Wlacon Counly  COUN  CAR 2  MACON COUNTY BOARD OF COMMISSIONERS  MAY 11, 2021 AGENDA  1. Call to order and welcome by Chairman Tate  2. Announcements 3. Moment of Silence 4. Pledge of Allegiance 5. Public Hearing(s) - None 6. Public Comment Period 7. Additions to agenda  8. Adjustments to and approval of the agenda  9. eport/Presentations 10.Old Business 11.New Business  (A) Duke Energy request to place transmission pole on county- owned parcel and discussion regarding power grid update = Lisa Leatherman, Duke Energy Nantahala District Manager (B) Macon County Board of Education resolution regarding Franklin High School - Macon County Schools Superintendent (C) Reappointment of Abby Braswell as Macon County Tax (D) Change order for New Atlantic Contracting, Inc. on Macon Middle School renovation project - Jack Morgan, Director of (E) Resolution regarding Memorandum of Understanding relating tot the settlement of the opioid litigation - County Attorney Eric  Dr. Chris Baldwin Administrator  Planning, Permitting and Development  Ridenour  MACON COUNTY COURTHOUSE, ANNEX PHONE 828-349-2000  5WEST MAIN: STREET  FRANKLIN,  NORTHO FAX: CAROLINA28734 828-349-2400    12.Consent Agenda - Attachment #12  All items below are considered routine and will be enacted by one motion. No separate discussion will be held except on request of a member of the Board of  Commissioners.  (A) Minutes of the March 9, 2021 regular meeting (B) Budget Amendments #255-264 (C)Tax releases for April in the amount of$1,509.71 (D)Amendment to Capital Project Ordinance for Macon Middle E)Amendment to Capital Project Ordinance for Macon Middle (F) COVID fee updates for Macon County Public Health (G)Monthly ad valorem tax collection report = no action necessary  School renovation School locker room project  13.Appointments  (A)Jury Commission = one seat  14.Closed session as allowed under North Carolina General Statute (if 15.Recess until Tuesday, May 25, 2021 at 6 p.m. in the commission boardroom on the third floor of the Macon County Courthouse, 5  necessary)  West Main Street, Franklin, NC 28734    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  CATEGORY - NEW BUSINESS  MEETING DATE: May 11,2021  11A. Lisa Leatherman, the Nantahala District Manager for Duke Energy, will be presenting a request to place a transmission pole on a county-owned parcel. She will also provide the board with an update on the company's 11B. Dr. Chris Baldwin, the Superintendent of Macon County Schools, will be presenting a resolution from the Macon County Board of Education "endorsing and encouraging" the examination of the current Franklin High School property as the site ofa a "secure, safe and self-contained" high school building, in cooperation with the county. A copy of that resolution will be included in the packet, and Dr. Baldwin will provide additional details at the 11C. Please see the enclosed memorandum from Tax Administrator Abby Braswell, who is requesting the board's consideration of her reappointment to this position for the period of July 1, 2021 through June 30, 2025, as 11D. Planning, Permitting and Development Director Jack Morgan will present a request from New Atlantic Contracting, Inc. regarding a change order on the Macon Middle School renovation project. The effect of the change order is a 60-day time extension, and a copy of the document will be included in the agenda packet. Mr. Morgan can provide further details at the  power grid.  meeting.  provided fori in state statute.  meeting. 11E.  County Attorney Eric Ridenour has prepared a resolution for the  board's consideration concerning the approval of a Memorandum of Agreement (MOA) between the state and local governments regarding the proceeds from the settlement of the opioid litigation. A copy of the    resolution, along with the MOA (which has been sent to all 100 counties) as well as a signature page for the county and officials of the towns of Franklin and Highlands, will be included in the packet, and Mr. Ridenour can provide  additional information at the meeting.    RESOLUTION OF THE MACON COUNTY BOARD OF EDUCATION ENDORSING AND ENCOURAGING THE EXAMINATION7 THE CURRENT FRANKLIN HIGH SCHOOL PROPERTY AS THE SITE OF A SECURE, SAFE, ANDSELF-CONTAINED HIGH SCHOOL BUILDING, IN COOPERATION WHEREAS, the Macon County Board of Education (the "School Board") has engaged inr numerous projects with Macon County (the "County," 'and collectively the "Parties") tocarry out the Parties' joint obligation to provide adequate, safe, secure, and orderly school buildings for the current and future student of Macon County; WHEREAS, the School Board greatly appreciates the leadership and partnership of the Board of County Commissioners in providing for school facilities and looks forward to future cooperation with the County in identifying and addressing priorities for future WHEREAS, due to the aging structures and multiple-building layout of the current Franklin High School campus, it is the opinion of the School Board that foremost among school facilities needs in the County is consideration for the siting, construction, and equipping of a new self-contained Franklin High School building; and WHEREAS, after several years of the Parties' joint exploration of the Franklin area fora suitable property of sufficient acreage and central location for ai new Franklin High School Building, the School Board now believes that the current property may be best suited to this purpose, if an adequate facility can safely be constructed upon the property while allowing school operations to continue in existing buildings during the construction BE ITTHEREFORE RESOLVED by The Macon County Board of Education, as  WITH THE COUNTY OF MAÇON  construction projects;  period. follows: 1.  The School Board affirms its determination to carry out future  construction projects in cooperation with the County to best meet the educational needs  ofi its students and the community interest ini its programs.  2. The School Board requests that the County cooperate with the School Board to engage a qualified architectural firm to carry out an advance planning study of the current Franklin High School property, after having first consulted with the County  and School Board to determine programming and spacing needs.  3.  The School Board welcomes the opportunity to confer with the County  and duly selected architectural firm to explore the current and future needs, feasibility and probable costs of construction of the new Franklin High School facility upon the  present school property.    Icertify as follows: that the foregoing resolution was properly adopted at a meeting of The Macon County Board of Education; that this meeting was properly called and held on April 26, 2021; that a quorum was present and acting throughout this meeting; and that this. resolution has not been modified or amended, and remains in full effect as of  today.  Dated this 4th day of May, 2021. Ze  Baldwin  Dr. Chris  Ex Officio Secretary, Macon County Board of Education    April 30, 2021  To: Macon County Board of Commissioners  From: Abby Braswell, Macon County Tax Administrator B Subject: Reappointment as established by N.C.G.S.105-294  l'am requesting the Macon County Board of Commissioners consider my reappointment as the Macon County Tax Administrator for the period of. July 1, 2021 through. June 30, 2025 as provided for by N.C.G. lam requesting this reappointment: solcan continue to serve and manage the county tax department of whichl I have been a dediçated team member for the last 15 years. Ina addition, lam excited that over the last 161 months our department has completed the first phase int the process of converting the new tax software. The previous tax software was obsolete and the project is on schedule with the last phase go live date slated for. June 2021. The team members are excited about the new options the: software offers to our processes. These enhancements will help each area in the department creating efficiencies not onlyi internally but also for our taxpayers. lam asking for the opportunity to continue to create and expand efficiencies in the department in turn bringing our systems and processes into a new era. The county's next revaluation is scheduled for 2023 and would like the opportunity to complete the revaluation with the new software and its many new functions that will increase the process efficiency and produce at fair and equitable 2023 revaluation for the taxpayers of Macon County. The new software has many features that will support our collection department with their effortsto collect delinquent taxes. The collection rate for the 2020 tax was .05% higher than 2019 and the county We, as a department, have built a solid working relationship andi it would be an honor to continue to manage and build on what has been established over the last 16 months as the Tax Administrator. Thank youi in advance for your consideration ofr my request to be reappointed as the Macon County Tax  $105-294 (a).  is in line with that collection rate for the 2021 taxy year.  Administrator.  CC: County Manager, Derek Roland    NewAtlantic CONTRACTING,NC.  PCO #001  New Atlantic Contracting Inc 2635 Reynolda Rd Winston Salem, North Carolina 27106 Phone: (336)759-7440 Fax: (336) 759-7445 TO:  Project:2102- Macon Middle School Renovations  1345 Wells Grove Road Franklin, 28734  Prime Contract Potential Change Order #001: 60 Day Time Extension  Macon County 5V West Main Street Franklin, North Carolina 28734  FROM: CONTRACT: CREATED! BY: CREATED DATE: PRIME CONTRACT CHANGE ORDER: ACCOUNTING METHOD: Amount Based PAIDI INI FULL: SIGNED CHANGE ORDER RECEIVED DATE: TOTAL AMOUNT:  New Atlantic Contracting Inc 2635F Reynolda Rd Winston Salem, North Carolina 27106 1- Macon Middle School Renovations Prime Contract Grant Spencer (New Atlantic Contracting Inc) 4/29/2021 None  PCOI NUMBER/REVISION: 001/0 REQUESTI RECEIVED FROM: STATUS: REFERENCE: FIELD CHANGE: LOCATION: SCHEDULEIMPACT: EXECUTED:  Pending In Review No 60 days No  No $0.00  POTENTIAL CHANGE ORDER TITLE: 60 Day Time Extension  CHANGE REASON: Client Request  POTENTIAL CHANGE ORDER DESCRIPTION: (The Contract Is Changed As Follows)  April 29,2021 Mr. Chris Coleman 1815 S. Tyron St. Suite A Charlotte, NC: 28203 RE:  Macon County Middle School Macon County Schools Franklin, NC 28734 Potential Change Order Number 001 60 Day Time Extension  NACJOB#2102  Dear Chris,  Attached is our proposal for a 60 dayt time extension tot the contract, to account for start of work ona approximately June 1,2021. The new revised  substantial completion date is November 19, 2022.  The total cost estimate of this work per the enclosed summary sheet and attached back-upi is $0.00. This change requires an extension oft the contract time of (60) calendar days. This proposali is based on the following qualifications:  We will proceed with this revised work upon receipt ofv written acceptance oft this proposal. Int thei interim, we are proceeding in accordance with our  current contract documents.  New Atlantic Contracting Inc  Page 1of2  Printed On: 5/3/2021 11:58AM    NewAtlantic CONTRACTING, INC.  PCO# #001  Itmay be necessary tor revise this proposali ifitisr not accepted within 5 days, ori ift the progress oft the work changes the conditions upony whicht this  proposali is based. ATTACHMENTS: # 1  Thank youf for your prompt consideration oft this proposal.  Budget Code  Description  Amount $0.00 $0.00  Grand Total:  Mark Sealy (SGA NarmourWright Design) 1815 S. Tryon Street, Suite A Charlotte, North Carolina 28226 Mark W Sealy O-SGAI Esmsesy@sganadesigne NarmourWright, com,  Macon County 5West Main Street Franklin, North Carolina 28734  New Atlantic Contracting Inc 2635 Reynolda Rd Winston Salem, North Carolina 27106  Digitallys signedbyn Marky ws Sealy. DN:C C-uS, CN=Mark) ws Sealy Date: 292105007235530100  SIGNATURE New Atlantic Contracting Inc  DATE  SIGNATURE  DATE  SIGNATURE  DATE  Page 2of2  Printed On: 5/3/2021 11:58AM    A. RESOLUTION BYTHE COUNTY OF MACON SETTLEMENT OF OPIOID LITIGATION  APPROVING THE MEMORANDUM OF AGREEMENT (MOA) BETWEENTHE STATE OF NORTH CAROLINA ANDI LOCAL GOVERNMENTS ON PROCEEDS RELATING TOTHE  WHEREAS, as of2019, the opioid epidemic had taken the lives ofmore than 16,500 North Carolinians, torn families apart, and ravaged communities from the mountains to the coast; and WHEREAS, the COVID-19 pandemic has compounded the opioid crisis, increasing levels of WHEREAS, the Centers for Disease Control and Prevention estimates the total "economic burden" of prescription opioid misuse alone. in the United States is $78.5 billion a year, including the costs ofhealthcare, lost productivity, addiction treatment, and criminal justice involvement; and WHEREAS, Macon County and its citizens have suffered from the opioid pandemic; and WHEREAS, certain counties and municipalities in North Carolina joined with thousands of local governments across the country to file lawsuit against opioid manufacturers and pharmaceutical distribution companies and hold those companies accountable for their misconduct; and  drug misuse, addiction, and overdose death; and  WHEREAS, representatives oflocal North Carolina governments, the North Carolina Association of County Commissioners, and the North Carolina Department of. Justice have negotiated and prepared al Memorandum of Agreement (MOA) to provide for the equitable distribution ofany proceeds from a settlement of national opioid litigation to the State of North Carolina and to individual  local governments; and  WHEREAS, Local Governments and the State of North Carolina anticipate a settlement in the WHEREAS, by signing onto the MOA, the state and local governments maximize North Carolina' s share of opioid settlement funds to ensure the needed resources reach communities, once a  national opioid litigation to be forthcoming; and  negotiation is finalized, as quickly, effectively, and directly as possible; and  WHEREAS, iti is advantageous to all North Carolinians for local governments, including Macon County and its citizens, to sign onto the MOA and demonstrate solidarity in response to the opioid epidemic, and to maximize the share ofc opioid settlement funds received both in the state and this  county to help abate the harm; and  WHEREAS, the MOA directs substantial resources over multiple years to local governments on the front lines oft the opioid epidemic while ensuring that these resources are used in an effective way to  address the crisis.    