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House | May 9, 2013 | Committee Room | Services

Full MP3 Audio File

...and be recognized when I call your name. Rachel Murney from New Hanover County sponsored by Representative Catlin. Madison Henderson from Sampson County, sponsored by Representative Lewis. Hunter Mullis from Lincoln County sponsored by Representative Saine. And Sarah Cleary from Avery County sponsored by Representative Dobson. Pages, thank you for being with us today. I hope you've had a good week at the General Assembly. Ladies and gentlemen, and members, we are time constrained. We have about 30 minutes for this meeting before we need to get out of here, so we're going start by saying that the House Bill 177 is pulled from today's calendar. You have two bills before you. We're going to begin with House Bill 832, there's a PCS to this bill that is being passed out right now. Representative Martin moves that the PCS be before us so without objection it is. Representative Avila, you are recognized to present your bill. [SPEAKER CHANGES] Thank you, Mr. Chairman and if you would, please I would like to recognize staff. Ms. Paul to go through the bill, please. [SPEAKER CHANGES] Thank you, Madam Chair. House Bill 832 would create a new section of the general statutes in the Pharmacy Practice Act to establish a new class or a new definition of an immunizing pharmacist and it would permit an immunizing pharmacist to administer immunizations of vaccinations within the constraints, the limitations prescribed in the bill. Section 1 of the PCS would define immunizing pharmacists and if you, again, refer to Section 1 of the bill, it indicates a licensed pharmacist who meets all of the specific qualifications and certifications that are listed in items 1 through 6. Section 2 of the bill takes the definition of the practice of pharmacy from where it's currently located in the general statutes, moves it to another section. Section 3 of the bill contains the new definition of the practice of pharmacy, which includes the activities that an immunizing pharmacist may conduct. Section 4 of the PCS would authorize an immunizing pharmacist to administer only the vaccines or the immunizations that meet the criteria of being recognized or recommended or required by the Centers for Disease Control, can administer to them only to persons who are 18 years of age or older. The section also lists the specific vaccinations or immunizations which an immunizing pharmacist is permitted to administer. Section 5 just makes conforming changes and Section 6 would direct the named organizations to cooperate and to collaborate to develop safety protocols, as well as to develop a questionnaire for patients who come in to seek an immunization from an immunizing pharmacist. [SPEAKER CHANGES] Thank you, Ms. Paul. Representative Avila, the understanding of the Chair that this is a consensus bill that has been worked out by both parties and there may not be opposition. If you would speak to that, I would appreciate it. Representative Avila, you're recognized. [SPEAKER CHANGES] Yes. Some of you may look at this and wonder, "Well, OK, what's the big deal?" But in North Carolina it is a very big deal. We currently recognize pharmacy immunizations for only three vaccinations. We're one of probably seven or eight States that have the lower number of vaccinations of the list that is recommended by the CDC. With this movement and the cooperation of a tremendous group of professionals, we've opened the door for citizens of the State to reach a higher level of protection by being able to get these vaccinations at a pharmacy location. I know one of the things that has been on my mind and the reason that I was in favor of this, I know many of you are...

