By Grace Vitaglione and Rose Hoban
After several months of sleepy committee hearings that moved only a handful of bills at a time, last week was a busy one at the North Carolina General Assembly, which went into overdrive ahead of a legislative deadline.
Dozens of bills moved through their respective committees; 24 bills were heard in health committees alone. Lawmakers are working quickly with an eye toward May 8, the biennial “crossover” deadline, when bills must pass in at least one chamber or they’re dead for the remainder of the two-year legislative session. In the frenzy of lawmaking, the House of Representatives worked on more than 80 bills on May 1.
Health policy topics ranged from a proposal to require insurance companies to cover prosthetic devices to one that would ban homeless people from sleeping or camping in public. NC Health News followed a few in particular below.
No public camping/sleeping
House Bill 781 would prevent local governments from allowing people to camp or sleep on any public properties. Co-sponsor Rep. Brian Biggs (R-Trinity) said governments in his Randolph County district asked him for help in what to do about homeless people in public places.
Rules around public camping vary from one city to another, he said, but this measure would establish a statewide rule.
Local governments would be permitted to designate areas where homeless people are allowed to camp or sleep for one year, according to the bill. Those areas must include access to restrooms and running water, prohibit illegal substance and alcohol use, and provide access to behavioral health services.
Randy Blair of Durham testified before the committee about the bill. Afterwards, he told NC Health News about how he lives in an RV with his family. He said that when he tries to park in a public place or use a public electrical outlet, neighbors often call the police.
But putting everyone who’s homeless in one spot wouldn’t solve the problem, he said.
“We pay taxes, and if it’s a public outlet at a public place, I don’t see why we shouldn’t be able to utilize that,” he argued.
Benjamin Horton, outreach director for Veterans Services of the Carolinas, told the committee that his organization serves almost 1,500 veterans annually. The organization’s street outreach team works in the woods and under bridges where homeless veterans sleep or camp, and he said this bill could make it harder for the team to find them. Horton also worried about the ability to keep veterans safe in designated areas.
“We’re a very stubborn bunch, right? You’re telling us where we can camp, where we can’t camp,” Horton said, “that’s going to make it harder on street outreach folks and mental health folks working with the VA.”
Chris Sharp, a retired Army officer, spoke in support of the legislation. He represented the conservative Cicero Institute, a Texas-based think tank that has pushed for similar bills in multiple states. Sharp said he had been homeless at age 16, and the designated camping areas would help vulnerable individuals.
But he was rebutted by Latonya Agard from the NC Coalition to End Homelessness, who argued that a better way to address homelessness was for municipalities to embrace the “housing first” model, an approach that has documented success over decades of research. That model prioritizes getting people into housing without requiring them to get sober and often includes supportive services.
Changing how physician assistants practice
Physician assistants could achieve more autonomy with Senate Bill 345, which would eliminate a physician supervision requirement for those who meet certain criteria. Those physician assistants would have to practice in a team-based setting, which can include hospitals and nursing facilities, as well as medical practices where physicians are involved in providing services.
The PA would also have to have 4,000 hours of clinical practice experience and more than 1,000 hours in a specialty.
Sen. Mark Hollo (R-Conover), who introduced the bill, is a former physician assistant. He said physician assistants would still be required to refer to other team members, such as physician specialists, when appropriate. Many physician assistants are already practicing in team-based settings, so this bill would align law with reality, he argued.
Several hundred physician assistants and students descended on the legislature March 19 to push for passage of the bill. Beth Ehlers said it would lessen the burden on physician assistants like her in team-based settings.
“We won’t need to continue with the unnecessary paperwork to get our patients cared for,” Ehlers said.
During the Senate health care meeting, Sen. Amy Galey (R-Burlington) introduced an amendment that would allow nurse practitioners and certified nurse midwives to be solely under purview of the Board of Nursing. Currently, they operate under the authority of the medical board, while the advanced practice nurses say they should be governed by other nurses.
The bill passed the committee and will be heard in the rules committee before going to the Senate floor for a vote. It is expected to pass.
Insurance coverage for prosthetics
House Bill 906, or “Reagan’s Law,” is named for the daughter of former state Sen. Jim Perry, who has been an amputee for a year and a half.
Speaking at several committees on April 29, Reagan said insurance companies will only cover one prosthetic device for amputees to be able to walk, but no more. This bill would require insurance companies to cover prosthetics that allow amputees to participate in sports.
“These sport-specific prosthetics cost upwards of $50,000 on average, making them inaccessible to most families,” she told the House Insurance Committee.
Reagan described being an athlete before being diagnosed with a disease that resulted in her amputation, and she said being able to play sports improves mental and physical health. For the amputee community, this bill would allow “access to sports, movement, and community that comes with both.”
The bill also requires insurers to cover replacing prosthetic devices.
Rep. Donny Lambeth (R-Winston-Salem) said at the House Health meeting that prosthetic device makers haven’t received a rate increase in years, so they’re struggling to make ends meet. He said the legislature should take action in the future to address the makers’ needs as well.
The bill is on the calendar for a vote in the full House of Representatives on May 6.
Coach safety training
Coaches of youth athletes would have to undergo yearly sports injury training if House Bill 602 were to become law. This would not apply to schools, but to associations for athletic activities on public property.
Athletics personnel and coaching staff, including volunteers, would have to complete a youth sports injury education course each year. The courses would have to fulfill certain requirements, including topics on concussions, heat and weather-related injuries and emergency preparedness.