NOW, THEREFORE BE. ITI RESOLVED, Macon County hereby approves the Memorandum of Agreement Between the State ofNorth Carolina and Local Governments on Proceeds Relating to the Settlement of Opioid Litigation, and any subsequent settlement funds that may come into North Carolina as a result oft the opioid crisis. Furthermore, Macon County authorizes the County Manager (or County Attorney) take such measures as necessary to comply with the terms oft the MOA and receive any settlement funds, including executing any documents related to the allocation of opioid settlement funds and settlement ofl lawsuits related to this matter. Be it further resolved copies ofthis resolution and the signed MOA be: sent to ppioiddoes@nedoi.gov as well as forwarded to the North Carolina Association  ofCounty Commissioners at ommunciions@nesetg  Adopted this the.  day of  2021.  James Tate, Chairman, Macon County Board ofCounty  Commissioners  ATTEST:  Derek Roland, Macon County Manager and Clerk  to the Board (Official Seal)    MEMORANDUM OF AGREEMENT  BETWEENTHE STATE OF NORTH CAROLINA ANDLOCALGOVERNMENTS ON PROCEEDS RELATING TOTHE SETTLEMENTOF OPOIDLITIGATION  Contents  Background Statement. Statement of Agreement A. Definitions..  B. Allocation of Settlement Proceeds 1. Method of distribution 2. Overall allocation of funds. 4. Municipal allocations  3. Allocation of funds between Local Governments a. Local Governments receiving payments.. b. Municipality may direct payments to county. 5. Use of funds for opioid remediation activities.. 6. Relationship of this MOA to other agreements and resolutions  C. Payment ofLitigating and Non-Litigating Parties.  D. Special Revenue Fund  1. Creation of special revenue fund 2. Procedures for special revenue fund. 3. Interest earned on special revenue fund.. E. Opioid Remediation Activities 1. Limitation on use off funds.  7 7 7 7 8 8 9 9  2. Opportunity to cure inconsistent expenditures 3. Consequences of failure to cure inconsistent expenditures 4. Annual meeting ofcounties and municipalities within each county 5. Use of settlement funds under Option A and Option B 6. Process for drawing from special revenue funds a. Budget item or resolution required. b. Budget item or resolution details.  a. Option A.. b. Option B..  7. Coordination group.  F. Auditing, Compliance, Reporting, and Accountability 2. Audits under other acts and requirements.  1. Audits under Local Government Budget and Fiscal Control Act.  3. Audit costs    4. Access to persons and records 5. Preservation oft records 6. Reporting  9 10 IO 10 10 11  a. Annual financial report required. b. Annual financial report timing and contents. C. Reporting to statewide opioid settlement dashboard d. Copy to NCDOJ ofa any additional reporting e. Compliance and non-compliance.  7. Collaboration. G. County Incentive Fund.. H. Effectiveness  1. When MOA takes effect 2. Amendments to MOA  12 12 12 12 12 12 12 .12 .13 13 13 13 13  a. Amendments to conform to final national documents. No amendments to allocation between local governments.  b. Coordination group. d. General amendment power. 3. Acknowledgement 4. When MOA is nol longer in effect.. 6. Applicable law and venue. 7. Scope of MOA. 8. No third party beneficiaries 9. No effect on authority of parties. 10. Signing and execution ofMOA.  5. Application ofMOA to settlements and bankruptcy resolutions.  Signature Pages Exhibits  A. High-Impact Opioid Abatement Strategies Under Option. A.. B. Additional Opioid Remediation Activities Under Option B C. Collaborative Strategic Planning Process Under Option B.  4 16 19 20 .22  D. Coordination Group E. - Annual Financial Report. F. Impact Information  G. Local Government Allocation Proportions.  2    Background Statement  Capitalized terms not defined below have the meanings set forth ini the Definitions section of the  Statement of Agreement.  WHEREAS, the State of North Carolina (the "State"), North Carolina counties and municipalities, and their people have been harmed by misconduct committed by certain entities that engage in or have engaged in the manufacture, marketing, promotion, distribution, or dispensing ofa an opioid analgesic Pharmaceutica. Supply Chain Participants"); and  WHEREAS, certain North Carolina counties and municipalities, through their counsel, and the State, through its Attorney General, are separately engaged in ongoing investigations, litigation and settlement discussions seeking to hold Pharmaceutical Supply Chain Participants  accountable for the damage caused by their misconduct; and  WHEREAS, the State and the Local Governments share a common desire to abate and alleviate the impacts ofthe misconduct described above throughout North Carolina and ini itsl local  communities; and  WHEREAS, while the Local Governments and the State recognize the sums which may be available from the aforementioned litigation will likely be insufficient to fully abate the public health crisis caused by the opioid epidemic, they share a common interest in dedicating the most  resources possible to the abatement effort; and  WHEREAS, settlements resulting from the investigations and litigation with Johnson & Johnson, AmerisourceBergen, Cardinal Health, and McKesson are anticipated to take the form of  a National Settlement Agreement; and  WHEREAS, this Memorandum of Agreement ("MOA") is intended to facilitate compliance by the State and by the Local Governments with the terms oft the National Settlement Agreement and, to the extent appropriate, in other settlements related to the opioid epidemic  reached by the state ofl North Carolina; and  WHEREAS, North Carolina's share of settlement funds from the National Settlement Agreement will be maximized only ifall North Carolina counties, and municipalities ofa certain  size, participate in the settlement; and  WHEREAS, the National Settlement Agreement will setac default allocation betweene each state and its political subdivisions unless they enter into a state-specific agreement regarding the distribution and use ofs settlement amounts (a State-Subdivision Agreement'); and  WHEREAS, this MOA is intended to serve as such a State-Subdivision Agreement under WHEREAS, the aforementioned investigations and litigation have caused some Pharmaceutical Supply Chain Participants to declare bankruptcy, and it may cause additional  the National Settlement Agreement; and  entities to declare bankruptcy in the future; and  3    WHEREAS, this MOA is also intended to serve as a State-Subdivision Agreement under resolutions of claims concerning alleged misconduct in manufacture, marketing, promotion, distribution, or dispensing of an opioid analgesic entered in bankruptcy court that provide for payments (including payments through a trust) to both the State and North Carolina counties and municipalities and allow for the allocation between a state and its political subdivisions to be set  through as state-specific agreement ("Bankruptcy Resolutions"); and  WHEREAS, specifically, this MOA isi intended to serve under the Bankruptcy Resolution concerning Purdue Pharma L.P. as a statewide abatement agreement, and under this MOA, a  statewide abatement agreement is a type ofState-Subdivision Agreement.  Statement of Agreement  The parties hereto agree as follows:  A. Delinitions As used in this MOA:  The terms "Bankruptcy Resolution," "MOA," Pharmaceutical Supply Chain Participant," "State,"and State-Subdivision Agreement" are defined in the recitals to this MOA. "Coordination group" refers to the group described in Section E.7 below. "County Incentive Fund" is defined in Section G below.  "Governing Body" means (I) forac county, the county commissioners ofthe county, and (2) for a municipality, the elected city council, town council, board of commissioners, or board of  aldermen for the municipality.  "Incentive Eligible Local Government" is defined in Section G below. "Local Abatement Funds" are defined in Section B.2 below,  "Local Government" means all counties and municipalities located within the geographic boundaries of the State ofNorth Carolina that have chosen to sign on to this MOA. "MDL Matter" means the matter captioned In re: National Prescription Opiate Litigation, MDL 2804 pending in the United States District Court for thel Northern District of Ohio. "MDL Parties" means all parties who participated in the matter captioned In re. National Prescription Opiate Litigation, MDL: 2804 pending in the United States District Court for the  Northern District ofOhio as Plaintiffs.  4    "National Settlement Agreement" means a national opioid settlement agreement with the Partiesand one ora all ofthe Settling Defendants concerning alleged misconduct in manufacture, "Opioid Settlement Funds" shall mean all funds allocated by the National Settlement Agreement and any Bankruptcy Resolutions to the State or Local Governments forj purposes of opioid remediation activities or restitution, as well as any repayment of those funds and any interest orinvestment earnings that may accrue as those fundsaretemporarily held before being expended on opioid remediation strategies. Not included are funds made available in the National Settlement Agreement or any Bankruptcy Resolutions for the payment of the Parties'  marketing, promotion, distribution, or dispensing of an opioid analgesic.  litigation expenses or the reimbursement of the United States Government. "Parties" means the State of North Carolina and the Local Governments.  "Settling Defendants" means Johnson & Johnson, AmerisourceBergen, Cardinal Health, and McKesson, as well as their subsidiaries, affiliates, officers, and directors named in a National  Settlement Agreement.  "State Abatement Fund" is defined in Section B.2 below.  B. Allocation of Settlement Proceeds  1. Method of distribution. Pursuant to the National Settlement Agreement and any Bankruptcy Resolutions, Opioid Settlement Funds shall be distributed directly to the State and to Local Governments in such proportions and for such uses as set forth in this MOA, provided Opioid Settlement Funds shall not be considered funds oft the State or any Local Government unless and until such time as each annual distribution is made. 2. Overall allocation of funds. Opioid Settlement Funds shall be allocated as follows: () 15% directly to the State ("State Abatement Fund"), (ii) 80% to abatement funds established by Local Governments ("Local Abatement Funds"), and (iii)5%toac County 3. Allocation of funds between Local Governments. The Local Abatement Funds shall be allocated to counties and municipalities in such proportions as set forth in Exhibit G, attached hereto and incorporated herein by reference, which is based upon the MDL Matter's Opioid Negotiation Class Model. The proportions shall not change based on population changes during the term oft the MOA. However, to the extent required by the terms of the National Settlement Agreement, the proportions set forth in Exhibit G shall be adjusted: (i) to provide no payment from the National Settlement Agreement to any listed county or municipality that does not participate in the National Settlement Agreement; and (ii) to provide a reduced payment from the National Settlement Agreement to any listed county or municipality that signs onto the National Settlement  Incentive Fund described in Section G below.  Agreement after the initial participation deadline. 4. Municipal allocations. Within counties and municipalities:  5    a. Local Governments receiving payments. The proportions set forth in Exhibit G provide for payments directly to (i) all North Carolina counties, (ii) North Carolina municipalities with populations over 75,000 based on the United States Census Bureau's Vintage 2019 population totals, and (ii) North Carolina municipalities b. Municipality may direct payments to county. Any municipality allocated a share in Exhibit G may elect to have its share of current or future. annual distributions of Local Abatement Funds instead directed to the county or counties in which it is located. Such an election may be made by January 1 each year to apply to the following fiscal year. If a municipality is located in more than one county, the municipality's funds will be directed based on the MDL Matter's Opioid  who are also MDL Parties as ofJanuary 1,2021.  Negotiation Class Model.  5. Use of funds for opioid remediation activities. This MOA requires that except as related to the payment of the Parties' litigation expenses and the reimbursement of the United States Government, all Opioid Settlement Funds, regardessofallocation, shall be utilized 6. Relationship of this MOA to other agreements and resolutions. All Parties acknowledge and agree the National Settlement Agreement will require aLocal Government to release all its claims against the Settling Defendants to receive Opioid Settlement Funds. All Parties further acknowledge and agree based on the terms of the National Settlement Agreement, a Local Government may receive funds through this MOA only after complying with all requirements set forth in thel NationalSetlement Agreement to release its claims. This MOA is not a promise from any Party that any National Settlement  only for opioid remediation activities.  Agreement or Bankruptcy Resolution will be finalized or executed.  C. Payment ofLitigating and Non-Litigating Parties  No Party engaged in litigating the MDL Matter shall receive a smaller payment than a similarly situated non-litigating Party, other than as based on the Allocation Proportions in Exhibit G or based on the eligibility criteria for payments from the County Incentive Fund  as provided by Section G below. D. Special Revenue Fund  1. Creation of special revenue fund. Every Local Government receiving Opioid Settlement Funds shall create a separate special revenue fund, as described below, that is designated 2. Procedures for special revenue fund. Funds in this special revenue fund shall not be commingled with any other money or funds of the Local Government. The funds in the  for the receipt and expenditure of the Opioid Settlement Funds.  