until I think January 2015 so they don't get caught up in the bill. I'll be glad to answer any questions and we have Mr. Chair and Ms. Baker, representative executive director of the nursing home administrators here as well, sir. [SPEAKER CHANGES] Thank you. Members of the committee, are there any questions? Senator Stein. [SPEAKER CHANGES] Thank you. Question about the public records provision confidentiality on page 5 and this is for either Senator Tucker or staff. But I know that we've done similar provisions as it related to medical board and state bar and as I recall, that there was some language having to do with when the matter has been adjudicated and it's been closed and something was found, then the records would become public. I didn't know if that was in here or contemplated. [SPEAKER CHANGES] Mr. Chair, asked Ms. Raleigh who helped me with the bill? [SPEAKER CHANGES] Yes Senator Stein. There is language here that makes a notice or a statement of the charges, notice the hearing and the decision. They all do become a public record. This provision, though, does mirror though, not exactly but is very close to the same provisions that are for a number of licensure boards, in fact a couple that we've considered this session, where they do not make the entire, all the records available once the decision has been rendered if that helps. [SPEAKER CHANGES] Follow-up. [SPEAKER CHANGES] Yes, go ahead. [SPEAKER CHANGES] What did we do with the medical board and the state bar before? I haven't focused on this in other licensure

agencies. [SPEAKER CHANGES]. If you give me a minute, I would have to look at the Medical Board provision, but I don't believe they have to release the entire record. It would take me a minute to look... [SPEAKER CHANGES]. How about this? I like the bill, why don't we talk after this? [SPEAKER CHANGES]. Yes, sir. I'll be amenable to discuss it and if there needs to be a change we'll do so. [SPEAKER CHANGES]. Thank you. [SPEAKER CHANGES]. Further questions from members of the Committee? Senator Tucker, you said that someone was here from the public that would like to have a comment on this? [SPEAKER CHANGES]. Mr. Chair, Mrs. Baker is here just in case we had questions from the Nursing Home Administrators, she's Executive Director. She doesn't really need to speak to unless there are some difficult questions I could not answer for the Committee. [SPEAKER CHANGES]. Senator McKissick. [SPEAKER CHANGES]. Simply, at an appropriate time, I just move for a favorable report. I think it's a good bill and I think it moves in the right direction, I like the grandfathering provisions, but... [SPEAKER CHANGES]. Yes, sir. [SPEAKER CHANGES]. You know, it gives those people transition if they're in the pipeline right now, but I think it's the right way to professionalize this group of individuals. [SPEAKER CHANGES]. Senator Wade. [SPEAKER CHANGES]. Senator Tucker, I just wanted to commend you for bringing this bill forward. I think we need to take a lot of looks at nursing homes and the care that's being given, and make sure we can do everything possible here at the state level to make sure that care is excellent. [SPEAKER CHANGES]. Well thank you, ma'am. [SPEAKER CHANGES]. Further questions from members of the Committee? Seeing none. Senator McKissick, you are recognized for a motion. [SPEAKER CHANGES]. Move for a favorable report. [SPEAKER CHANGES]. To the Committee Substitute as amended? [SPEAKER CHANGES]. That is exactly correct, Mr. Chair. [SPEAKER CHANGES]. And unfavorable to the original bill? [SPEAKER CHANGES]. That is correct. [SPEAKER CHANGES]. And re-referral to Finance. [SPEAKER CHANGES]. Re-referral to Finance is included in that motion. I like the way you put it. Very succinctly. [SPEAKER CHANGES]. Excellent motion, sir. [SPEAKER CHANGES]. You're most welcome. [SPEAKER CHANGES]. All those in favor of the motion, please say aye. All opposed, no. The motion carries. Thank you very much. [SPEAKER CHANGES]. Thank you, members of Committee. [SPEAKER CHANGES]. Senator Hise, recognized for Senate Bill 553, LME/MCO Enrollee Grievances & Appeals. This bill also has a PCS, is there a motion to consider the PCS? Senator Randleman. All in favor say aye. All opposed, no. The PCS is before you. [SPEAKER CHANGES]. Thank you, Mr. Chairman, Members of the Committee, and I will begin to say that I have some staff who can come at much more on the legal side of this bill. Again, I don't play an attorney and allege such, that's coming over. The purpose of this bill is really twofold. It is one, to clarify and streamline the appeal processes