2022 Public Health Legislative Update
During its 2022 “short session,” the General Assembly has revisited the Current Operations Appropriations Act of 2021 (also known as the 2021 budget) and enacted, to date, 75 session laws. This blog post summarizes legislative action taken thus far during the 2022 short session that impacts public health in North Carolina.
The 2022 Short Session
On May 18, 2022, the North Carolina General Assembly convened its short session, which was adjourned just a few weeks later on July 1, 2022. Instead of adjourning sine die (literally, “without a day” in Latin), the General Assembly determined it would reconvene monthly for the duration of 2022. The dates for these additional sessions are set out in Resolution 2022-6, which also limits the types of matters that may be taken up during the monthly sessions. The General Assembly is next scheduled to convene on Tuesday, November 15, 2022, and on Tuesday, December 13, 2022. If legislation pertaining to public health is enacted during these sessions, this blog post will be updated.
More Protective Lead Dust Standards
S.L. 2022-75, Sec. 6.(a)-(c)
Section 6.(a) of Session Law (“S.L.”) 2022-75 amends G.S. 130A-131.7(7), which sets out the criteria for different types of lead poisoning hazards, by lowering the standard for lead dust. Once this provision takes effect on December 1, 2022, North Carolina’s lead dust standard will change from 40 to 10 micrograms of lead dust per square foot on floors and from 250 to 100 micrograms per square foot of lead dust on interior windowsills. The lead dust standard for vinyl miniblinds, bathtubs, kitchen sinks, and lavatories remains unchanged and continues to be 250 micrograms per square foot. Section 6.(b) also amended G.S. 130A-131.9C(i), which establishes the standards for remediation of lead poisoning hazards, to reflect the changes in North Carolina’s lead dust standards.
Lead is a naturally occurring heavy metal and exposure to lead can have significant health consequences, particularly for children under age six. Lead dust is often generated from flaking or chipping lead-based paint, but exposures can also occur from lead-contaminated soil or lead dust that collects on the clothing of workers in certain industries. Although federal law prohibits lead in newer paint, lead-based paint can still be found in some homes built before 1978. Construction or renovation activities, including activities to abate a known lead hazard, can also produce lead dust.
The lower lead dust standard enacted by S.L. 2022-75 aligns with the standards established by the United States Environmental Protection Agency. The new standard also provides for greater protection of the public’s health by reducing the amount of lead dust that can be present in a residential building or a child-occupied facility before the hazard must be abated or remediated in accordance with G.S. 130A-131.9C.
Temporary Pause on Conditioning Receipt of State Funds on Providers’ Connection to NC HealthConnex
S.L. 2022-74, Sec. 9B.3.(b)
NC HealthConnex is North Carolina’s health information exchange, which is operated by the Health Information Exchange Authority (HIEA) within the North Carolina Department of Information Technology. Pursuant to G.S. 90-414.4, many health care providers, including those that receive State funds (e.g., payment for Medicaid claims), are required to “connect” to NC HealthConnex. A provider “connects” to NC HealthConnex when they are able to submit clinical and demographic data about their patients through the exchange. G.S. 90-414.4 sets different deadlines for these providers, allowing groups of providers to connect in stages, and establishes a hardship exemption process for those who cannot meet their individual deadline. The final connection deadline is January 1, 2023, with no pathway to exempt providers unable to connect by that date.
Prior to the enactment of S.L. 2022-74, and under G.S. 90-414.4, a provider’s failure to timely connect to NC HealthConnex could have resulted in the withholding of certain State funds. Section 9B.3.(b) of S.L. 2022-74 temporarily pauses this method of enforcement until the General Assembly establishes a lead agency for enforcement of the Statewide Health Information Exchange Act. While the January 1, 2023 connection deadline has not changed, providers that fail to timely connect will not be barred from receiving State funds, at least for now.
Elimination of NC Health Choice, Merger into Medicaid Program
S.L. 2022-74, Sec. 9D.15
Pursuant to Section 9D.15 of S.L. 2022-74, DHHS must eliminate NC Health Choice (NCHC) and merge it into North Carolina’s Medicaid program by July 1, 2023. NCHC is North Carolina’s Children’s Health Insurance Program (sometimes also referred to as “CHIP”). The Centers for Medicare and Medicaid Services (CMS) within the United States Department of Health and Human Services is the federal agency that helps fund NCHC and Medicaid. CMS must approve the proposed changes to both programs before they can be implemented.