6    special revenue fund shall not be used for any loans or pledge of assets, unless the loan or pledge is for an opioid remediation purpose consistent with the terms of this MOA and adopted under the process described in Section E.6 below. Although counties or municipalities may make contracts with or grants to a nonprofit, charity, or other entity, counties or municipalities may not assign to another entity their rights to receive payments from the national settlement or their responsibilities for funding decisions. 3. Interest earned on special revenue fund. The funds in the special revenue fund may be invested, consistent with the investment limitations for local governments, and may be placed in an interest-bearing bank account. Any interest earned on the special revenue  fund must be used in a way that is consistent with this MOA.  E. Opioid Remediation Activities.  1. Limitation on use of funds. Local Governments shall expend Opioid Settlement Funds only for opioid-related expenditures consistent with the terms oft this MOA and incurred after the date of the Local Government's execution of this MOA, unless execution ofthe 2. Opportunity to cure inconsistent expenditures. IfaLocal Government spends any Opioid Settlement Funds on an expenditure inconsistent with the terms of this MOA, the Local Government shall have 60 days after discovery of the expenditure to cure the inconsistent expenditure through payment of such amount for opioid remediation activities through 3. Consequences of failure to cure inconsistent expenditures. Ifa Local Government does not make the cure. required by Section E.2 above within 60 days, (i) future Opioid Fund payments to that Local Government shall be reduced by an amount equal to the inconsistent expenditure, and (ii) to the extent the inconsistent expenditure is greater than the expected future stream of payments to the Local Government, the Attorney General may initiate a process up to and including litigation to recover and redistribute the overage among all eligible Local Governments. The Attorney General may recover any litigation expenses incurred to recover the funds. Any recovery or redistribution shall be distributed 4. Annual meeting ofcounties and municipalities within each county. Each county receiving Opioid Settlement Funds shall hold at least one annual meeting with all municipalities in the Local Government" 's county invited in order to receive input as to proposed uses ofthe Opioid Settlement Funds and to encourage collaboration between local governments both within and beyond the county. These meetings shall be open to the public. 5. Use ofsettlement funds under Option A and Option B. Local Governments shall spend Opioid Settlement Funds from the Local Abatement Funds on opioid remediation: activities using either or both of the processes described as Option A and Option B below, unless the relevant National Settlement Agreement or Bankruptcy Resolution further limit the  National Settlement Agreement requires a later date.  budget amendment or repayment.  consistent with Sections B.3 and B.4 above.  spending.  7    a. Option A. i.  Without any additional strategic planning beyond the meeting described in Section E.4 above, Local Governments may spend Opioid Settlement Funds from the list of High-Impact Opioid Abatement Strategies attached as Exhibit A. This list is a subset oft the initial opioid remediation strategies ii. Exhibit A may be modified as set forth in Exhibit D below; provided. however, that any strategy listed on Exhibit A must be within the list of opioid remediation activities for the then-current National Settlement Agreement. Opioid remediation activities undertaken under a previously authorized strategy list may continue ift they were authorized at the time of the Local Government's commitment to spend funds on that activity.  listed in the National Settlement Agreement.  b. Option B.  1. A Local Government that chooses to participate in additional voluntary, collaborative, strategic planning may spend Opioid Settlement Funds from the broader list of categories found in Exhibit B. This list contains all the initial opioid remediation strategies listed in the National Settlement  Agreement.  ii. Before spending any funds on any activity listed in Exhibit B, but not listed on Exhibit A, a Local Government must first engage in the collaborative strategic planning process described in Exhibit C. This process shall result in a report and non-binding recommendations to the Local Government's Governing Body described in Exhibit C (right-hand column).  iii. A Local Government that has previously undertaken the collaborative strategic planning process described in Exhibit Cand wishes to continue implementing a strategy listed in Exhibit B, but not listed in Exhibit A, shall undertake a new collaborative strategic planning process every four iv. A - Local Government that has previously undertaken the collaborative strategic planning process describedi inl Exhibit C that wishes toi implement ar new strategy listed in Exhibit B but not listed in Exhibit A, shall undertake a new collaborative strategic planning process. V. Two or more Local Governments may undertake a single collaborative strategic planning process resulting in a report and recommendations to all  years (ort more often ifdesired).  ofthe Local Governments involved.  8    6. Process for drawing from special revenue funds.  a. Budget item or resolution required. Opioid Settlement Funds can be used for a purpose when the Governing Body includes in its budget or passes a separate resolution authorizing the expenditure of a stated amount of Opioid Settlement Funds for that purpose or those purposes during a specified period oftime. b. Budget item or resolution details. The budget or resolution should (i) indicate that iti is an authorization for expenditure of opioid settlement funds; (ii) state the specific strategy or strategies the county or municipality intends to fund pursuant to Option A or Option B, using the item letter and/or number in Exhibit A or Exhibit B to identify each funded strategy, and (iii) state the amount dedicated to  each strategy for a stated period oftime.  7. Coordination group. A coordination group with the composition and responsibilities described in Exhibit D shall meet at least once a year during the first three years that this MOA: is in effect. Thereafter, the coordination group shall meet at least once every three years until such time as Opioid Settlement Funds are no longer being spent by Local  Governments.  F. Auditing, Compliance, Reporting, and Accountability  1. Audits under Local Government Budget and Fiscal Control Act. Local Governments' Opioid Settlement Funds are subject to financial audit by an independent certified public accountant in a manner no less than what is required under G.S. 159-34. Each Local Government must file an annual financial audit of the Opioid Settlement Funds with the Local Government Commission. Ifany such audit reveals an expenditure inconsistent with the terms of this MOA, the Local Government shall immediately report the finding to the 2. Audits under other acts and requirements. The expenditure of Opioid Settlement Funds iss subject to the requirements of the Local Government Budget and Fiscal Control Act, Chapter 159 ofthe North Carolina General Statutes; Local Government Commission arules; the Federal Single Audit Act of 1984 (as if the Opioid Settlement Funds were federal funds); the State Single Audit Implementation Act; Generally Accepted Government Auditing Standards; and all other applicable laws, rules, and accounting standards. For expenditures for which no compliance audit is required under the Federal Single Audit Act of1984, ac compliance audit shall be required under a compliance supplement approved by 3. Audit costs. Reasonable audit costs that would not be required except for this Section F 4. Access to persons and records. During and after the term ofthis MOA, the State Auditor and Department of. Justice shall have access to persons and records related to this MOA and expenditures of Opioid Settlement Funds to verify accounts and data affecting fees or  Attorney General.  the coordination group.  may be paid by the Local Government from Opioid Settlement Funds..  9    performance. The Local Government manager/administrator is the point of contact for 5. Preservation ofrecords. The Local Government must maintain, for a period ofat least five years, records of Opioid Settlement Fund expenditures and documents underlying those expenditures, sO that it can be verified that funds are being orhave been utilizedi in a manner consistent with the National Settlement Agreement, any Bankruptcy Resolutions, and this  questions that arise under this MOA.  MOA. 6. Reporting.  a. Annual financial report required. In order to ensure compliance with the opioid remediation provisions of the National Settlement Agreement, any Bankruptcy Resolutions, and this MOA, for every fiscal year in which a Local Government receives, holds, or spends Opioid Settlement Funds, the county or municipality must submit an annual financial report specifying the activities and amounts it has b. Annual financial report timing and contents. The annual financial report shall be provided to the North Carolina Attorney General by emailing the report to opioiddocs@nedo)goy, within 90 days of the last day of the state fiscal year covered by the report. Each annual financial report must include the information C. Reporting to statewide opioid settlement dashboard. Eachl Local Government must provide the following information to the statewide opioid settlement dashboard  funded.  described on Exhibit E.  within the stated timeframes:  i.  The budget or resolution authorizing the expenditure ofas stated amount of Opioid Settlement Funds for a specific purpose or purposes during a specified period of time as described in Section E.6.b above (within 90 ii. Ifthe Local Government is using Option B, the report(s) and non-binding recommendations from collaborative strategic planning described in Section E.5.b.ii above and Exhibit C (right hand column) (within 90 days of the date the report and recommendations are submitted to the local iii. The annual financial reports described in Section F.6.a and Exhibit E (within 90 days oft the end of the fiscal year covered by the report); and iv. The impact information described in Exhibit F (within 90 days oft the end The State will create an online portal with instructions for Local Governments to  days of the passage of any such budget or resolution);  governing body for consideration);  oft the fiscal year covered by the report).  report or upload each of these four items by electronic means.  10    d. Copy tol NCDOJ ofany additional reporting. Ifthe National Settlement Agreement or any Bankruptcy Resolutions require that a Local Government file, post, or provide a report or other document beyond those described in this MOA, ori ifany Local Government communicates in writing with any national administrator or other entity created or authorized by the National Settlement Agreement or any Bankruptcy Resolutions regarding the Local Government's compliance with the National Settlement Agreement or Bankruptcy Resolutions, the Local Government shall email a copy of any such report, document, or communication to the North  Carolina Department ofJ Justice at pioiddoes@ncdo.sovy  e. Compliance and non-compliance.  1. Every Local Government shall make a good faith effort to comply with all of its reporting obligations under this MOA, including the obligations ii. ALocal Government that engages in a good faith effort to comply with its reporting obligations under Section F.6.c but fails in some way to report information in an accurate, timely, or complete manner shall be given an opportunity to remedy this failure withina a reasonable time. ir. ALocal Government that does not engage in a good faith effort to comply with its reporting obligations under this MOA, or that fails to remedy reporting issues within a reasonable time, may be subject to action for iv. Notwithstanding anything to the contrary herein, al Local Government that isins substantial compliance with the reporting obligations in this MOAshall not be considered in breach of this MOA or in breach of contract.  described in Section F.6.c above.  breach ofcontract.  7. Collaboration. The State and Local Governments must collaborate to promote effective use of Opioid Settlement Funds, including through the sharing of expertise, training, technical assistance. They will also coordinate with trusted partners to collect and share information about successful regional and other high-impact strategies and opioid  treatment programs..  G. County Incentive Fund  A Local Government receiving Settlement Proceeds pursuant to Section B.4.a shall be an Incentive Eligible Local Government if every municipality in the Local Government's county with population of at least 30,000 has executed this MOA by October 1, 2021, but no later than any such deadline set in the National Settlement Agreement for the highest possible participation in incentive structures for North Carolina. Each Incentive Eligible Local Government shall receive a share of the 5% County Incentive Fund set forth in Section B.2.i1, distributed pro rata among only Incentive Eligible Local Governments as set forth in Exhibit G. For purposes of the calculations required by this Section, populations will be based on United States Census Bureau's Vintage 2019 population totals, and a1 municipality with populations in multiple counties will be counted only toward the county which has the largest share ofthat mumnicpaliy'spopulation.  