dealing specifically with LME/MCO's as we have the state. And to create an appeal process that recognizes that they are LME/MCO's. We kind of got into a position where we took our appeal process that existed under current fee for service models and ported it in to the LME/MCO's. It's led to some very interesting complications that we are dealing with now all across the state and we're really trying to adjudicate those and move them forward at a more consistent rate and looking more at the standings and medical necessities that are made by third party and how those are appealed. This bill is looking specifically at the individual side. I know some in the House kind of got into the provider side, but we've kind of narrowed this focus down in this particular bill. So, I'd be happy to take any questions that you may have. [SPEAKER CHANGES]. Good Morning. It's kind of a long bill as you can tell, so I will go quickly through it and then be happy to answer any more specific questions that you have. So, starting on the first page is the definitions section, and I'll say there are two sort of guiding principles that I believe the bill sponsor used in this. One is the code of Federal Regulations that pertain to a grievance system for managed care. If you look at the background of the summary, this last paragraph under the background sort of explains that. So that was one of the things and you'll see continuous references in here to the code to try and make sure we're in compliance and consistent with that. The other guiding principle was to, and Senator Hise, I don't want to put words in your mouth so if you disagree this, was to mirror the current appeal process in place for Medicaid to the extent that it was practical and possible

Representative: in the preference of the sponsor. So, essentially, this sets up a new chapter, 108D, for LMEMCO agreements and repeals, page 1 is all of the definitions and, again, as I said earlier, you will see references to federal code in that. Section 2, which is 108D too, sets out the scope of applicability of the chapter to apply to every LMEMCO, to every applicant enrollee provider of emergency services and network provider of a LMEMCO. Section 3 of the article establishes the conflict and severability, provides of the big picture for the enrollee, grievance and repeal procedures. I am not sure how much detail you want me to go into with that. Summary will provide you with an outline of that process. Moving on along, 108D5, provides for grievances which are set out as the filing of the grievance, the notice of the grievance, and the appeal of the grievance disposition. Then moving down to 108D6, you have the standard enrollee appeals. So, 5 has to do with grievances; 6, you move into the repeal process. On the notice of managed care action, one thing I will point out, which I mentioned before, this is one of those cases where it mirrors the language providing for notice of Medicaid recipient appeals. Then, if you look on page 2, under the summary of LMEMCO standard appeals, it will give you a short paragraph that summarizes, essentially, what is included in the request of the appeal, the continuation of notice of benefits, notice of resolution, right to request a contest the case hearing, and request a form for the contest a case hearing. With regard to the continuation of benefits, the LMEMCO shall continue the enrollee’s benefits during the dependency of the appeal to the same extent required by federal law, and you will see the code reference there. 108D7 provides for expedited enrollee level appeals and this is when time limits for completing a standard appeal could jeopardize an enrollee’s life or health, or ability to attain, maintain or regain maximum function. So, there is a process of that, for denial of expedited appeal, for continuation of benefits, notices to the resolution, right to request a contested case hearing. Moving down to the bottom of page 4, 108D8, is the contested case hearing on the disputed managed care actions. Again, there are a number of sections in here that mirror or are substantially similar to the current law for Medicaid contested cases. So, I have not summarized those but have pointed them out so that if you are comfortable with the current Medicaid contested cases, you should be fairly comfortable with the ones in this. That is subsection 8, simple procedures, mediation or burden of proof, I or J, K is new evidence and L, issue for new hearing. One thing I will point out is maybe an improvement to some extent, and certainly works better with the LMEMCO process, you will see a footnote on page 3 of the summary that indicates one of the differences in the simple procedures in this bill is that it allows in person hearings to be conducted in the county that contains the NC headquarters of the LMEMCO as opposed to the current law which provides that Medicaid cases be heard in Wade County unless certain situations exist. So that is one thing that may be a little bit different, I guess, more relevant to similar situation. Then, moving to 108D9, you have the notice of final decision and the right to seek judicial review. Section 2 amends the definition of LMEMCO in 128C3 and I think this is a definition that you have seen before and