Rep. Tim Reeder (R-Ayden), who co-sponsored the bill, told the House Health committee April 29 that there are existing programs that offer these courses at minimal cost. One of those told him their module would cost $20.
Other lawmakers, though, had concerns over requiring volunteer coaches to pay anything. Rep. Phil Shepard (R-Jacksonville) said it’s already difficult to find volunteer coaches, so this could make it harder.
Rep. Donny Lambeth (R-Winston Salem) shared his concerns and said he would have preferred the requirement be a pilot program in a particular area.
The bill passed the health committee despite a “no” vote from Lambeth and will be heard in the State and Local Government Committee.
Baby boxes
House Bill 139 would allow emergency departments and fire stations to install devices called “baby boxes,” where parents can surrender an infant anonymously. The boxes are temperature-controlled and alarm-monitored, said co-sponsor Rep. Jennifer Balkcom (R-Hendersonville). Parents can choose to leave their identifying information with the child.
Two boxes are already being used in the state — one in Gates County and the other by the sheriff’s department in Ashe County, Balkcom said. The baby boxes would expand the current Safe Surrender Law instead of replacing it, she argued.
Rep. Donna White (R-Clayton) told the House health committee that she felt the existing safe surrender law was working well. That law requires parents to surrender their infants to an individual. White had some concerns about the safety of the boxes. “Bells and whistles don’t always work, and computers don’t always work,” she said.
The bill would require local social services workers to inspect the boxes, which is an added burden on staff who are overworked and underpaid, said Rep. Sarah Crawford (D-Raleigh).
Balkcom argued that when a parent places the baby in the box, the average wait time for someone to find the infant is two minutes. There have been no reported problems with the existing boxes, she said.
During the bill’s hearing in the House chamber May 1, Rep. Julia Greenfield (D-Charlotte) said she worked as a nurse and received babies in the emergency department. The current law is the most humane way to handle the situation, she argued.
The bill passed the House 75-33 and will go to the Senate.
Other bills
Last week was a busy one in health committees from the Senate and House of Representatives. These are other bills that made it through committees.
H135: Misbranding/Cell-Cultured Meat/Env. Assess – would create labeling standards for meat products created by cell culture processes.
H156: Increase Access for Small Employers/Insurance – would make stop loss, catastrophic and reinsurance available for firms with as few as five employees, down from the prior limit of 12 employees.
H433: Registered Nurses in Schools – changes minimum educational and experience requirements for school nurses and sets salary minimum scale for those nurses.
H489: Insurance Coverage Emergency Ambulance Trans – would require insurers to cover emergency ambulance transportation.
S503: A More Efficient Office of Vital Records – would require the Office of Vital Records and local registers of deeds to process change requests to birth and death certificates within 30 days. It would also prevent vital records employees from working remotely if that would adversely impact the timeline.
H536: Physical Therapy Practice Act Mods – would allow the North Carolina Board of Physical Therapy Examiners to restrict licenses of physical therapists who breach the standards of practice, extend the window for license renewal to Nov. 1 through Jan. 1 and levy a fee of $150 for approving a continuing education course.
H547: Children’s Services Protection Act – would limit liability for nongovernmental contractors working with public agencies.
H562: Com. Coll. Behav. Health Workforce Enhan. Act – would allow community college graduates with associate degrees in human services fields and specified experience to qualify as an associate professional, a qualified professional, or a qualified substance abuse prevention professional.
H567: Ensure Access to Biomarker Testing – would require insurers to cover biomarker testing to help early diagnosis of dementia.
H572: Veterans/eTMS Pilot Program – would direct the Department of Military and Veterans Affairs to find a provider to establish a statewide pilot program to make electroencephalogram combined transcranial magnetic stimulation treatment available to veterans, first responders and their immediate families.
H590: Patient Safety/Med. Imaging/Radiation Therapy – would require licensure for health care providers who provide radiologic imaging or radiation therapy and create the Medical Imaging and Radiation Therapy Board of Examiners.
H663: Living Donor Protection Act – would prohibit insurers from discriminating against living organ donors, establish an income tax credit for live organ and bone marrow donors and provide leave to state employees and state-supported personnel who are living organ and bone marrow donors.
H681: Update Opioid Abatement Treatment Prog. Rules – would update rules about opioid abatement treatment programs to align with federal guidelines. Observed urine drug testing would still be required, and the programs would be allowed to administer methadone to patients who are not enrolled with the OTPs as their patients.
H696: Health Care Practitioner Transparency Act – would require all advertisements for health care practitioners to identify the type of license, certification or registration they hold and allow licensing boards to discipline providers who hire unlicensed individuals to provide health care.
H697: NC Genetic Counselors Workforce Act – would define the scope of practice of genetic counseling, require a license for genetic counselors and set up an occupational licensing board to enforce those requirements.
H727: Marriage/Family Therapy Mods – would require marriage and family therapists who are licensed by reciprocity to pass an examination and reduce the required number of years of practice experience to two.
H746: Limited Immunity/Nurses – would provide limited immunity from medical malpractice actions for registered nurses acting under the supervision of a health care provider.
H772: North Carolina Student Lifeline Act – would require public schools, nonpublic schools and community colleges of the University of North Carolina to share the Suicide and Crisis Lifeline number and the NC Peer Warmline.
H928: Allow PTs in School Concussion Protocol – would allow physical therapists to evaluate middle and high school student athletes exhibiting signs of a concussion.
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