11    H. Effectiveness  1. When MOA takeseffect. Thisl MOA shall become effective at the time as sufficient number ofLocal Governments have joined the MOA to qualify this MOA as a State-Subdivision Agreement under the National Settlement Agreement or any Bankruptcy Resolution. If this MOA does not thereby qualify as a State-Subdivision Agreement, this MOA will have  no effect. 2. Amendments to MOA.  a. Amendments to conform to final national documents. The Attorney General, with the consent ofar majority vote from a group ofLocal Government attorneys appointed by the Association ofCounty Commissioners, may initiate aj process to amend this MOA to make any changes required by the final provisions ofthe National Settlement Agreement or any Bankruptcy Resolution. The Attorney General's Office will provide written notice of the necessary amendments to all the previously joining parties. Any previously joining party will have a two- week opportunity to withdraw from the MOA. The amendments will be b. Coordinations group. The coordination group may make the changes authorized No amendments to allocation between Local Governments. Notwithstanding any other provision of this MOA, the allocation proportions set forthin Exhibit d. General amendment power. After execution, the coordination group may propose other amendments to the MOA, subject to the limitation in Section H.2.c above. Such amendments will take effect only if approved in writing by the Attorney General and at least two-thirds of the Local Governments who are. Parties to this MOA. Inthe vote, eachLocal Government Party will have a number of votes measured by the allocation proportions set  effective to any party that does not withdraw.  in Exhibit D.  G may not be amended.  forth in Exhibit G.  3. Acknowledgement, The Parties acknowledge that this MOA is an effective and fair way to address the needs arising from the public health crisis duet to the misconduct committed by 4. When MOA isr no longer in effect. This MOA is effective until one year after the last date on which any Opioid Settlement Funds are being spent by Local Governments pursuant to 5. Application ofMOA to settlements and bankruptcy resolutions. This MOA applies to all settlements under the National Settlement Agreement with the Settling Defendants and any Bankruptcy Resolutions. The Parties agree to discuss the use, as the Parties may deem appropriate in the future, of the settlement terms set out herein (after any necessary  the Pharmaceutical Supply Chain Participants.  the National Settlement Agreement and any Bankruptcy Resolution.  12    amendments) for resolutions with Pharmaceutical Supply Chain Participants not covered 6. Applicable law and venue. Unless required otherwise by the National Settlement Agreement or a Bankruptcy Resolution, this MOA shall be interpreted using North Carolina law and any action related to the provisions of this MOA must be adjudicated by the Superior Court of Wake County. Ifany provision ofthis MOA is held invalid by any court of competent jurisdiction, this invalidity does not affect any other provision which 7. ScopeofMOA. The Parties acknowledge that this MOA does not excuse any requirements placed upon them by the terms of the National Settlement Agreement or any Bankruptcy Resolution, except to the extent those terms allow: for a State-Subdivision Agreement to do 8. No third party beneficiaries. No person or entity is intended to be a third party beneficiary 9. No effect on authority of parties. Nothing in this MOA shall be construed to affect or 10. Signing and execution ofMOA. This MOA may be signed and executed simultaneously in any number of counterparts, each of which shall be deemed an original, but all ofwhich together shall constitute one and the same agreement. A signature transmitted by facsimile or electronic image shall be deemed an original signature for purposes of executing this MOA. Each person signing this MOA represents that he or she is fully authorized to enter into the terms and conditions of, and to execute, this MOA, and that all necessary approvals  by the National Settlement Agreement or a Bankruptcy Resolution.  can be given effect without the invalid provision.  SO.  ofthis MOA.  constrain the authority of the Parties under law.  and conditions precedent to his or her execution have been satisfied.  (Signature, pages.follow.)  13    Signature pages will be structured as one page for the State ofNorth Carolina, These signature pages will also include blanks for the comnty'smunicipalitites. Toa avoid having 101 signature pages in the middle oft this file, the signature pages are in a: separate document.  followed by separate signature pages for each county.    EXHIBIT A TONC: MOA:  HIGH-IMPACT OPIOID ABATEMENT STRATEGIES ("OPTION A" List) In keeping with. the National Settlement Agreement, opioid settlement funds may support programs or. services listed below that serve persons with Opioid Use Disorder (OUD) or any co-occurring Substance Use Disorder (SUD) or mental health condition. Asused in this list, the words "fund" and "support" are usedi interchangeably and mean. to 1. Collaborative strategic planning. Support collaborative strategic planning to address opioid misuse, addiction, overdose, or related issues, including staff support, facilitation services, or any activity or combination ofactivities listed in Exhibit C to the MOA 2. Evidence-based addiction treatment. Support evidence-based addiction treatment consistent with the American Society of Addiction Medicine's national practice guidelines for the treatment of opioid use disorder - including Medication-Assisted Treatment (MAT) with any medication approved for this purpose by the U.S. Food and Drug Administration - through Opioid' Treatment Programs, qualified providers of Office-Based Opioid Treatment, Federally Qualified Health Centers, treatment offered in conjunction with justice system programs, or other community-based programs offering evidence-based addiction treatment. This may include capital expenditures for facilities that offer evidence-based treatment for OUD. (Ifonly aj portion of a facility offers such treatment, then only that portion qualifies for funding, on a pro rata basis.) 3. Recovery support services. Fund evidence-based recovery support services, including peer support specialists or care navigators based in local health departments, social service offices, detention facilities, community-based organizations, or other settings that support people ini treatment or recovery, or people who use drugs, in accessing addiction treatment, recovery support, harm reduction services, primary healthcare, or other services or supports they need toi improve their health or well-being. 4. Recovery housing support. Fund programs offering recovery housing support to people in treatment or recovery, or people who use drugs, such as assistance with rent, move-in deposits, or utilities; or fund recovery housing programs that provide housing to individuals receiving Medication-Assisted Treatment for opioid use disorder. 5. Employment-related services. Fund programs offering employment support services to people in treatment or recovery, or people who use drugs, such as jobi training,, job skills, job placement, interview coaching, resume review, professional attire, relevant courses at community colleges or vocational schools, transportation services or transportation vouchers to facilitate any ofthese activities, or similar services or supports. 6. Early intervention. Fund programs, services, or training to encourage early identification and intervention for children or adolescents who may be struggling with problematic use of drugs or mental health conditions, including Youth Mental Health  create, expand, or sustain a program, service, or activity.  (collaborative strategic planning).  Exhibits, page 1    First Aid, peer-based programs, or similar approaches. Training programs may target parents, family members, caregivers, teachers, school staff, peers, neighbors, health or human services professionals, or others in contact with children or adolescents. 7. Naloxone distribution. Support programs or organizations that distribute naloxone to persons at risk of overdose or their social networks, such as Syringe Service Programs, post-overdose response teams, programs that provide naloxone to persons upon release from jail or prison, emergency medical service providers or hospital emergency departments that provide naloxone to persons at risk of overdose, or community-based organizations that provide services toj people who use drugs. Programs or organizations involved in community distribution ofnaloxone may, in addition, provide naloxone to 8. Post-overdose response team. Support post-overdose response teams that connect persons who have experienced non-fatal drug overdoses to addiction treatment, recovery support, harm reduction services, primary healthcare, or other services or supports they 9. Syringe Service Program. Support Syringe Service Programs operated by any governmental or nongovernmental organization authorized by section 90-113.27 oft the North Carolina General Statutes that provide syringes, naloxone, or other harm reduction supplies; that dispose of used syringes; that connect clients to prevention, treatment, recovery support, behavioral healthcare, primary healthcare, or other services or supports 10. Criminal justice diversion programs. Support pre-arrest or post-arrest diversion programs, or pre-trial service programs, that connect individuals involved or at risk of becoming involved in the criminal justice system to addiction treatment, recovery support, harm reduction services, primary healthcare, prevention, or other services or supports they need, or that provide any oft these services or supports. 11. Addiction treatment for incarcerated persons. Support evidence-based addiction treatment, including Medication-Assisted Treatment with at least one FDA-approved 12. Reentry Programs. Support programs that connect incarcerated persons to addiction treatment, recovery support, harm reduction services, primary healthcare, or other services or supports they need upon release from jail or prison, or that provide any of  first responders.  need to improve their health or well-being.  they need; or that provide any ofthese services or supports.  opioid agonist, to persons who are incarcerated in jail or prison.  these services or supports.  Exhibits, page 2    EXHIBIT BTO NC MOA:  Additional Opioid Remediation Activities ("OPTION B" List)  This list shall be automatically updated to match the list ofapproved. strategies in the most  recent National Settlement Agreement. PART ONE: TREATMENT  A. TREAT OPIOID USE DISORDER (OUD)  Support treatment of Opioid Use Disorder (OUD) and any co-occurring Substance Use Disorder or Mental Health (SUD/MH) conditions through evidence-based or evidence-informed programs 1.Expand availability oft treatment for OUD and any co-occurring SUD/MFiconditions, including all forms of Medication-Assisted Treatment (MAT) approved by the U.S. Food and Drug 2. Support and reimburse evidence-based services that adhere to the American Society of Addiction Medicine (ASAM) continuum of care for OUD and any co-occurring SUD/MH 3. Expand telehealth to increase access to treatment for OUD and any co-occurring SUD/MH conditions, including MAT, as well as counseling, psychiatric support, and other treatment and 4. Improve oversight of Opioid Treatment Programs (OTPs) to assure evidence-based or evidence- informed practices such as adequate methadone dosing and low threshold approaches to treatment. SSuprmohlemerenion, treatment, and recovery services, offered by qualified professionals and service providers, such as peer reçovery coaches, for persons with OUD and any co-occurring SUD/MH conditions and for persons who have experienced an opioid overdose. 6.Treatment oftrauma fori individuals with OUD( (e.g., violence, sexual assault, human trafficking, or adverse childhood experiences) and family members (e.g., surviving family members after an overdose or overdose fatality), and training of health care personnel to identify and address such 7. Support evidence-based withdrawal management services for people with OUD and any co-  or strategies that may include, but are not limited to, the following:  Administration.  conditions.  recovery support services.  trauma.  occurring mental health conditions.  As used in this Exhibit B, words like "expand," "fund," "provide" or the like shall noti indicate aj preference  for new or existing programs.  Exhibits, page 3    8. Training on MAT for health care providers, first responders, students, or other supporting professionals, such as peer recovery coaches or recovery outreach specialists, including telementoring to assist community-based providers in rural or underserved areas. 9. Support workforce development for addiction professionals who work with persons with OUD 10. Fellowships for addiction medicine specialists for direct patient care, instructors, and clinical 11.Scholarships and supports for behavioral health practitioners or workers involved ina addressing OUD and any co-occurring SUD or mental health conditions, including but not limited to training, scholarships, fellowships, loan repayment programs, or other incentives for providers to work in 12. Provide funding and training for clinicians to obtain a waiver under the federal Drug Addiction Treatment Act 0f2000(DATA200) to prescribe MAT1 for OUD, and provide technical assistance and professional support to clinicians who have obtained al DATA 2000 waiver. 13. Dissemination of web-based training curricula, such as the American Academy of Addiction Psychiatry's Provider Clinical Support Service-Opioids web-based training curriculum and 14. Development and dissemination ofnew curricula, such as the American Academy of Addiction Psychiatry's Provider Clinical Support Service for Medication-Assisted Treatment. B. SUPPORT PEOPLE IN TREATMENT AND RECOVERY  and any co-occurring SUD/MH conditions.  research for treatments.  rural or underserved areas.  