...and other bills. Section 3 amends 122C 151.3, to provide that the section doesn't apply to enrollee grievances or appeals subject to Chapter 108D, which is what this bill enacts. 122C 151.4. Again, provides a similar amendment that enrollee grievances are appealed subject to 108D are not applicable to that section. Section 5 adds a new section to 150B, to provide that a Medicaid enrollee or network provider acting on behalf of an enrollee who appeals a notice of resolution issued my a LMACA?? may commence a contested case in the same manner as any other petitioner and the case shall be conducted in the same manner as other contested cases. Section 6 requires DHAS to submit to CMS, Center for Medicare and Medicaid Services, a Medicaid state plan amendment necessary to implement the act and section 6 provides your effective date which specifies that the act becomes effective June 1st of 2014. Upon approval from CMS, of the Medicaid state plan amendment required section 6, and DHAS is required to report to the reviser of statue when approval is obtained and the date of the approval. [SPEAKER CHANGES] Senator Kinnaird. Thank you very much, Miss Matula?? [SPEAKER CHANGES] Thank you. That was a good overview. I just have one question because I'm not familiar with this, but on page 5, line 1. Is this a change where the Office of Administrative Hearings does not have jurisdiction? What has been the past role of the OAH and administrative law judges? [SPEAKER CHANGES] It would be in staff messages as well. The concept of grievance, which is under here, is the new concept thats added in the from the application of the federal statutes. [SPEAKER CHANGES] Quick follow-up here because it says its the exclusive method. Now, is that a change or has that been that way all along on the grievance process? [brief silence] On page 5. [SPEAKER CHANGES] Are you referring to subsection A jurisdiction of OAH? [SPEAKER CHANGES] Yes. I'm just wondering is that a change. [SPEAKER CHANGES] Consistent with what Sen. High said, OAH does not have jurisdiction over the dispute concerning a grievance. So, there is a process set up for grievances but it does not move beyond the process that's contemplated in the previous section of the bill and then the second sentences provides that OAH does not have jurisdiction over a dispute involving a managed care action except as expressly set forth in the chapter; and yes that is new and different because it pertains to managed care actions in the bill. [SPEAKER CHANGES] So, one last question. [SPEAKER CHANGES] Yes, go ahead. [SPEAKER CHANGES] It seems to me that's a narrowing of options and it does say somewhere that you do have judicial at the very end somewhere --you can then also – on page 7, line 38. [SPEAKER CHANGES] I will speak. I'd staff like to follow-up especially if I'm stepping out on this. The entire concept of following a grievance is a new process allowed by this bill did not exist. So, the fact that were not putting it under OAH is not a narrowing; it didn't exist at all prior to. [SPEAKER CHANGES] Senator Kinnard. I'm not an expert on the current process for Medicaid repeals. Jennifer Hillman is new to the research staff and works with the fiscal staff in appropriations and she has relevant experience in this area and if your question is more to how this process may differ from the current process, then she may be able to respond better to your question. She is sitting over there. [SPEAKER CHANGES] Senator Kinnaird will get with her later. [SPEAKER CHANGES] Senator Hartsell. [SPEAKER CHANGES] I know a little bit about some of that current process and that's one of my concern here. To what extent-- I understand grievances are new. I have no problem with grievances and they are clearly defined as to what they are or aren't. The second line does cause me some pause having to do with OAH does not have a dispute over involving a managed care action except as expressed.