news stories regarding the issue of whooping cough, that has been resurrected in our society and is driven a lot of the discussion. So as much as I would like to stand up here and tell you how great I am to get this bill, it is totally the work of the organizations that you saw named in section six. They did long hours, some hard discussions, and put the health of the North Carolinians ahead of a lot of considerations. And Mr. Chairman, if I may, I'd like to be recognized for a favorable report. [SPEAKER CHANGES] Thank you Representative Avila. This time the chair would also like to recognized Representative Hollo. [SPEAKER CHANGES] Uh, for a motion at the appropriate time. [SPEAKER CHANGES] Representative Fulghum, you're recognized. [SPEAKER CHANGES] Thank you Mr. Chairman. A question for the sponsor or perhaps staff. I just wondered if this definition of immunizing pharmacy conforms to a national standard? [SPEAKER CHANGES] Representative Avila? [SPEAKER CHANGES] I'm hearing from staff that she's not aware of what the, what the national standard is. I'm assuming we have the Representatives in the audience that might be able to speak to that. [SPEAKER CHANGES] Any further members, further discussion, further debate? Representative [Zucca?]. [SPEAKER CHANGES] Thank you Mr. Chair. I just have one question. On the portion where the pharmacist is supposed to tell the family physician, whoever's providing the primary care for that within 72 hours, it, how, how would that work in real life? Would it be a fax, would it be a phone call? How would that work. [SPEAKER CHANGES] Could you, the section please. [SPEAKER CHANGES] It's in section four, I was just looking at the summary here. Said, finally section four would require an immunizing pharmacist to maintain a record of vaccines administered to patient within 72 hours to notify the patients' primary care provider that the vaccine was administered. So I, how do we see conceptually that actually working, and it, we might need a pharmacist to tell us how that works, I don't know. [SPEAKER CHANGES] It, I would defer to an expert on that. [SPEAKER CHANGES] Representative Murry, you're recognized as the expert on that. [SPEAKER CHANGES] Thank you Mr. Chairman. Expert means I was formerly a pert, I think that's what that means, but, um, we fax it to the doctor's office. And with regards to the addition-, that's generally how we notify that we, we, on the day that we admi-, the immunization is administered is generally faxed by the pharmacy to the doctor's office notif-, notifying what vaccines are received, the patient's name, date of birth, and what arm we injected the, um, um, immunization in. With regards to the question that Doctor Fulghum asked about national standard, it is in the national standard that pharmacists are trained by the American Heart Association,American Red Cross on CPR. That's, that's part of that. The CDC vaccination program that every pharmacist that administers immunization in consistent with the national standard. There, it's also consistent that pharmacists are require to have continuing education on an annual basis, specific to immunizations and the, all this, every board of pharmacy that has an immunization status for pharmacists requires that you notify the board of pharmacy that you are an immunizing pharmacist so they can track who, who, who administers immunizations. So the five or six things that are listed here are consistent with. I'm licensed in three states, and I'm an immunizing pharmacist in all three of those states, and I have to do the same things for all three states that are listed in section one of the bill. [SPEAKER CHANGES] Follow up, Mr. Chairman. [SPEAKER CHANGES] Follow up. [SPEAKER CHANGES] I think that speaks partially to what I'm trying to get at, I'm trying to perhaps get the number of states in this country that recognize this sub-category of pharmaceutical practice. [SPEAKER CHANGES] All 50. [SPEAKER CHANGES] Follow up. [SPEAKER CHANGES] All 50, all 50 states recognize immunizing pharmacists. [SPEAKER CHANGES] Okay. [SPEAKER CHANGES] Thank you. [SPEAKER CHANGES] [Mr. Allen?], the chair saw you rise, did you, did you desire to speak? [SPEAKER CHANGES] Okay. [SPEAKER CHANGES] Representative Hollo is recognized for a motion. [SPEAKER CHANGES] Motion for a favorable report to PCS of House Bill 832, unfavorable to the original, with referral to Commerce. [SPEAKER CHANGES] Representative Hollo moves for a favorable report for the proposed Committee Substitute to House Bill 832, unfavorable to the origninal, if favorable, moving to commerce and job development. All in favor signify by saying aye. [SPEAKER CHANGES] Aye. [SPEAKER CHANGES] All opposed, no. The ayes have it.