motivational interviewing.  Support people in treatment for or recovery from OUD and any co-occurring SUD/MH conditions through evidence-based or evidence-informed programs or strategies that may include, but are not 1. Provide comprehensive wrap-around services to individuals with OUD and any co-occurring SUD/MH conditions, including housing, transportation, education, job placement, job training, or 2. Provide the full continuum of care of treatment and recovery services for OUD and any CO- occurring SUD/MH conditions, including supportive housing, peer support services and counseling, community navigators, case management, and connections to community-based 3. Provide counseling, peer-support, recovery case management and residential treatment with access to medications for those who need it to persons with OUD. and any co-occurring SUD/MH 4. Provide access to housing for people with OUD and any co-occurring SUD/MH conditions, including supportive housing, recovery housing, housing assistance programs, training forl housing providers, or recovery housing programs that allow or integrate FDA-approved medication with  limited to, the following:  childcare.  services.  conditions.  other support services.  Exhibits, page 4    5. Provide community support services, including social and legal services, to assist in deinstitutionalizing persons with OUD and any co-occurring SUD/MH conditions. 6. Support or expand peer-recovery centers, which may include support groups, social events, computer access, or other services for persons with OUD and any co-occurring SUD/MH 7. Provide or support transportation to treatment or recovery programs or services for persons with 8. Provide employment training or educational services for persons in treatment for or recovery 9. Identify successful recovery programs such as physician, pilot, and college recovery programs, and provide support and technical assistance to increase the number and capacity of high-quality 10. Engage non-profits, faith-based communities, and community coalitions to support people in treatment and recovery and to support family members in theirefforts to support the person with 11. Training and development of procedures for government staff to appropriately interact and provide social and other services to individuals with or in recovery from OUD, including reducing 12. Support stigma reduction efforts regarding treatment and support for persons with OUD, 13.Create or support culturally appropriate services and programs for persons with OUD and any  conditions.  OUD and any co-occurring SUD/MH conditions. from OUD and any co-occurring SUD/MH conditions.  programs to help those in recovery.  OUD in the family.  stigma.  includingreducingi the stigma on effective treatment.  co-occurring SUD/MH conditions, including new Americans. 14. Create and/or support recovery high schools.  15. Hire or train behavioral health workers to provide or expand any of the services or supports C. CONNECT PEOPLE WHO NEED HELP TO THE HELP THEY NEED Provide connections to care for people who have = or at risk of developing - OUD and any cO- occurring SUD/MH conditions through evidence-based or evidence-informed programs or 1. Ensure that health care providers are screening for OUD and other risk factors and know how toa appropriately counsel and treat (or refer if necessary) a patient for OUD treatment. 2. Fund Screening, BriefIntervention and Referral to Treatment (SBIRT) programs to reduce the transition from use to disorders, including SBIRT services to pregnant women who are uninsured  listed above.  CONNECTIONSTOCARE)  strategies that may include, but are not limited to, the following:  or not eligible for Medicaid.  Exhibits, page 5    3. Provide training and long-term implementation of SBIRT in key systems (health, schools, colleges, criminal justice, and probation), with a focus on youth and young adults when transition 4. Purchase automated versions of SBIRT and support ongoing costs of the technology. 5.1 Expand services such as navigators and on-call teams to begin MAT in hospital emergency 6. Training for emergency room personnel treating opioid overdose patients on post-discharge planning, including community referrals for MAT,recovery case management or support services. 7. Support hospital programs that transition persons with OUD and any co-occurring SUD/MH conditions, or persons who have experienced an opioid overdose, into clinicaly-appropriate 8. Support crisis stabilization centers that serve as an alternative to hospital emergency departments forj persons with OUD. and any co-occurring SUD/MH conditions or persons that have 9. Support the work of Emergency Medical Systems, including peersupport specialists, to connect individuals to treatment or other appropriate services following an opioid overdose or other opioid- 10. Provide funding for peer support specialists or recovery coaches in emergency departments, detox facilities, recovery centers, recovery housing, or similar settings; offer services, supports, or connections to care to persons with OUD and any co-occurring SUD/MH conditions or to persons  from misuse to opioid disorder is common.  departments.  follow-up care through a bridge clinic or similar approach.  experienced an opioid overdose.  related adverse event.  who have experienced an opioid overdose.  11. Expand warm hand-off services to transition to recovery services.  12. Create or support school-based contacts that parents can engage with to seek immediate treatment services for their child; and support prevention, intervention, treatment, and recovery  programs focused on young people.  13. Develop and support best practices on addressing OUD ini the workplace. 14. Support assistance programs for health care providers with OUD.  15. Engage non-profits and the faith community as a system to support outreach for treatment, 16. Support centralized call centers that provide information and connections to appropriate services and supports for persons with OUD and any co-occurring SUD/MH conditions. D. ADDRESS THE NEEDS OF CRIMINAL-JUSTICE-INVOLVED PERSONS Address the needs of persons with OUD and any co-occurring SUD/MH conditions who are involved in, are at risk of becoming involved in, or are transitioning out of the criminal justice  Exhibits, page 6    system through evidence-based or vidence-informed programs or strategies that may include, but 1.S Support pre-arrest or pre-arraignment diversion and deflection strategies for persons with OUD and any co-occurring SUD/MH conditions, including established strategies such as:  are not limited to, the following:  a. Self-referral strategies such as the Angel Programs or the Police Assisted Addiction b. Active outreach strategies such as the Drug Abuse Response Team (DART)model; C. "Naloxone Plus" strategies, which work to ensure that individuals who have received naloxone to reverse the effects of an overdose are then linked to treatment programs or d.Officer prevention strategies, such as the Lawl Enforcement Assisted Diversion (LEAD) e. Officer intervention strategies such as the Leon County, Florida Adult Civil Citation Network or the Chicago Westside Narcotics Diversion to Treatment Initiative; or Co-responderand/oralterative respondermodels to address OUD-related 911 calls with  Recovery Initiative (PAARI);  other appropriate services;  model;  greater SUD expertise.  2. Support pre-trial services that connect individuals with OUD and any co-occurring SUD/MH conditions to evidence-informed treatment, including MAT, and related services. 3. Support treatment and recovery courts that provide evidence-based options for persons with 4. Provide evidence-informed treatment, including MAT, recovery support, harm reduction, or other appropriate services to individuals with OUD and any co-occurring SUD/MH conditions 5. Provide evidence-informed treatment, including MAT, recovery support, harm reduction, or other appropriate services to individuals with OUD and any co-occurring SUD/MH conditions who are. leavingjail or prison, have recently leftj jail or prison, areonprobationor) parole, are under 6. Support critical time interventions (CTI), particularly for individuals living with dual-diagnosis OUD/serious mental illness, and services for individuals who face immediate risks and service 7.1 Provide training on best practices for addressing the needs of riminaljustice-involved persons with OUD and any co-occurring SUD/MH: conditions to law enforcement, correctional, orjudicial personnel or to providers of treatment, recovery, harm reduction, case management, or other services offered in connection with any of the strategies described in this section.  OUD and any co-occurring SUD/MH conditions.  who are incarcerated in jail or prison.  community corrections supervision, or are in re-entry programs or facilities.  needs and risks upon release from correctional settings.  Exhibits, page 7    E. ADDRESS THE NEEDS OF PREGNANT OR PARENTING WOMEN AND THEIR FAMILIES, INCLUDING BABIES WITH NEONATAL ABSTINENCESYNDROME Address the needs of pregnant or parenting women with OUD and any co-occurring SUD/MH conditions, and the needs of their families, including babies with neonatal abstinence syndrome (NAS), through evidence-based ore vidence-informed programs or strategies that may include, but 1.Support evidence-based or evidence-informed treatment, including MAT, recovery services and supports, and prevention services for pregnant women - or women who could become pregnant - who have OUD and any co-occurring SUD/MH conditions, and other measures to educate and 2. Expand comprehensive evidence-based treatment and recovery services, including MAT, for uninsured women with OUD and any co-occurring SUD/MH conditions for up to 12 months 3. Training for obstetricians or other healthcare personnel that work with pregnant women and their families regarding treatment of OUD and any co-occurring SUD/MH conditions. 4. Expand comprehensive evidence-based treatment and recovery support for NAS babies; expand services for better continuum of care with infant-need dyad; expand long-term treatment and 5. Provide training to health care providers who work with pregnant or parenting women on best practices for compliance with federal requirements that children born with Neonatal Abstinence 6.Child and family supports for parenting women with OUD and any co-occurring SUD/MH 7. Enhanced family supports and child care services for parents with OUD and any co-occurring 8. Provide enhanced support for children and family members suffering trauma as a result of addiction in the family; and offer trauma-informed behavioral health treatment for adverse 9. Offer home-based wrap-around services to persons with OUD and any co-occurring SUD/MH 10. Support for Children's 's Services - Fund additional positions and services, including supportive housing and other residential services, relating to children being removed from the home and/or  are not limited to, the following:  provide support to families affected by Neonatal Abstinence Syndrome.  postpartum.  services for medical monitoring OfNAS babies and their families.  Syndrome get referred to appropriate services and receive aj plan ofsafe care.  conditions.  SUD/MH conditions.  childhood events.  conditions, including but not limited to parent skills training.  placed ini foster care due to custodial opioid use.  Exhibits, page 8    PARTTWO: PREVENTION  F. PREVENT OVER-PRESCKIEING AND ENSURE APPROPRIATE PRESCRIBING Support efforts to prevent over-prescribing and ensure appropriate prescribing and dispensing of opioids through evidence-based orevidence-informed programs or strategies that may include, but 1.F Fund medical provider education and outreach regarding best prescribing practices for opioids consistent with Guidelines for Prescribing Opioids for Chronic Pain from the U.S. Centers for Disease Control and Prevention, including providers atl hospitals (academic detailing). 2. Training for health care providers regarding safe and responsible opioid prescribing, dosing,  AND DISPENSING OF OPIOIDS  are not limited to, the following:  and tapering patients off opioids.  3. Continuing Medical Education (CME) on appropriate prescribing of opioids.  4. Support for non-opioid pain treatment alternatives, including training providers to offer or refer 5. Support enhancements or improvements to Prescription Drug Monitoring Programs (PDMPs),  tor multi-modal, evidence-informed treatment of pain. including but not limited to improvements that:  a. Increase the number of prescribers using PDMPs;  b. Improve point-of-care decision-making by increasing the quantity, quality, or format of data available to prescribers using PDMPS, by improving the interface that prescribers use c. Enable states to use PDMP data in support of surveillance or intervention strategies, including MAT referrals and follow-up for individuals identified within PDMP data as likely to experience OUD in a manner that complies with all relevant privacy and security 6. Ensuring PDMPS incorporate available overdose/naloxone deployment data, including the United States Department of Transportation's Emergency Medical Technician overdose database  to access PDMP data, or both; or  laws and rules.  in ai manner that complies with all relevant privacy and security laws and rules. 7. Increase electronic prescribing to prevent diversion or forgery. 8. Educate Dispensers on appropriate opioid dispensing. G. PREVENT MISUSE OF OPIOIDS  Support efforts to discourage or prevent misuse of opioids through evidence-based or evidence- informed programs or strategies that may include, but are not limited to, the following:  Exhibits, page 9    1. Fund media campaigns to prevent opioid misuse.  2. Corrective advertising or affirmative public education campaigns based on evidence.  3. Public education relating to drug disposal. 4. Drug take-back disposal or destruction programs.  5. Fund community anti-drug coalitions that engage in drug prevention efforts.  