...this chapter. My first question is who does have jurisdiction over a management care action that is otherwise not dealt with? To what extent does that differ from current process or law consistent with the MOU that OAH and the department have already established with, I guess it's DMA or somebody? [SPEAKER CHANGES] I think Jennifer may be able to answer that question for you, Senator Hartsell. [SPEAKER CHANGES] Ms. Hillman, would you like to comment? [SPEAKER CHANGES] Sure, I'll comment on if OAH does not have jurisdiction, then a complaint could be filed in Superior Court. [SPEAKER CHANGES] Senator Hartsell? Follow up. [SPEAKER CHANGES] Why would we want that? That's my question. I mean, we set up a standard process throughout for appeals from administrative matters or determinations consistently across State government and State agencies to go to OAH. I understand the grievance piece, but why wouldn't we want to continue to have, as long as we have defined a managed care action as consistent with the federal definition and we have adopted our underlying law such that it is also consistent with the federal definitions, why would we not want to continue to have managed care action appeals going to the body that has some express expertise in dealing with these kinds of appeals? That's what I'm trying to figure out. [SPEAKER CHANGES] It's my understanding that this bill will allow managed care actions to be heard by OAH. It's just only as set forth in this bill. It doesn't extend any additional jurisdiction to OAH outside of what's expressly set forth in the bill. [SPEAKER CHANGES] But you'd have to do a summary of what is set forth, I mean I think that would make...I know it's medical decisions... [SPEAKER CHANGES] I know I'm being fairly technical here, Mr. Chairman, but there is some reason behind this technicality, because we adopted some provisions last year to authorize, and in fact it was one of the reasons that we could do some things. Overcoming some regulatory reform that we got an awful lot of people to buy into it and I'm just trying to figure out why we would want to change that now. Or are we? That's the question. On a managed care action. [SPEAKER CHANGES] Senator, do you want to try to work with staff in between and see where we're at on this kind of particular matter? [SPEAKER CHANGES] Sure. I'd be glad to. [SPEAKER CHANGES] We believe that the areas in which an LME, I believe it's the alias which an LME MCO action are very broad that this is what it's going through, this kind of says some outside of those, if we're missing something that's outside of that, I'd be glad to get it a part of it. [SPEAKER CHANGES] My understanding is much of that is taken care of by defining grievances as one thing and managed care actions as another. If it's a grievance and you've got a new process all that, that's not a big deal. But if it's a managed care action and we have modified our underlying law to reflect what the federal law is in managed care actions, why wouldn't we, because that's been the problem because the underlying State law has been inconsistent with federal process and procedure. What we're trying to do is to marry the two up, but if the State is going to apply the federal law as it applies in a managed care action, which we I think have defined that they is, why would we not want to have a consistency associated with that process. That's, I'm probably talking around in circles again, too, but that's a concern. [SPEAKER CHANGES] Senator Hartsell, this bill is supposed to go to J2? [SPEAKER CHANGES] That answers that. [SPEAKER CHANGES] I believe that your question...

From the dividend of one other question the issue and that is home here, but Dole mentioned something about she would go to the headquarters of big accounting headquarters will be given the fact that are home television channel insurance only reflect flexible rally we actually adopted some provisions that would have these going to the county were to fall and close to the headquarters county which might be a part of town and country of law said by phone at five L that this is two C stempel and from one year are calling if you look at on OM the simple procedures switch says, begins on page five N, subdivision two N may be a centerpiece of Baghdad on a bus that perhaps a positive thing in the delta, if you looked down too are only for airlines 7:00 AM (SPEAKER CHANGES) this is an impersonal city conducted in Canada contains electronic orders, LECM however for takeoffs saying the impression he may be conducting turning presence in relief or near Michael ELFSN Miller two the process that you are speaking same with weary said, and 5K6 nine ??........ the line in person hearing should be conducted and then there's a good product ID calls process from that allows it to be conducted the county residents this administration of inflation is counting Crows months was actually going to talk about both chambers in this selection this the senate adopted the location probably the following couples as much as six weeks ago when the news and Britain just returned from a reverse your knowledge to absolutely seven cover like you won't miss sure, and follow 274 shall serve more shall there has been some inconsistencies with a late release the calls are confused a 22 for service in managed care bill as long as I call Mary scare wall in their determination that does not have to be appeals spear: they can Michael initial the fall Mr. Law so much alike are spawned some less than the other holder: the big issue that has taken place in the crash was the color line North Carolina wall provided one coming and Federal law provided another what he appears to me we're trying to raise chickens and Helen H applies to walker on wall and there was a provision that should the Federal law trumpet ?? (SPEAKER CHANGES) we think we got network L and try to make sure the work week came to be consistent such that, where that these differences… With regard to prefer Russian and your the week of August, the one we should one be sure we don't throw the baby out with the bathwater and overrun the official if the judges for toll in the statute says to 2:00 and Medicaid rules in North Carolina section five and the national player of the weirdest and called fourth and slated to take this post six and we'll actually come up with some dismay among Unix is currently between only HM fish abuse children under the under lying problem with Motorola two for the Santa Monica sick of fur cents a day shares their marshals to concerns from nine to nothing to count me in looking at is well within 24 cities did also will be seen cardiologist process for an expedited appeal to see the extent to which was standards would be used in deciding when to break that are denied a request that obviously in Rollie year because he is receiving benefits while on the appeals process is ongoing until said automated process for establishing a 90 day turnaround be expanded prosecution obviously occur much more efficiently much more intense than exporting to databases with a withstand ??....