Bill will be referred to commerce. Again ladies and gentleman we've got about 20 minutes remaining. It would be the Chair's hope that we have an opportunity to take a vote today on house bill 900 but we'll see where the discussion goes. Representative Avila you are recognized for house bill 900. [SPEAKER CHANGES] Thank you Mr. Chairman and I hope we can reach that too because I bring before you today a bill that has opposition. We vote on a lot of things around here that have opposition and you do the best you can to arrive at a consensus as we did with the previous bill with all parties concerned. But I feel in this case that with the language as its been drafted it's as tight as we can make it with the protections of the law as well as the different organizations within government that hold responsibility over this particular area of healthcare. What the bill does is simply allow continuing care retirement communities to be able to offer home health care services to their residents and their residents only. And the reason this is something that they were interested in is because in these continuing care facilities they have everything from independent living up to skilled nursing care. So they have the available personnel and the expertise in infrastructure to be able to offer this to their clients. The concerns I feel like from the opponents are unwarranted and for several reasons, One is the language because we specified that ti is for people that have a contract for lodging but as an extra safety feature we had reiterated that if at any point in time they try to open that door into non-resident territory that they will then have to come back and get a certification for COEN. They will be licensed to offer these services just like any home health care service provider is, it's just that this would be another option for their residents to be able to take advantage of care on their property in terms of the facility. Also there is the fear of other states and I don't know what other states CON laws look like or how loose they are or what happened, but I do know here in North Carolina that the health service regulation division with the section for certificate of need would be overseeing this, and if any attempt to circumvent the law that we specified residents contracted only, they would really come down on that. [SPEAKER CHANGES] Representative Avila. The Chair's apologies, the Chair failed to recognize that we do have a proposed committee substitute, it is attached to your bill summary if you haven't noticed that members, and representative Fulghum moves that the proposed committee substitute be before us and without objection it is. Representative Avila the Chair's intent and Ive already notified the speakers for and against the bill that they will have up to five minutes per side to speak to divide as they choose. I've got a list of speakers. And speakers just be aware that due to the constraint of the time the chair will be a little bit more tight in enforcing that than would be usual, but representative Avila keep that in mind that we are time constrained and we want to hear from our speakers. [SPEAKER CHANGES] The final two points of why I feel like concern is unwarranted here is the fact that this is isn't precedent setting for CCRC's. Actually in the 2013 and previous state medical facilities plans there's already an exemption for CCRC's with regards to nursing beds. So I feel like they are very well aware of how to comply, and the language in there says will be used exclusively to meet the needs of people with whom the facility has continuing care contracts, and that's with regard to the nursing beds. and I feel like the language that we put into house bill 900 guarantees us that same level of control. And also it is not a mandate that the residents use the service, they will still have choice if they so desire to use another home health care service provider. [SPEAKER CHANGES] Thank you representative Avila. At this time the speakers or the chair is going to recognize the speakers against and for this bill, and I have speaking we'll start with the speaker against the bill, I have one speaker that has signed up. It is Tim Rogers CEO for the Association for Home and Hospice Care.

An elderly and I said that if Mr. Rogers and speakers four F, Quemoy enforcing a 5 minute, the maximum and Thomas Rogers you're recognized before. I can see comments on pages chairman of national and two brothers and in the industry will help them off. (SPEAKER CHANGES) She 21 years in 14 years as one product substitution this is about Medicare and Medicaid certified Home Health Services was dedicated in CS and campus with strings with difference in a letter from the age of North Carolina since your sins Home Health agencies across the state be a public health department of hospital based agency on nonprofit agency or some mom and pop for profit agencies of the data which Serbian residents in CC or C since their inception in the 19/8 on were very concerned about the extension that he would Cornell four certificate of need for Home Health assistance involving manicured or it's as well as a potential were likely make sure that the potential for Medicaid dollars down the road to residents replies to come and our concerns that is you're not read trolling the market's you're not free market correction fueling them excessive Uri one must play by the CIA when rules that Northampton County health department gets CC and see the stately cost little bit or you'll feel that CC or cities without a different set of rules laid out respects , as I respect of medicine, will very much for working with six your season she could bring both are parties together with apples within the last three weeks of the call from a friend from a deadly nation of 34 weeks ago that he would win something bombing of this is a luxury box in the sixties, said this would be rewriting away Home Health agencies operate in the state of the first from 40 arts and artists also was cited on pa seven in nurse practitioners and Physicians are contract in which to store C's Knock's on the planet care than the other self referral practices under inspection by the Federal government so I really wonder if we call taking off from to really study and look at what the ramifications or were willing to work with CC or seizes our agency said dawned on our association of Home Health agencies is supposed to pitch the way it's written banking pages Rogers said that say that edges Chairman Mao would like to clarify that still follow people to 10:00 AM and they have received a message from our extensive on the Yelm Health Care Services a week to discuss the bail swindling it's enough for discussion for tools are banking that receive this time we have some three speakers and a sign that for the deal and speakers on one goalie and recognize all three of the abyss, value, four and a word in Woodstock, recognizing the recognize yourself by in god and what they do you represent if humility, you'll be sharing. (SPEAKER CHANGES) 9TH minutes, speakers are, making six requiter anchor of leading H North Carolina is tax break his head was heather march and, beginning with some Mr. Aiken's by your recognize for. I can see comments accused your money in Islam eight. President and CEO of the nature of Carolina were a statewide association of nonprofit retirement communities or 57 of those across the state of like to visit with you briefly about what exactly is the house bill $900 almost a $100 is indicates each year CDs that they would not have to go to the statistic that need process simply for determination D (SPEAKER CHANGES) and take your counties where he is no other rule that would change seize your seas and then requested by their residences is about to which it's about race and shorts they come to us and said you provide services staff for just about everything else but when it comes to Home Health because there are no slots available in the state medical facilities plan a Home Health agencies we can provide that service to you all this bill does is allow C. Search used to make application to provide Health Services effort ??.....