Medicaid and NCHC both provide health care coverage to lower-income populations, but key differences, including program eligibility requirements, currently exist between the two programs. While Medicaid serves both children and adults, NCHC only serves children ages 6 to 18 whose families are low-income but earn too much money to qualify for Medicaid. In State Fiscal Year (SFY) 2021, NCHC served 137,000 children in North Carolina, whereas Medicaid served 2.2 million people across the state. Medicaid is also an “entitlement” program, meaning that anyone who meets the program’s eligibility criteria can enroll and receive services. Therefore, Medicaid’s funding varies as the need for services rises and falls. By contrast, NCHC is a block grant program, which means NCHC gets a set amount of federal funding. When program funding is not immediately available, eligible children can be put on waitlists. In addition to eliminating NCHC, Section 9D.15 of S.L. 2022-74 changes the income eligibility criteria for Medicaid in North Carolina, which ensures that children who are currently enrolled in NCHC will be eligible for Medicaid following the merger.
Electronic Filing for Death Certificates
S.L. 2022-74, Sec. 9G.4
The Division of Public Health (DPH), Office of Vital Records within DHHS recently rolled out the North Carolina Database Application for Vital Events (NCDAVE, pronounced “NC Dave”) system, allowing North Carolina to move away from its paper-based vital records system. Under Section 9G.4.(a) of S.L. 2022-74, local health departments and local registers of deeds must continue to accept paper death certificates until August 31, 2022. But starting September 1, 2022, all death certificates must be certified and filed electronically using NCDAVE. Under G.S. 130A-115(b), death certificates are filed by the funeral director (or the person acting as the funeral director) who first assumes custody of the dead body. This person is also responsible for obtaining the medical certification of the cause of death from one of the individuals identified in G.S. 130A-115(c), who are now also required to use NCDAVE to complete their certifications. After September 1, 2022, any individual who willfully and knowingly violates the requirement to certify and file death certificates through NCDAVE may be subject to administrative penalties of $250 for an initial violation, $500 for a second violation, and $1,000 for a third and each additional violation.
Access to Client Data in the North Carolina Immunization Registry
S.L. 2022-74, Sec. 9G.6
Section 9G.6 of S.L. 2022-74 creates a new statute, G.S. 130A-158.5, that requires DHHS to give pre-paid health plans (PHPs) and primary care case management entities (PCCMs) access to client-specific information held in the North Carolina Immunization Registry (NCIR). NCIR is a web-based tool that serves as the official repository for North Carolina immunization data. G.S. 130A-158.5 requires that PHPs and PCCMs keep the immunization information that they access in NCIR confidential, which is consistent with existing protections for individual immunization information set out at G.S. 130A-12, G.S. 130A-153(c), and 10A NCAC 41A .0406.
Authority for State Health Director to Issue Statewide COVID-19 Standing Orders
S.L. 2022-74, Sec. 9G.7
Section 9G.7.(a) of S.L. 2022-74 authorizes the State Health Director (SHD) to issue statewide standing orders for COVID-19 vaccines, diagnostic tests, and treatments when such an order is necessary to protect the public’s health, safety, and welfare. A standing order is a written protocol that enables certain health care providers (e.g., nurses) to complete a specific clinical task without obtaining a physician’s order for each separate action. Standing orders are a commonly used tool in health care and can be particularly useful during public health emergencies, such as the COVID-19 pandemic. Under this legislation, any statewide standing order regarding COVID-19 vaccines, diagnostic tests, or treatments issued by the SHD before July 1, 2022 will remain in effect until such order is rescinded, but the SHD’s authority to issue new COVID-19 statewide standing orders will expire on December 31, 2023.
New Framework for Quarantine and Isolation Orders
S.L. 2022-74, Sec. 9G.8
Isolation is a public health control measure that may be used to prevent further spread of illness when a person or an animal is infected, or is reasonably suspected to be infected, with a communicable disease or condition. Quarantine is a public health control measure that may be used when a person or animal has been exposed, or is reasonably suspected of being exposed, to a communicable disease or condition. Quarantine can also be used to limit access to a physical area that may be contaminated with an infectious agent. Under G.S. 130A-145(a), the SHD and local health directors are empowered to issue orders for quarantine and isolation, but only when the public’s health is threatened, “all other reasonable means for correcting the problem have been exhausted, and no less restrictive alternative exists.” Quarantine and isolation authority also exists at the federal level, where it may be exercised by the United States Centers for Disease Control and Prevention (CDC). Isolation and quarantine are just two of many control measures that can be used to reduce the spread of a communicable disease or condition.
