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Public Policy Update - May 09, 2023

Public policy update


Limit, Save, Grow Act (HR 2811): This bill, which includes new work rules for Medicaid enrollees, was passed by the US House on April 26. This was offered in exchange for lifting the debt ceiling. The bill would require all Medicaid beneficiaries ages 19–55 to meet an 80-hour per month work-reporting requirement. Failure to meet the requirement would stop federal funds for that person and allow states to terminate coverage. This bill applies to all Medicaid recipients, including those on Supplemental Security Income (SSI) and Home and Community-Based Services (HCBS) waivers. In order to be exempt from the work rules, people with disabilities would need a doctor or other medical professional to deem them “physically or mentally unfit for employment.”  

While the plan is not expected to move forward in the Senate, it is disheartening and concerning that services for people with disabilities would be compromised in this way.  Representatives and Senators need to hear how this type of bill would hurt people with disabilities.

This bill passed the House and is now in the Senate.

Direct Care Workforce Bills Introduced

HR 2941/S 1332 – Recognizing the Role of Direct Support Professionals (DSP) Act:  Introduced by Senators Maggie Hassan (D-NH) and Susan Collins (R-ME), along with Representatives Brian Fitzpatrick (R-PA) and Joseph Morelle (D-NY), this bill would create a standard occupational classification (SOC) code for Direct Support Professionals (DSPs). Currently,  DSPs do not have their own SOC code. Having a specific code could help provide the data needed to set adequate rates.

Introduced to the House and Senate but not passed. 

S 1298 – Supporting our Direct Care Workforce and Family Caregivers Act: This bill, introduced by Senator Tim Kaine (D-VA), would support the recruitment, training, and retention of direct care workers and family caregivers, as well as provide grants and technical assistance to states through the Administration on Community Living 

Introduced to the House and Senate but not passed.

Plain Language: Representatives and senators in Congress are writing bills that affect people with disabilities. One that was passed in the House would make it harder for people to keep their services because it would require them to work. Advocates are fighting against this. There are other bills that would help the workers who support people with disabilities. Advocates are hoping these become laws. 


Centers for Medicare & Medicaid Services Proposed Rules 

This effort includes key changes to the rules governing HCBS through what’s being called the Ensuring Access to Medicaid Services regulation, or the “Access Rule.”

Under the proposal, states would be required to reassess the needs of each individual receiving HCBS on an annual basis and revise service plans accordingly. In addition, the rule would require that at least 80% of what Medicaid pays for personal care, homemaker services, and home health aide services directly compensate the person providing the service rather than going towards administrative funds or profit. And, states would need to publish the average hourly rate paid to direct care workers.

The regulation also includes several new mandates for states. This includes reporting the length of their waiting lists, whether services are accessible once the recipient is granted a waiver, and various quality measures in their HCBS programs. Center for Medicare & Medicaid Services (CMS) would expect states to maintain an electronic incident management system and respond to incidents within certain time frames. States would also be required to create a grievance process for HCBS recipients in traditional Medicaid plans so they could file complaints against a provider or the state, much like the current process of managed care plans.

In addition to the Access Rule, CMS is also proposing the Managed Care Access, Finance and Quality rule. That regulation would require states to regularly survey managed care enrollees about their experiences, institute maximum appointment wait time standards, and require states to conduct annual secret shopper surveys to ensure that managed care plans are complying with appointment wait time standards and that their provider directories are accurate.

Both of the proposed rules are up for public comment until July 3.

Plain Language: The agency that oversees Medicaid is proposing rules to improve Home and Community Based Services for people with disabilities. The rules would require states to make sure people get the services they need and to ask people about their experiences with those services. 



The General Assembly is working on the state budget for 2023-2025 biennium.  The House passed a budget which includes: 

  •       250 Innovations Waiver slots 
  •       Funding for DSP wage increases in Innovations Waiver and Intermediate Care Facilities (ICF)
  •       Funding for the Medicaid “rebase” and ongoing Medicaid Transformation (tailored care management and 1915i services)
  •       Increases for teacher/school staff salaries
  •       Funding for new I/DD programs at state universities

NCCDD and other I/DD stakeholders were hoping to see more Innovations slots to address the 16,000-person waitlist. 

The Senate is currently working on their version of the budget. The Senate budget is expected by the end of May. Following the Senate budget approval, a Conference Committee will be appointed to work out the differences.

Plain Language: The NC Legislature is working on the state budget. The House passed a budget bill that included some of the things that advocates have asked for, like better DSP wages, but only 250 Innovations slots were approved when most people were hoping for 1,000 slots. The Senate is working on their budget. 



HB 11: Schools for Deaf and Blind: This bill changes oversight of schools and creates a local board of trustees. This would change the admissions process and could result in possible exclusion of students with behavioral health needs. 

Passed House and Senate; became law without Governor’s signature.

H77 – Driver’s License Designation/Autism: This bill directs the Department of Motor Vehicles to develop a designation for driver’s licenses that can be given to a person with autism upon request. It is entirely voluntary and can only be requested by the person who holds the driver’s license. It also requires additional training for law enforcement. The database would only be accessible to law enforcement, but many concerns have been raised by opponents that have been addressed.

Passed House; in Senate Rules Committee.

H76 – Access to Healthcare Options: This is the Medicaid expansion bill. This bill extends Medicaid benefits to people who have been in a healthcare coverage gap and extends coverage to people under 133% of the federal poverty level who have not previously been eligible. 

Signed into law on 3/27/23.

H188 – Standards of Student Conduct: This bill removes existing language that prevents schools from labeling behaviors such as dress code violations, non-compliance with staff directives, disrespectful language, and altercations that do not involve injury as serious violations. This would disproportionately affect students of color and those with disabilities.

Passed House; in Senate Rules Committee.

H323 – Retain Adult Developmental Vocational Programs: This bill prohibits DHHS from reducing or eliminating services provided at Adult Developmental and Vocational Programs (ADVP) or Community Rehabilitation Programs (CRP) without fully following procedures regarding stakeholder notification and input, as well as appropriately funding a robust array of services that reflect choice. 

Passed House; in Senate Rules committee.

H478 – Support Students with Disabilities Act: The act creates funding mechanisms for specialty day schools for students with I/DD and severe behavioral challenges. It also allows for IEP teams to have specialty schools as an option on the continuum. 

Bill did not move in the House, but funding is in the House budget; there is hope to get it in the Senate budget.

S171 – Dept of Public Safety Agency Bill: This bill updates North Carolina’s "Silver Alert" system. It clarifies that the statewide alert system includes all law enforcement agencies and individuals of any age that have conditions which would make them more vulnerable to abuse, physical harm, neglect, or exploitation. This clarifies that people with I/DD can be included in ‘Silver Alerts.’ 

Passed Senate; in House Rules Committee.

Plain Language: The legislators are working on bills that affect people with disabilities. Advocates are supporting bills that would create more safety in the community for people and bills that would support students with disabilities in schools. 



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North Carolina Council on Developmental Disabilities

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This project was supported, in part by grant number 2001NCSCDD-02, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.

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