…by their residents and only for their residents. CCRCs in this state are not interested in competing in the larger market. All we’d like to do is to serve our own residents. This bill does not exempt us from applying for a license, from being regulated by the state. We still have to go through all of that and follow all of the rules. All this says is that for the purpose of applying for the license, we wouldn’t have to be bound by that certificate of need determination. Let me add one other thing that I think is very important in this discussion. Currently the state develops a medical facilities plan on an annual basis. In the last seven years, there have only been seven slots that have opened up statewide with the provision of home health and that’s been in three counties. One in Forsyth, three in Wake and three in Mecklenburg. That means in 97% of the counties in this state, you don’t have an opportunity to apply for that home health license. All this does is carve out an exemption for CCRCs to serve their residents and their residents only. [SPEAKER CHANGES] Good morning. I’m Pat Sprig. I am the president and CEO of Carol Woods, which is the retirement community in Chapel Hill. I have been in the field for 38 years, serving older adults. In fact so long that I’ve become one. The reality is that for 20 years I have spent that at Carol Woods. Carol Woods has had a reputation of quality healthcare for 34 years and of that 34 years, we have always had an exemption of CO and in our skilled nursing Medicare facility. This is not necessarily anything more than something that we’ve already wanted to have for awhile. It is not competing with the larger public. It is not competing in terms of the home health agencies. It’s just being true to our own residents. The reality is that Carol Woods has a full service with physicians and nurses and a geriatric nurse practitioner, full service clinic. We have a home care license. We have assisted living. We have a skilled Medicare non-CON skilled nursing center. The piece we do not allow to deliver to our own residents is home health and so the reason I’ve been there 20 years. I can’t remember when the last CON slot became available in Orange County. So all we’re asking is for your understanding that we simply want to give this option to our residents who are asking for it. Let me put a face on it. My 89 year old mother lives at my community. I can deliver anything to her except home health services in which another staff, that she does not know, has to come in and deliver care to her who does not know her. I am not saying that home health does not do an excellent job. I am saying that we have continuity of care. It is one of the reasons why we have such a stellar reputation of five star nursing home. It is because we care about that family relationship. I know every resident in my community for 20 years by name and their families and to sit down and say to them, I’m sorry we cannot have our staff deliver home healthcare to your apartment, is unconscionable for me. It is really heart sickening. I ask that you understand this is nothing more than giving us the ability to serve our own residents, who live with us in terms of under a contract. Thank you. [SPEAKER CHANGES] Miss March your side has about 40 seconds remaining. [SPEAKER CHANGES] Thank you. Due to the time constraints, I just wanted to say thank you for your consideration. My colleagues have done well this morning representing us and our residents really appreciate you taking a look at that. My name is Heather March, I’m the campus administrator and health services director at Croasdaile Village in Durham and we look forward to being able to serve our residents with all the services possible and allow them resident choice. Thank you. [SPEAKER CHANGES] Members of the committee. I’m going to recognize the bill’s sponsor first who would like to make a motion but I’m going to also respect the members of the committee and recognize that I will follow your wishes. We have about five minutes or a little bit more we can spend with this. If that’s not enough time, we will not vote today but Representative Avila, you’re recognized. [SPEAKER CHANGES] Thank you Mr. Chairman. I’d like to make a motion for favorable report to the P…