Understanding the effect of Section 9G.8 of S.L. 2022-74 requires a review of prior legislative action by the General Assembly. In 2021, the legislature created a new paragraph at G.S. 130A-145(f) when it enacted Section 19E.6(e) of S.L. 2021-180. In doing so, it set out a process for a novel use of quarantine and isolation orders by giving the SHD authority to issue an isolation or quarantine order, effective for no more than seven days, for a “class or category of persons,” to protect the public’s health. When this authority is exercised, the SHD may seek to extend the seven-day duration of the order by filing a motion in Superior Court. The exception, though, is when the order applies “statewide,” meaning that it applies to 2/3 or more of North Carolina’s 100 counties. In these instances, the SHD must also notify the Governor and the Governor must receive a concurrence of the Council of State before the extension can be sought from the court. Additionally, if the SHD’s order “would extend the application of the class or categories in areas, when combined, to statewide application,” then the SHD must notify the Governor and the Governor must receive concurrence of the Council of State before an extension can be pursued.
In 2022, the General Assembly revisited the framework set forth in S.L. 2021-180 and made two key changes by way of Section 9.G.8(a) of S.L. 2022-74. First, the law was amended to include local health directors, giving them authority to issue orders to categories and classes of people that mirrors the authority of the SHD. Second, for orders that apply less than statewide, the maximum length of the order was increased from seven to 30 days. The new statutory language at G.S. 130A-145(f) will take effect on January 1, 2023.
Reaccreditation and Recertification of Asbestos Management and Lead Abatement Professionals
S.L. 2022-74, Sec. 9G.9.(a)
Section 9G.9.(a) of S.L. 2022-74 offers North Carolina’s asbestos management and lead abatement professionals a limited amount of additional time to complete the trainings necessary for reaccreditation or recertification in their fields. At this time, the “refresher” trainings required for reaccreditation or recertification in North Carolina are only offered in person and far fewer training courses were offered during the pandemic than in typical years. The law gives these professionals 180 days from the end of the COVID-19 State of Emergency, which terminated on August 15, 2022, to obtain the training necessary to become reaccredited or recertified.
Appropriations
S.L. 2022-74 includes numerous modifications to S.L. 2021-180, also known as the “Current Operations Appropriations Act of 2021” or “the budget bill.” Several of these provisions direct how North Carolina’s public health agencies should allocate and spend funds. For example, the General Assembly in S.L. 2021-180 established the Opioid Abatement Fund within DHHS using the proceeds of legal settlements reached between the State and companies that manufacture, market, distribute, dispense, or sell opioids. Section 9F.1.(c) of S.L. 2022-74 directs the State Controller to transfer an additional $14,781,203 into the Opioid Abatement Fund for SFY 2022-2023, to be used by various entities for work on the opioid crisis.
Section 9G.1.(a) of S.L. 2022-74 specifies that $1,750,000 of funds appropriated to the DPH, Office of the Chief Medical Examiner (OCME) within DHHS must be used to fund seven new full-time forensic pathologist positions. Another $3,000,000 in funds appropriated to OCME must be used to increase the contract rate that DHHS pays for the transport of bodies for death investigations or autopsies.
Section 9G.10.(b) of S.L. 2022-74 clarifies that the funds appropriated to DHHS under S.L. 2021-180 from the Youth Electronic Nicotine Dependence Abatement Fund will remain available to spend as specified by the General Assembly until the appropriated money runs out. Finally, Section 9G.10 of S.L. 2022-74 requires that $2,585,000 of funds appropriated to DPH be allocated to a group of 10 “nonprofit pregnancy centers” across the state, with funding for each individual center ranging from $100,000 to $500,000.
Other Legislation of Interest
In addition to the action summarized above, there were a handful legislative provisions that did not directly impact or require action by North Carolina’s public health agencies but that may be of interest to public health professionals. For example: Sections 2.4 and 4 of S.L. 2022-71 included action on the sale of snacks and sodas in vending machines in public schools and on the development of a system that could be used to identify and address safety threats in public schools, respectively; Section 1 of S.L. 2022-52 established an interstate professional counseling licensure compact, which could impact access to professional counseling services for North Carolinians; Section 7.10.(a) of S.L. 2022-74 codified the Feminine Hygiene Products Grant Program for North Carolina’s public schools; Section 8.3 of S.L. 2022-74 mandated the study of ways to increase the number of graduates from North Carolina nursing programs; and Section 9K.2 of S.L. 2022-74 revised requirements for the treatment of women and pregnant people in local confinement facilities.
Want to Know More?
A comprehensive list of all the session laws enacted in 2022 can be found here on the General Assembly’s website. If you would like to know more about the status and content of legislation in North Carolina, consider visiting the website for the UNC School of Government’s Legislative Reporting Service where you can read additional legislative updates and sign up to receive the Daily Bulletin via email.
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