6. Support community coalitions in implementing vidence-informed prevention, such as. reduced social access and physical access, stigma reduction including staffing, educational campaigns, support for people in treatment or recovery, or training of coalitions in evidence-informed implementation, including the Strategic Prevention Framework developed by the U.S. Substance 7. Engage non-profits and faith-based communities as systems to support prevention. 8. Fund evidence-based prevention programs in schools or evidence-informed school and community education programs and campaigns for students, families, school employees, school 9.School-based or youth-focused programs or strategies that have demonstrated effectiveness in preventing drug misuse and seem likely tol be effective inj preventing the uptake and use ofopioids. 10. Create or support community-based education ori intervention services for families, youth, and 11. Support evidence-informed programs or curricula to address mental health needs of young people who may be atl riskofmisusing opioids or other drugs, including emotional modulationand 12. Support greater access to mental health services and supports for young people, including services and supports provided by school nurses, behavioral health workers or other school staff, to address mental health needs in young people that (when not properly addressed) increase the H. PREVENT OVERDOSE DEATHS AND OTHER HARMS (HARM REDUCTION) Support efforts to prevent or reduce overdose deaths or other opioid-related harms through evidence-based or evidence-informed programs or strategies that may include, but are not limited 1.I Increase availability and distribution ofnaloxone and other drugs that treat overdoses for first responders, overdose patients, individuals with OUD and their friends and family members, individuals at high risk ofoverdose, schools, community navigators and outreach workers, persons  Abuse and Mental Health Services Administration (SAMHSA).  athletic programs, parent-teacher and student associations, and others.  adolescents at risk for OUD and any co-occurring SUD/MH conditions.  resilience skills.  risk ofo opioid or other drug misuse.  to, the following:  being released from jail or prison, or other members of the general public. 2. Public health entities that provide free naloxone to anyone in the community.  Exhibits, page 10    3. Training and education regarding naloxone and other drugs that treat overdoses for first responders, overdose patients, patients taking opioids, families, schools, community support 4. Enable school nurses and other school stafft to respond to opioid overdoses, and provide them 5. Expand, improve, or develop data tracking software and applications for overdoses/naloxone  groups, and other members ofthe general public. with naloxone, training, and support.  revivals.  6. Public education relating to emergency responses to overdoses. 7.Public education relating to immunity and Good Samaritan laws.  8. Educate first responders regarding the existence and perationofimmuniy, and Good Samaritan 9. Syringe service programs and other evidence-informed programs to reduce harms associated with intravenous drug use, including supplies, staffing, space, peer support services, referrals to treatment, fentanyl checking, connections to care, and the full range of harm reduction and 10. Expand access to testing and treatment for infectious diseases such as HIV and Hepatitis C 11. Support mobile units that offer or provide referrals to harm reduction services, treatment, recovery supports, health care, or other appropriate services to persons that use opioids or persons 12. Provide training in harm reduction strategies to health care providers, students, peer recovery coaches, recovery outreach specialists, or other professionals that provide care to persons who use  laws.  treatment services provided by these programs. resulting from intravenous opioid use,  with OUD and any co-occurring SUD/MH conditions.  opioids or persons with OUD and any co-occurring SUD/MH conditions. 13.S Support screening for fentanyl in routine clinical toxicology testing.  PART THREE: OTHER STRATEGIES  I.FIRST RESPONDERS  In addition toi items in sections C, D, and H of this Exhibit relating to first responders, support the 1. Educate law enforcement or other first responders regarding appropriate practices and 2. Provision of wellness and support services for first responders and others who experience  following:  precautions when dealing with fentanyl or other drugs.  secondary trauma associated with opioid-related emergency events.  Exhibits, page 11    J.LEADERSHIP, PLANNING AND COORDINATION  Support efforts to provide leadership, planning, coordination, facilitation, training and technical assistance to abate the opioid epidemic through activities, programs, ors strategiesthati mayinclude, 1. Statewide, regional, local, or community regional planning toi identify root causes of addiction and overdose, goals for reducing harms related to the opioid epidemic, and areas and populations with the greatest needs for treatment intervention services; to support training and technical assistance; or to support other strategies to abate the opioid epidemic described in this opioid 2. A dashboard to share reports, recommendations, or plans to spend Opioid Settlement Funds; to show how Opioid Settlement Funds have been spent; to report program or strategy outcomes; or to track, share, or visualize key opioid-related or health-related indicators and supports as identified through collaborative statewide, regional, local, or community processes. 3. Invest in infrastructure or staffing at government or not-for-profit agencies to support collaborative, cross-system coordination with the purpose of preventing overprescribing, opioid misuse, or opioid overdoses, treating those with OUD and any co-occurring SUD/MH conditions, supporting them in treatment or recovery, connecting them to care, or implementing other strategies to abate the opioid epidemic described in this opioid abatement strategy list. 4. Provide resources to staff government oversight and management of opioid abatement  but are not limited to, the following:  abatement strategy list.  programs. K. TRAINING  Ina addition tot the training referred to throughout this document, support training to abate the opioid epidemic through activities, programs, or strategies that may include, but are not limited to, the 1.P Provide funding for stafftraining or networking programs and services to improve the capability ofg government, community, and not-for-profit entities to abate the opioid crisis. 2. Support infrastructure and staffing for collaborative cross-system coordination to prevent opioid misuse, prevent overdoses, and treat those with OUD and any co-occurring SUD/MH conditions, or implement other strategies to abate the opioid epidemic described in this opioid abatement  following:  strategy list (e.g., health care, primary care, pharmacies, PDMPS, etc.).  L. RESEARCH  Support opioid abatement research that may include, but is not limited to, the following: 1. Monitoring, surveillance, data collection, and evaluation of programs and strategies described  in this opioid abatement strategy list. 2. Research non-opioid treatment of chronic pain.  Exhibits, page 12    3. Research on improved service delivery for modalities such as SBIRT that demonstrate 4. Research on novel harm reduction and prevention efforts such as the provision of fentany! test 5. Research on innovative supply-side enforcement efforts such as improved detection of mail- 6. Expanded research on swift/certain/fair models to reduce and deter opioid misuse within criminal justice populations that build upon promisinga approaches used to address other substances 7. Epidemiological surveillance of OUD-related behaviors in critical populations including individuals entering the criminal justice system, including but not limited to approaches modeled 8. Qualitative and quantitative research regarding public health risks and harm reduction opportunities within illicit drug markets, including surveys of market participants who sell or 9. Geospatial analysis of access barriers to MAT and their association with treatment engagement  promising but mixed results in populations vulnerable to opioid use disorders.  strips.  based delivery ofsynthetic opioids.  (e.g. Hawaii HOPE and Dakota 24/7).  on the Arrestee Drug Abuse Monitoring (ADAM) system.  distribute illicit opioids. and treatment outcomes.  Exhibits, page 13    EXHIBIT C to NC MOA:  COLLABORATIVE STRATEGIC PLANNING PROCESS UNDER OPTION B  ACTIVITY ACTIVITY NAME Engage A diverse stakeholders B Designate facilitator planning Agree on  CONTENTOF REPORT & RECOMMENDATIONS Report on stakeholder engagement) per "ITEMA DETAIL" below Identify the facilitator Report any related planning efforts you will build upon or coordinate with Report on shared vision  DETAIL  Engage diverse stakeholders, "ITEM Al DETAIL"! throughout the collaborative strategic planning Designate aj person or entity to facilitate the strategiccollaborative planning process. Consider a trained, neutral facilitator. including but not] limited to community health assessinents. Agree on as shared vision for positive community change, considering how strategic investments of Opioid Settlement Funds have the root causes ofa addiction, drug misuse, overdose, andi related issues change gauge progress towards the shared vision. (The NC Opioid. Action Report on the key  per  below, process  Build upon Build upon or coordinate with prior or concurrent planning efforts any related that address addiction, drug misuse, overdose, or relatedi issues,  shared vision potential toi improve community health and well-being and address for positive community  Identify key Identify one or more population-level measures to monitor in order to indicator(s) Plan Data Dashboard contains several such measures.) Identify and Explore root causes of addiction, drug misuse, overdose, and related F explore root issues in the community, using quantitative data as well as Identify and Identify potential strategies to address root causes or other aspects of Identify gaps For each potential strategy identified (or for favored strategies),  E  indicators selected Report on root causes as  causes evaluate potential strategies efforts Prioritize strategies Identify goals, J measures, and evaluation plan Consider K ways to align strategies Identify  stakeholder narratives, community voices, the stories of those with described  lived experience, or similar qualitative information  the opioid epidemic; identify these strategies (by letter ori nunber) on Identify and evaluate EXHIBIT A or EXHIBIT B, and consider the effectiveness ofe each potential strategies  strategy based on available evidence  H ine existing survey existing programs, services, or supports that address the same Report ons survey of and  ors sinilar issues; and identify gaps or shortcomings Prioritize strategies, taking into account yours shared vision, analysis ofroot causes, evaluation of each strategy, and analysis of gaps in For eachs strategy (or favored strategy), develop goals and an evaluation plan that includes at least one process measure (How doi it?), and at least one outcome measure (Is anyone better off?) For each potential strategy identified (or for favored strategies), funding streams; develop regional solutions; form strategic partnerships; or to pursue other creative solutions  gaps in existing efforts Report on prioritization of strategies Report on goals, measures, each chosen strategy Report on opportunities to described strategy  existing efforts  much did you do?), at least one quality measure (How well did you and evaluation plan for  consider opportunities to braid  Settlement Opioid  Funds with other align strategies as  Identify organizations and agencies with responsibility toi implement Identify organizations and  organizations each strategy; andi identify the human, material, and capital resources needs to implement each  toi implement eachs strategy  Exhibits, page 14    Develop timelines Offer dations  Develop: a detailed global budget for each strategy with anticipated  M budgets and expenditures, along with timelines for completing components of N recommen- Offer recommendations to local governing body (e.g., the county  Report budgets and timelines for each strategy Report recommendations tog governing body  each strategy  board, city council, or other local governing body)  ITEM. Al DETAIL: STAKEHOLDER INVOLVEMENT  STAKE- A- Local officials 2 providers 3 providers Education A- and service providers 5 funders A- Law A-  CONTENT OF REPORT& RECOMMENDATIONS involvement (who and how involvedi inj process)  HOLDERS DESCRIPTION  County and municipal officials, such as those with responsibility over Report stakeholder  public health, social services, ande emergency services Hospitals and] health systems, addiction professionals and other  A- Healthcare providers of behavioral health services, medical professionals, A- Social service Providers ofhuman services, social services, housing services, and  pharmacists, community health centers, medical safety net providers, same as above community health services such as harm reduction, peer support, and same Educators, such as representatives of] K-12 schools, community job skills training, or related employment services  and other healthcare providers recovery support services  4 employment colleges, and universities; and those providing vocational education, same A- Payers and Health care payers and funders, such as managed care organizations,  prepaid health plans, LME-MCOs, private insurers, and foundations same  6 enforcement Law enforcement and corrections officials 7 Employers Employers and business leaders  same same same.  