[??] for House Bill 900; unfavorable to the original, with a referral to regulatory reform, and side note, that would give us another shot at answering questions that people might have, and I would ask for your support. Thank you. [SPEAKER CHANGES] Thank you, Representative Avila. I'll hold that motion, and Representative Dollar, you are recognized. [SPEAKER CHANGES] Well, quick--quick question, then. Would this preclude, or would individuals be able to receive information--let's say they're in a cottage or something at a continuing care. Would they be able to receive information from the service providers--other service providers of home health services--other than the home grown one within their community? In other words, would they be able to continue to have choice, in a sense, of who they would--if they decided that they wanted to have somebody that they were very comfortable with from the outside coming in? [SPEAKER CHANGES] Yes, I do not see this as a mandate that the only option they would have would be within the service of the CCRC, that they would still have the option of choice, which is what they have now. They are given a list and they make their decisions from that list. [SPEAKER CHANGES] Representative Samuelson, you're recognized. [SPEAKER CHANGES] Thank you. I have a quick question somewhat related to that--that I think the first speaker, Tim, brought up--he may be able to answer; somebody else may be able to answer. You made some comment about doctors not being able to sign the contract, and I'm wondering if that means if they are a resident of the CCRC, and they want to pursue someone other than the care provider at the CRCC [sic], does somebody have to sign something that would then possibly be deemed as, well I won't sign it because I work for this facility and you are an outside provider. And, I'm not sure if that's what he meant, but I--somebody, if they know the answer? [SPEAKER CHANGES] If you would, please recognize yourself again for the record. [SPEAKER CHANGES] Tim Rogers, with the Association for Home and Hospice Care of North Carolina. We have a self-referral statute in federal law. Physicians cannot self-refer to hospital-based agencies, much less CCRC's. Meaning nurse practitioners, PA's, they do a great job of hiring a very good clinical staff, but they would not be able to sign the initial plan of care. That would be from a discharging physician in a hospital, or someone else, and then they would also not be able to sign what's now required by Medicare, and Dr. Fulghum can--can elaborate on this--the face to face documentation that now Medicare has placed on physicians, to do in the first 60 days of a home health plan of care, the receiving physician must see the patient again in his office or her office, and sign a face to face. But the physician that is employed or contracted by the CCRC, to my knowledge, would not be able to do the face to face documentation, or the initial plan of care. [SPEAKER CHANGES] Thank you, I've got five members in the queue. Representative Baskerville. [SPEAKER CHANGES] Quick follow-up, Mr. Speaker. Just to--I mean--Mr. Chair. I'll make it real quick. Since this is the health committee, I think that's an important question we need to get answered. We're out of time, but I would ask them to make sure that the members of the committee who might be on reg reform, of which I am not one, gets that information. Because, I think that is a health issue and this is the health committee and I want to make sure I understand it. [SPEAKER CHANGES] Okay, thank you. Representative Baskerville. [SPEAKER CHANGES] Thank you, Mr. Speaker. We've heard a lot about residents, but I don't see the word resident anywhere in the statute. It seems to me that the language in the statute talking about individuals who have entered into a contract with the continuing care retirement community--I mean--that's not clear to me. That does mean resident. I mean, I don't see--we're talking about residents and we're worried about the impact on the residents, why that explicit term is not in the statute. [SPEAKER CHANGES] The term that covers that here is the phrase with lodging, as it recognizes the contract between the CCRC and the resident, that lodging is a requirement for this applicative delivery of services. [SPEAKER CHANGES] Members, by show of hands, how many of you are prepared to vote on this bill today? How many of you are not? We'll displace this bill; we'll take it up at our next meeting. Ladies and Gentlemen, this meeting's adjourned. [end of data]