So we’re establishing whether that request for an expedited appeal is granted. [TALKING IN BACKGROUND] [SPEAKER CHANGES] On Page 4, I don't know if this will answer your question, Sen. McKissick, if you desire a more specific answer. But Page 4, line 22, provides that when time limits for completing a standard appeal seriously jeopardize the enrollee's life or health or ability to attain, maintain or regain maximum function, an enrollee or network provider authorized in writing on behalf of an enrollee has the right to file a request an expedited appeal of a managed care action no later than 30 days after the mailing date of the notice of the managed care action. [SPEAKER CHANGES] A follow-up? [SPEAKER CHANGES] Yes, sir. [SPEAKER CHANGES] Let me ask you this, then. I'm assuming, and maybe I should not assume this, but under prior provisions for an appeal, the enrollee continues receiving the benefits in the interim. This does allow for that to continue as the practice. Is that -- ? [SPEAKER CHANGES] For the expedited appeal. [SPEAKER CHANGES] How about under the regular process? In regular process, if it -- and let's make the distinction. In the past, continuation of benefits pending some final decision being made, whether it would be expedited, whether it would be regular, is that benefit, since it is an entitlement, continued. It's always been my understanding that as the result of being an entitlement, we were required to continue it. [SPEAKER CHANGES] Under the managed care rules that exist in Medicaid and the federal that exist under the entitlement program, when you have made the medically-necessary decision that someone does not need this service going forward, they do not continue to receive those services under a standard appeal under the federal regulations while the standard appeal is going on. We have provided for the expedited appeal for those ? if someone's live or health or other things were in danger, that they would continue to receive those while we go through the expedited appeal process. The problem is, the reason that's inconsistent in a managed-cared model, we are not paying for a fee for service from every one of those providers coming up. They're paid under capitated rate that assumes they only provide medically-necessary services that are going forward, so that you can't merely extend by just having an appeal. That you would go through an expedited if you were saying that this was detrimental to your health by not receiving these. That's why we have the expedited appeal, and you would continue to receive during those. But for standard appeals, we do not make it under a managed care system that you automatically -- the federal law does not make it automatically that you receive those moving forward under a standard appeal process. [SPEAKER CHANGES] Quick follow-up: That's dealing with the grievance process we're now dealing with, or is this separate apart from that? [SPEAKER CHANGES] This is the individual enrollee -- [SPEAKER CHANGES] Individual enrollee. Okay. Well, perhaps we can look at this a little bit more closely as it comes to J2, since I understand it's going there, and get some of these issues resolved. Thank you. [SPEAKER CHANGES] Thank you, Sen. McKissick. This bill does go to J2 if it receives a favorable report from here. Is there a motion? Sen. Hartsell? [SPEAKER CHANGES] I'll move to give, I guess it's PCS favorable report, unfavorable to the original and with a serial referral to J2. [SPEAKER CHANGES] You've heard the motion. All those in favor, please say Aye. All opposed No. The ayes have it, and the bill will be referred to J2. We have one final bill that we're not going to be able to do justice to today, but Sen. Goolsby, if you'd like to come up for the remaining time, we have a PCS to Senate Bill 530: Prohibit e-cigarette sales to minors. Is there a motion to consider? Sen. Wade has a motion to consider the PCS. I would like to remind everyone that an incarceration report will be required before this bill can receive a favorable report, but, in the time remaining, Sen. Goolsby, go ahead with your bill. [SPEAKER CHANGES] Thank you, Mr. Chairman. This is a pretty simple bill. Basically what is does is it takes the smokeless, the e-type cigarettes that you see, and it puts them and makes them subject to the laws right now as they pertain to people under 18, and that's pretty much what it does [CUTS OFF]