Community groups, such as faith communities, community coalitions youth leadership organizations, and grassroots community Stakeholders with' "lived experience," such as people with addiction,  A- Community that address drug misuse, groups supporting people in recovery,  groups  organizations  A- Stakeholders people who use drugs, people in medication-assisted or other with' "lived treatment, people in recovery, people with criminal justice experience" involvement, and family members or loved ones of the individuals Stakeholders Stakeholders who represent the racial, ethnic, economic, and cultural 10 diversity of Americans, members of thel LGBTQ community, andi members of community traditionally unrepresented or underrepresented, groups  same  just listed  A- reflecting  diversity of the community, such as people ofcolor, Native  same  Exhibits, page 15    EXHIBIT DTONCI MOA: COORDINATION GROUP  COMPOSITION  The Coordination Group shall consist of the following twelve members:  Five Local Government Representatives:  Four appointed by the North Carolina Association ofCounty Commissioners including:  One county commissioner One county manager One county attorney  One county local health director or consolidated human services director One municipal manager appointed by the North Carolina League ofMunicipalities  Four Experts Appointed by the Department ofHealth and Human Services  Four appointed by the Secretary ofthe Department ofl Health and Human Services, having relevant experience or expertise with programs or policies to address the opioid epidemic, or with behavioral health, public health, health care, harm reduction, social services, or  emergency services.  One Expert Appointed by the Attorney General  One appointed by the Attorney General of North Carolina from the North Carolina Department of Justice or another state agency, having drug policy or behavioral health  experience or expertise.  Two Experts Appointed by Legislative Leaders  One representative from the University of North Carolina School of Government with relevant expertise appointed by the Speaker of the North Carolina House of One representative from the board or staff oft the North Carolina Institute of Medicine with relevant expertise appointed by the President Pro Tem oft the North Carolina Senate. The coordination group may appoint a non-voting administrator to convene meetings and facilitate the work oft the coordination group. The administrator will not bej paid from the Opioid Settlement Appointees shall have relevant experience or expertise with programs or policies to address the opioid epidemic, behavioral health, public health, health care, socialservices, emergency services, Those responsible for making appointments to the coordination group are encouraged to appoint individuals who reflect the diversity of North Carolina, taking into consideration the need for geographic diversity; urban and rural perspectives; representation of people of color and  Representatives.  Funds distributed under this MOA.  harm reduction, management oflocal government, or other relevant areas.  Exhibits, page 16    traditionally underrepresented groups; and the experience and perspective of persons with "lived experience." Those responsible for making appointments may appoint a successor or replace a member at any time. Members of the coordination group serve until they resign or are replaced by the appointer. Eight members oft the coordination group constitutes a quorum.  RESPONSIBILITIES  a. As provided in Section F.2 oft the MOA, where no compliance audit would be required under the Federal Single Audit Acto of1 1984 for expenditures ofOpioid Settlement Funds, ac compliance audit shall be required under a compliance supplement established by a vote of at least 8 members of the coordination group. The compliance supplement shall i. Whether the Local Government followed the procedural requirements ofthe ii. Whether the Local Government's expenditures matched one oft the types of opioid-related expenditures listed in Exhibit A oft the MOA (ift the Local Government selected Option A) or Exhibit B oft the MOA (ifthe Local  address, at least, procedures for determining:  MOA in ordering the expenditures.  Government selected Option B).  iii. Whether the Local Government followed the reporting requirements in the MOA. iv. Whether the Local Government (or sub-recipient of any grant or loan, if  applicable) utilized the awarded funds for their stated purpose, consistent with this  MOA and other relevant standards.  V. Which processes (such as sampling) shall be used:   Tol keep the costs oft the audit at reasonable levels; and ii, Tailor audit requirements for differing levels ofe expenditures among  different counties.  b. The coordination group may, by a vote ofat least 8 members, propose amendments to the MOA as discussed in Section H of the MOA or modify any oft the following: i. Thel high-impact strategies discussed in Section E.5 oft the MOA and described in ii. The collaborative strategic planning process discussed in Section E.5 oft the MOA iii. The annual financial report discussed in Section F.4 ofthel MOA and described in iv. The impact information discussed in Section F.4 of the MOA and described in  Exhibit A to the MOA;  and described inl Exhibit C to the MOA;  Exhibit E to the MOA; Exhibit F to the MOA; or  V. Otheri information reported to the statewide opioid dashboard.  Exhibits, page 17    C. The coordination group may, by consensus or by vote of a majority ofmembers present and voting, work with the parties to this MOA, the North Carolina Association ofCounty Commissioners, the North Carolina League ofl Municipalities, other associations, foundations, non-profits, and other government or nongovernment entities to provide support to Local Governments in their efforts to effectuate the goals and implement the terms ofthis MOA. Among other activities, the coordination group may coordinate, facilitate, support, or participate in any ofthe following activities:  Providing assistance to Local Governments in identifying, locating, collecting, analyzing, or reporting data used to help address the opioid epidemic or related ii. Developing resources or providing training or technical assistance to support Local Governments in addressing the opioid epidemic and carrying out the terms iri. Developing pilot programs, trained facilitators, or other resources to support the collaborative strategic planning process described in this MOA; iv. Developing and implementing a voluntary learning collaborative among Local Governments and others to share best practices in carrying out the terms oft this MOA and addressing the opioid epidemic, including in-person or virtual V. Developing voluntary leadership training programs for local officials on strategies to address the opioid epidemic, opportunities forl Local Governments to harness the ongoing transition to value-based healthcare, and otherrelevant topics; vi. Taking other actions that support Local Governments in their efforts to effectuate the goals and implement the terms of this MOA but do not in any way change the terms oft this MOA or the rights or obligations ofj parties to this MOA.  challenges, including data referred to in Exhibit F;  oft this MOA;  convenings or connections;  Exhibits, page 18    EXHIBIT ETO NC MOA: ANNUAL FINANCIAL REPORT  Each annual financial report must include the following financial information:  1. The amount of Opioid Settlement Funds in the special revenue fund at the beginning 2. The amount of Opioid Settlement Funds received during the fiscal year. 3. The amount of Opioid Settlement Funds disbursed or applied during the fiscal year, broken down by funded strategy (with any permissible common costs prorated among 4. The amount of Opioid Settlement Funds used to cover audit costs as provided in 5. The amount of Opioid Settlement Funds in the special revenue fund at the end ofthe  ofthe fiscal year (July 1).  strategies).  Section F.3 ofthis MOA. fiscal year (June 30).  AllLocal Governments that receive two-tenths of one percent (0.2 percent) or more ofthe total Local Government Allocation as listed in Exhibit G shall provide the following additional  information:  6. For all Opioid Settlement Funds disbursed or applied during the fiscal year as reported in item 3 above, a single breakdown of the total amount disbursed or applied for all funded strategies during the fiscal year into the following categories: b. Subcontracts, grants, or other payments to sub-recipients involved in implementing oft the funded strategies listed item 4 above.  a. Human resource expenditures. Operational expenditures. d. Capital expenditures. e. Other expenditures.  7. With respect to item 6.b above, the Local Government shall provide the following information for any sub-recipient that receives ten percent or more oft the total amount that the Local Government disbursed or applied during the fiscal year: b. The amount received by the sub-recipient during the fiscal year. , Av very briefdescription oft the goods, services, or other value provided by the sub-recipient (for example, "addiction treatment services" or peer-support services" or "syringe service program" or "naloxone purchase").  a. The name of the sub-recipient.  The coordination group may clarify or modify specifications for this annual financial report as  provided in Exhibit D.  Exhibits, page 19    EXHIBIT FTO NC MOA: IMPACTINFORMATION  Within 90 days of the end of any fiscal year in which a Local Government expends Opioid Settlement Funds, the Local Government shall report impact information for each strategy that it funded with Opioid Settlement Funds during that fiscal year ("funded strategy"), using the The STANDARD FORM is recommended to all Local Governments for all funded strategies.  STANDARD FORM or the SHORT FORM for each funded strategy. However, Local Governments may use the SHORT FORM as follows:  AIILocal Governments that receive less than 0.2 percent (two-tenths ofc one percent) ofthe total Local Government Allocation as shown on Exhibit G may use the SHORT FORM All Local Governments that receive 0.2 percent (two-tenths of one percent) or more but less than 0.3 percent (three-tenths ofone percent) ofthe totall Local Government Allocation as shown on Exhibit G must use the STANDARD FORM for the funded strategy that received the largest amount of settlement funds during the fiscal year and may use the All Local Governments that receive 0.3 percent (three-tenths of one percent) or more but less than 0.4 percent (four-tenths ofone percent) ofthe total Local Government Allocation as shown on Exhibit G must use the STANDARD FORM for the two funded strategies that received the largest amount ofs settlement funds during the fiscal year and may use the  for all funded strategies.  SHORT FORM for all other funded strategies.  SHORT FORM for all other funded strategies.  STANDARD FORM  1. County or municipality and fiscal year covered by this report. 2. Name, title, and organization of person completing this report.  3. Name of funded strategy, letter and/or number of funded strategy on Exhibit A or Exhibit B to the MOA, and number and date ofresolution(s) authorizing expenditure of settlement 4. Briefprogress report describing the funded strategy and progress made during the fiscal 5. Briefsuccesss story from a person who has benefitted from the strategy (de-identified unless the person has agreed in writing to be identified). Recommended length: approximately one 6. One or more process measures, addressing the question, "How much did you do?" Examples: number of persons enrolled, treated, or served; number of participants trained; 7. Oneor more quality measures, addressing the question, "How well did you do it?" Examples: percentage ofc clients referred to care or engaged in care; percentage of staffv with  funds on funded strategy.  year. Recommended length: approximately one page (250 words).  page (250 words).  units ofnaloxone or number ofs syringes distributed.  Exhibits, page 20    certification, qualifiçation, or lived experience; level ofclient or participant satisfaction 8. One or more outcome measures, addressing the question, "Is anyone better off?" Examples: number or percentage of clients with stable housing or employment; self-reported measures of client recovery capital, such as overall well-being, healthy relationships, or ability to. manage affairs; number or percentage of formerly incarcerated clients receiving community services or supports within X days ofleaving jail or prison. 9. Inc connection with items 6, 7,and 8 above, demographic information on the participation or performance of people of color and other historically marginalized groups. The State will provide counties and municipalities with recommended measures and sources of data for common opioid remediation strategies such as those listed in Exhibit A. Counties or municipalities that have engaged in collaborative strategic planning are encouraged to use the measures for items 6 through 8 above identified through that process.  shown in survey data.  SHORT FORM  1. County or municipality and fiscal year covered by this report. 2. Name, title, and organization of person completing this report.  3. Name offt funded strategy, letter and/or number of funded strategy on Exhibit A or Exhibit B to the MOA, and number and date ofresolution(s). authorizing expenditure of settlement 4. Briefprogress report describing the funded strategy and progress made on the funded strategy during the fiscal year. Recommended length: approximately one-halfto one page  funds on strategy.  (125-250 words).  