McGuireWoods Consulting - North Carolina General Assembly Week in Review

May 27, 2022

North Carolina General Assembly Week in Review

The North Carolina General Assembly made up for several weeks without official business in Raleigh by introducing multiple wide-ranging pieces of legislation in back-to-back committee meetings throughout the week. Following a half dozen meetings by the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion, the Senate introduced an omnibus healthcare package to address many of the topics covered by the joint committee. The Senate also rolled out several other impactful bills on topics ranging from agriculture to education.

Omnibus Healthcare Bill

Through a newly unveiled senate bill, North Carolina could be the 40^th state to expand Medicaid, the 25^th state to approve full practice authority for advanced practice nurse practitioners (APRNs), and the ninth state to enact comprehensive telehealth policies. House Bill 149: Expanding Access to Healthcare would also relax many of the state’s Certificate of Need (CON) laws and expand access to telehealth services. Senate President Pro Tempore Phil Berger (R-Rockingham) joined five other Republican Senators to introduce the legislation during a Tuesday press conference before advancing the bill through several committees this week.

Under the Affordable Care Act, states can adopt the expansion of Medicaid to provide healthcare coverage to individuals making incomes up to 138% of the federal poverty level. This includes around 600,000 North Carolinians who fall into the coverage gap, meaning they work and make too much money to qualify for Medicaid currently, but cannot afford to have private insurance. The Senate's version of HB 149 includes a work requirement, which could lead to future controversy since similar work requirements have been repeatedly struck down in other states by federal judges. The Affordable Care Act requires the federal government to cover 90% of the cost for a state’s share of additional Medicaid enrollees, with the state covering the remaining 10%. The Senate’s bill would pay for most of the state's 10% share by implementing an additional hospital assessment.

Another reform in the bill would make it possible for APRNs like nurse practitioners, certified nurse midwives, clinical nurse specialists, and certified registered nurse anesthetists to practice without being under direct supervision of a physician. Sen. Joyce Krawiec (R-Forsyth), a sponsor of the bill, noted in committee that 34 other states have already adopted similar rules around the practice of nursing. Opponents of the provision raised concerns over the education received by APRNs compared to that of physicians and anesthesiologists.

The bill also revises the state’s complex rules that limit the ability of hospitals and health care service providers to construct new facilities. Currently in North Carolina, CON laws require providers to prove that expansions are needed. The legislation would end many of the requirements for specific types of facilities that require a CON review by the Department of Health and Human Services (DHHS). Additionally, the bill would expand the usage of telehealth by developing statewide standards and implementation guidelines.

The legislation passed the Senate Health Care and Finance committees by voice vote and will make its way to the Senate Rules committee next week. However, the bill still has a long way to go. House Speaker Tim Moore (R-Cleveland) told reporters Wednesday afternoon that he did not think members of his own caucus had the appetite for Medicaid expansion during this summer's short session.

2022 Farm Act

The General Assembly’s annual omnibus agricultural legislation, often called the “farm act”, was introduced and advanced through three Senate committees this week. Senate Bill 762: North Carolina Farm Act of 2022 passed the Senate Rules Committee earlier this week which will likely be its last stop before heading to the Senate floor. The bill is wide-ranging, and its appearance in committee brought dozens of people from across the state to speak during public comment about various components of the bill.

The bill has eight main sections affecting the agricultural industry. Most notably, the bill permanently legalizes the hemp industry by distinguishing hemp from marijuana. It also excludes hemp from the state’s list of controlled substances, to conform with federal law. Legislators are introducing this provision early in the short session because a 2015 law that temporarily legalized hemp cultivation is set to expire June 30 of this year. If the legalization were to expire, hundreds of hemp farmers in the state who transport their products would be violating state law.

Additionally, the bill relaxes building codes for certain farms that store of cotton, peanuts, and sweet potatoes, and their byproducts. This section would clarify that any of the buildings storing these commodities are exempt from county zoning policies. The discussion of this section was met with some pushback in committee this week, as Senators questioned whether the policy would apply to structures hosting weddings and events with attendees from the public. Sponsors of the bill contended that wedding venues were not included in the policy and similar bills have passed allowing the exemption for other farming products, including chemicals and seeds.

Most of the debate on the bill surrounded a provision that would have required farming equipment manufactures to sell manuals and software diagnostic tools directly to independent repair shops and customers at the same price they sell to dealers. Nearly twenty public speakers, most of whom owned or represented manufacturers and licensed dealerships, spoke against the measure, saying it would allow unsafe or illegal modifications to equipment. The provision was stricken by the bill’s sponsor, Sen. Brent Jackson (R-Sampson), and converted to a study on the potential ramifications of enacting the policy.

Education Bill

During a Tuesday evening press conference, Republican Senate leaders, led by Senator Deanna Ballard (R-Watauga) announced House Bill 755: Parents' Bill of Rights. The bill is designed to enumerate and clarify the rights of parents to direct the education of their children. The bill would allow parents to access health, curriculum, and financial records related to their children at public schools. Additionally, the bill would place some limits on what can be taught to kindergarten through third grade students about gender identity and sexual orientation. Senator Ballard spoke to the reasoning behind the bill, highlighting how the COVID-19 pandemic initially sparked interest in proposing the bill, noting that at-home education led to a sense from constituents that school was becoming overly politicized. Further, Senator Ballard opined that young school children effected by the bill did not need to hear about such topics such as gender identity from teachers, and that these topics should be introduced at a later age by parents. These policies will be disseminated to parents through individual school systems according to the bill.

The bill drew criticism from Democratic Senators Gladys Robinson (D-Guilford) and Joyce Waddell (D-Mecklenburg). Senator Robinson proposed amending the bill to explicitly allow for parents to monitor hallways and doorways at school on a volunteer basis, which came as a response to the recent tragedy at Robb Elementary in Texas. Senator Ballard responded that the bill could incorporate such an amendment. Senator Waddell voiced concerns on the very specific requirements of the bill in regard to curriculum and questioned whether teachers would still be able to provide innovative and creative ways to teach school curriculum. Senator Ballard rebutted that the bill will only make curriculum changes based on parent request and would simply ensure that age-appropriate topics would only be taught in schools. Several public speakers voiced concerns to the committee as well, ranging from pro-parental right advocates to those who felt that children in abusive relationships may be negatively affected by this bill.