Across the board as you can see throughout the bill were it goes through the different statutes as far as regulating products that have tobacco and it ends up putting in vapor products like this and other tobacco derived products. Basically nicotine delivery devices other than a cigarette. I don’t know of any electronic chewing tobacco at this point. I would appreciate your support on it and would be happy to try to answer any questions you might have. It seems like something we need to do for the children. I’m sorry… [SPEAKER CHANGES] Senator Kinnaird? [SPEAKER CHANGES] I was originally in favor of this bill until I heard from my public health people who are very concerned because it creates another product and gives them sort of authority. I have a lot of concern over this bill. Obviously, we should not be selling these to minors. If there was some way we could separate that out in response to what the public health people are concerned over, and the heart people, and the lung people, and everbody. There are some problems that if we could work out. It would be protection for those children but not create a new product which is under the auspices of the health people. [SPEAKER CHANGES] It is a product ma’am, if I may answer Mr. Chairman. It’s sold online. It’s sold in stores. It’s currently unregulated. This bill you could look at as a first step if need be in order to start regulating this product and protect the children. [SPEAKER CHANGES] Senator Stein? [SPEAKER CHANGES] Thank you Mr. Chairman. I think one way to address…this is a great bill. I wholeheartedly agree that we should keep these e-vapor, because it contains nicotine, and you just don’t want to get kids on a path towards eventually smoking. Thank you for bringing the bill. I think Senator Goolsby and I talked about a way to address some confusion in North Carolina law and actually a distinction with federal law. Federal law defines tobacco product to include these vapor products. He and I are amendable to an amendment when the next time this comes up in committee or on the floor. I think it would address your points Senator Kinnaird. It would keep consistency of the definition of tobacco product by including vapor product as a sub-set of it. That way, wherever Senator Roucho is, it won’t create confusion in North Carolina law as it relates to tax. Because all our tax codes refer to tobacco products and these shouldn’t be tax favored since their are tobacco products. Senator Gooslby said he would work with us on that and we appreciate that. [SPEAKER CHANGES] I would be happy to look at that. I also understand that these products, and I don’t smoke occasionally a cigar. I understand these are also cessation products. I’m not quite sure they would fall under an actual tobacco product. I will be happy to talk with you about that. I did not understand you were talking about putting them under the federal definition and what that all entailed. I will be happy to speak with the members further on that. I do know that we tax cessation products differently than we tax full fledged tobacco products. [SPEAKER CHANGES] Senator Gooslby, pardon me. I was mistaken about the incarceration reported. It is not required at this time for us to have a favorable report. With that I recognize Sen. Hise. [SPEAKER CHANGES] Thank you, Mr. Chairman. To address that as well…I would move that we give this bill a favorable report. Serial referring to J-2. As to the PCS, unfavorable as referral to the original bill, favorable as referral to J-2. That was (??) hand. Give you a chance to work these out in between. [SPEAKER CHANGES] J-1? [SPEAKER CHANGES] That would be to J-1. I don’t have any objections. Here and now we can go ahead and get these addressed in between. [SPEAKER CHANGES] You’ve heard the motion. All those in favor of the motion please say aye, all opposed may say no. Thank you very much. I’m sorry for the time restraints we’ve had. Thank you. The meeting is adjourned.