Exhibits, page 21    EXHIBIT GTONCI MOA:  LOCAL GOVERNMENT ALLOCATION PROPORTIONS  Counties: Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee Chowan Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham Edgecombe Forsyth Franklin Gaston Gates Graham Granville  13780289676124909s 0.51000787958051494 0.14909039892935294 0.18219296036652294 033863918852197494 02659967669300094 047788843488785894 0.139468575095652"4 04292178094761794 2.11523850759120094 251158785732273094 2.090196827047270'4 1.66957344662600094 127630114619465094 .07303640041266394 1.12846339385230094 0.17292023752467494 2.0726952269969094 044981438307758594 0.78275915290447894 .1570539612682196 0.22442994890457694 1199280277491209a 1.22093693898605094 133686019024719094 2.63729963963461094 0.18677855129444494 053312673127381194 19402693039325094 031314752686774594 0.3827851473968959a 1.797994362446096 04171019390266694 .06845080948474094 0.30050364329057894 09817388690771094 .07956751663241494 .8348456170848894 039010340934014094  Exhibits, page 22    Greene Guilford Halifax Harnett Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones Lee Lenoir Lincoln Macon Madison Martin McDowell Mitchell Montgomery Moore Nash Onslow Orange Pamlico Pasquotank Pender Perquimans Person Pitt Polk Randolph Richmond Robeson Rockingham Rowan Rutherford Sampson Scotland  0.1232748186477994 37501523114790094 0453/6117397626494 098898077219889094 08033151101104594 1.38159508704093094 020684305012875494 033248580457015796 0.02723735408560394 2.11593137454002094 0.5077577313306749a 125088746821767094 0.08796098699463196 0.65311568361453494 .60428259262568794 0.92683362712525394 04667676010074594 023777649610488894 02328822205795159a 0.58754457649285694 030931415156413794 02260505430419394 097173911277548194 0.84565363963510294 1.64400136471085094 1.0583941902309094 0.11993615102800194 037481621081533494 0.58574933186031294 0.11183318034491494 040302429672713194 1.36900806641593094 026014298595485194 152543398617418094 0.749132839979529s 135973534357408094 1.3636883747756094 33521928791337094 09289416179946874 0.6195137405262269a 0.491482742094029s  Mecklenburg .03830125992055094  New Hanover 289726489200101094 Northampton .120962389218789s  Exhibits, page 23    Stanly Stokes Surry Swain Transylvania Tyrrell Union Vance Wake Warren Washington Watauga Wayne Wilkes Wilson Yadkin Yancey Municipalities: Asheville Canton Cary Charlotte Concord Durham Fayetteville Gastonia Greensboro Greenville Henderson Hickory High Point Jacksonville Raleigh Wilmington  0.7249742085895594 0.62395311243430594 141082670609165094 028116292860450296 049759550945143594 0.04144090720778594 46670267986970094 0536258255282162"a 4.90245566720551094 .106.39058349512294 0.07477072045360494 0.4696757993988894 0.97069933307880494 199717716058910094 0.6464708414904594 0.5621471450736384 0.382149768892729a  02358147242529894 0.01145382322120594 0.14415164537013794 124748381436683094 022745587028748394 0.38040502668497194 030976905518143394 02577638237898394 05273916963843296 0.1626647465943294 0.03225347879418194 0.0948758368231594 02064287629058596 .0950098697884094 .56672461272267994 .1194974939684694  Winston-Salem 04944399238036494  Exhibits, page 24    MEMORANDUM OF AGREEMENT  BETWEEN: THE STATE OF NORTH CAROLINA AND LOCAL GOVERNMENTS ON PROCEEDS RELATING TO' THE SETTLEMENT OF OPIOIDLITIGATION IN WITNESS WHEREOF, the parties, through their duly authorized officers, have  executed this Memorandum of Agreement under seal as oft the date hereof.  SIGNATURE PAGE FOR MACON COUNTY ANDITS MUNICIPALITIES  County Government  MACON COUNTY  By:  Name: Title: Date:  Municipal Governments  By:  By:  Name: Title: Date:  Name: Title: Date:    MACON COUNTY BOARD OF COMMISSIONERS  AGENDA ITEM  CATEGORY - CONSENT AGENDA  MEETING DATE: May 11,2021  Item 12A. Minutes from the March 9, 2021 regular meeting are nearly complete and will be forwarded to you in a separate email. (Mike Decker) Item 12B. Budget Amendments #255-264 are attached for your review and Item 12C. Approval of tax releases in the amount of $1,509.71 for the Item 12D. Approval of an amendment to the Capital Project Ordinance for the Macon Middle School Renovation project in the amount of $10,496,435. Item 12E. Approval of an amendment to the Capital Project Ordinance for the Macon Middle School Locker Room project in the amount of Item 12F. Approval of COVID-19 vaccine administration billing updates and fees for the Macon County Health Department. The Macon County Board of Health voted to approve this item on April 27, 2021, a copy of which is attached. (Carrie Pazcoguin, Finance Section Administrator, Public 12G. A copy of the ad valorem tax collection report, which shows an overall 97.96 percent collection rate as of April 30, 2021. No action is  approval. (Lori Carpenter)  month of April 2021. (Teresa McDowell)  (Lori Carpenter)  $1,088,868. (Lori Carpenter).  Health)  necessary. (Teresa McDowell)    MACON COUNTY BUDGET AMENDMENT AMENDMENT# # 255 FROM: FINANCE DEPARTMENT: TRANSIT EXPLANATION: ACCOUNT 11-3839-485000 11-4935-556503  Move insurance funds received for vehicle accident  (veh 302-03-31-21 accident) DESCRIPTION INSURANCE SETTLEMENT VEHICLE REPAIR & MAINT  INCREASE DECREASE $ 2,660.00 $ 2,660.00  Kunun Cngp Pslaps  REQUESTED BY DEPARTMENT HEAD: RECOMMENDED BY FINANCE OFFICER: APPROVED BY COUNTY MANAGER:  ACTION BY BOARD OF COMMISSIONERS: 6luhoinuting  APPROVED AND ENTERED ON MUNIS DATED:  CLERK:    MACON COUNTY BUDGET AMENDMENT AMENDMENT # 256 FROM: FINANCE DEPARTMENT: TRANSIT  EXPLANATION: Receive Third Allocation of CARES ACT Funds  ACCOUNT 11-3570-445715 11-4935-561102  DESCRIPTION CARES ACT NCDOT 20.509 CARES ACT  INCREASE DECREASE $ 160,000.00 $ 1 160,000.00  Kin Ongel Aunlagpta  REQUESTED BY DEPARTMENT HEAD: RECOMMENDED BY FINANCE OFFICER: APPROVED BY COUNTY MANAGER: ACTION BY BOARD OF COMMISSIONERS: APPROVED: AND ENTERED ON MUNIS DATED:  Slukoi mechy  CLERK:    MACOIN COUINT DUDJEI AMENDMENI  AMENDMENTL257 DEPARTMENT: HEALTH EXPLANATION:  Ftzl  Agreement Addemdum for FY22 includes monies that are budgeted to  pay for June 2021 expenses. The budget for FY22 needs to beea reducedby $5062 in order to cover the June 2021 expenses. Need to increase Revenue Budget from $86,971 to $92,033 and increase expenditures in 115125-555106 from $53,436 to $58,498. This increase will  cover the June 2021 expenses.  ACCOUNT 115125-555106 113511-426001  DESCRIPTION Contracted Services Tobacco Grant  INCREASE  DECREASE  5,062 5,062  REQUESTED BY DEPARTMENTI HEAD RECOMMENDED BY FINANCE OFFICER APPROVED BY COUNTY MANAGER  buridkin  Bexlapp  ACTION BY BOARD OF COMMISSIONERS SlR0al merbng  APPROVED AND ENTERED ON MINUTES DATED  CLERK    MMACOIN COUI AMENDMENT! 258 - DEPARTMENT: HEALTH EXPLANATION:  AMENDMENI  Aal  Agreement Addemdum for FY22 includes monies that are budgeted to  pay: for June 2021 expenses. The budget for FY22 needs to been reduced by $4683 in order to cover the June 2021 expenses. Need to increase total Budget for FY21 from $191,682 to $196,365 in revenue and expenditures. This increase will cover the June 2021 expenses.  ACCOUNT 115153-565031 113511-426007  DESCRIPTION  INCREASE  DECREASE  Minority Diabetes Prevention Grant Minority Diabetes Prevention Grant  4,683 4,683  REQUESTED BY DEPARTMENTI HEAD hzake  RECOMMENDED BY FINANCE OFFICER APPROVED BY COUNTY MANAGER  Kuslyso  ACTION BY BOARD OF COMMISSIONERS 5laa0al ynehng  APPROVED AND ENTEREDONI MINUTES DATED  CLERK    MACON COUNTY BUDGET AMENDMENT AMENDMENTLR59 FROM: Robert LI Holland DEPARTMENT: ACCOUNT 11-3839-4850-00 1I1-4313-5696-01  Sheriff DESCRIPTION Insurance Settlement Vehicle  EXPLANATION: 20301 Dedge Dufango Vin 436os- ttalloss  INCREASE $31,507.00 $31,507.00  DECREASE  REQUESTED BY DEPARTMENT HEAD RECOMMENDED BY FINANCEO OFFICER APPROVED BY COUNTY MANAGER  u Capto  ACTION BY BOARDO OF COMMISSIONERS 5llf0aL mechngy  APPROVED AND ENTERED ON MINUTES DATED  CLERK    MACON COUNTY BUDGETAMENDMENT AMENDMENTE 6D FROM: Lindsay Leopard DEPARTMENT: Sheriff'sOffice  EXPLANATION: Move money to cover expenditures for the remaining of FY20-21.  ACCOUNT 113850-445800  DESCRIPTION Donations  INCREASE $2,700.00 $2,700.00  DECREASE  114310-55601 Operating Supplies K-9  REQUESTED. BY DEPARTMENTI HEAD RECOMMENDED BY FINANCE OFFICER APPROVED COUNTY    a  BY  MANAGER  ACTION BY BOARD OF COMMISSIONEBS APPROVED. AND ENTERED ON MINUTES DATED  5l/20a1 meehng  CLERK    MACON COUNTY BUDGE/AMENDMENT AMENDMENT# DEPARTMENT Occupancy tax  alol  EXPLANATION Amend occupancy tax budget to reflect increased revenue  ACCOUNT  DESCRIPTION  INCREASE  DECREASE 829,405 190,352 254,683 110,821 254,683 829,405 190,352 110,821  283344 432002/OCCUPANCYT TAX HIGHLANDS 283344 432003JOCCUPANCYI TAXI NANTAHALA 283344 432004/OCCUPANCYT TAXF FRANKLIN 283344 432005/ADMINSTRATIVE FEE/OT 284920 537001 FRANKLIN CHAMBER/OT 284920 537002,HIGHLANDS CHAMBER/OT 284920 537003 NANTAHALA DISTRICT/OT 284920 537004/ADMINSTRATVE FEE/OT  REQUESTED BY DEPARTMENT HEAD RECOMMENDED BY FINANCE OFFICER APPROVED BY COUNTY MANAGER ACTION BY BOARD OF COMMISSIONERS 5/11/2021 meeting APPROVED & ENTERED ONI MINUTES DATED  7 A  fapse  CLERK    MACON COUNTY BUDGET AMENDMENT# DEPARTMENT EXPLANATION ACCOUNT  372 Debt Service Fund  Refunding ofe existing debt- amend budget by $11,204,930  DESCRIPTION  INCREASE 9,820,000.00 1,384,930.00 201,121.00 11,003,809.00  DECREASE  303930 491000ADVANCE REFUNDING PROCEEDS 303930] 491200PREMIUMI ON BONDS 309300 519900ISSUANCE COSTS 309300] 575000PMT TO REFUNDING ESCROW. AGENT  REQUESTED BY DEPARTMENT HEAD RECOMMENDED BYF FINANCE OFFICER tmdps APPROVEDI BY COUNTYMANAGER ACTION BY BOARD OF COMMISSIONERS 6/fona/ APPROVED & ENTERED MINUTESDATED  mebg  ONN  CLERK    MACON COUNTYBUDGET AMENDMENT  AMENDMENTH DEPARTMENT EXPLANATION ACCOUNT  063 School Capital Projects  MMS renovation bondi issuance set up budget  DESCRIPTION  INCREASE DECREASE 9,500,000 996,435 1,046,368 256,441 817,800 8,178,000 197,826  463031 491000MMS BOND PROCEEDS 463031 491200/PREMIUME ONE BONDS 466031 519902,ARCHTECTFEES 466031 555100PROFESSIONAL FEES 466031 579000CONTINGENCY 466031 80900/CONSTRUCTION 466031 799400ISSUANCE COSTS  REQUESTED BY DEPARTMENT HEAD APPROVEDI BY COUNTY MANAGER ACTION BY BOARD OF COMMISSIONERS APPROVED: & ENTERED ON MINUTES DATED  RECOMMENDED BY FINANCE OFFICER auntapts  511/2021 mesnf  CLERK    MACON COUNTY BUDGET AMENDMENT  AMENDMENTH DEPARTMENT EXPLANATION ACCOUNT  3104 School Capital Projects  Movet transfer from general fund from MMS renovation tol MMSI locker room.  DESCRIPTION  INCREASE 1,053,868 1,053,868  DECREASE 1,046,368 7,500 1,053,868  466032 80900/CONSTRUCTION 466031 519902/ARCHITECTFEES 466031 5510OPROFESIONAL FEES  463032 980011MMS LOCKER TRANSFER FR GENF FUND 463031 980011MMS TRANSFER. FROM GENERAL FUND  REQUESTED BY DEPARTMENT HEAD RECOMMENDED BY FINANCE OFFICER APPROVED BY COUNTYMANAGER ACTION BYE BOARD OF COMMISSIONERS APPROVED CLERK  Muntps 51/202  & ENTERED ONI MINUTES DATED  merbny        MACON COUNTY, NORTRCAROLINA CAPITAL PROJECT ORDINANCE AMENDMENT MACON MIDDLESCHOOL RENOVATION  BEI IT ORDAINED byt thel Macon County Board ofComunissioners, Macon County, North Carolina, that, pursuant to Section 13.2 of Chapter 159 oft the General Statutes of! North Carolina, the  following capital project ordinance is hereby amnended:  SECTION1. The project authorized is Macon Middle School) Renovation.  SECTION2. The officers oft this unit are hereby directed to proceed with the capital project  within thet terms oft the financing agreement and the budget contained herein. SECTION3. The following amounts are appropriated for the project:  Architect Fees Issuance Costs Professional Fees Construction Contingency Total Bond proceeds Premium on bonds Total  $ 1,046,368 197,826 256,441 8,178,000 817.800 10,496.435 $ 9,500,000 996.435 $10,496.435  SECTION4. The following revenues are anticipated tol be available to complete the project:  SECTION5. The Finance Directori is hereby directed to maintain within the Capital Project Fund sufficient specific detailed accounting records to satisfy the requirements oft the financing agreement and SECTION 6. The Finance Director is hereby authorized to transfer appropriations between line SECTION7. Copies of this capital project ordinance shall be furnished to the County Manager  the General Statutes oft the State ofNorth Carolina. items within the capital projects fund.  andt the Finance Director for direction in carrying out this project. ADOPTED this 11"h day of May, 2021.  James P. Tate, Chairman Macon County Board of Commissioners    MACON COUNTY,NORTH CAROLINA CAPITAL! PROJECT ORDINANCE AMENDMENT MACON MIDDLE SCHOOL LOCKER ROOM  BE IT ORDAINED by the Macon County Board ofCommissioners, Maçon County, North Carolina, that, pursuant to Section 13.2 of Chapter 159 oft the General Statutes ofNorth Carolina, the SECTION1. The project authorized. is Macon Middle Schooll Locker Room. SECTION2. The ofticers ofthis unit are hereby directed top proceed with the capital project  following capital project ordinance is hereby amended:  within thet terms ofthe budget contained herein.  SECTION3. The following amounts are appropriated for the project:  Architect Fees Construction Total  S 35,000 $ 1.053,868 1.088.868 $ 1,088,868 1.088,868  SECTION 4. The following revenues: are anticipated to be available to complete the project:  Transfer from general fund Total  SECTION5. Thel Finance Director isl hereby directed to maintain within the Capital Project Fund sufficient specific detailed accounting records to satisfy the requirements oft the General Statutes of the SECTION 6. The Finance Director is hereby authorized to transfer appropriations between line SECTION7. Copies ofthis capital project ordinance shall be furnished to the County Manager  State ofNorth Carolina.  items within the capital projects fund.  and the Finance Director for direction in carrying outt this project. ADOPTED this 11h day ofMay,2021.  James P. Tate, Chairman Macon County Board of Commissioners    Fee (Updated)  CPT 913000  Name/Description  Pfizer-BioNTech Vaccine: Severe acute respiratory syndrome coronavirus 2 (SARS- MRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent Pfizer: Immunization administration by intramuscular injection of severe acute  $0.00 CoV-2) (Coronavirus disease [COVID-19]) vaccine, reconstituted, fori intramuscular use. respiratory syndrome coronavirus. 2 preservative free, 30 mcg/0.3mL dosage, diluent reconstituted; first dose. respratorysyndrome coronavirus2 preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; second dose.  0001A $ 50.00 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein,  Pfizer: Immunization administration byi intramuscular injection ofs severe acute  0002A $ 50.00 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein,  Moderna COVID-19 Vaccine: Severe acute respiratory syndrome coronavirus? 2 mRNA-LNP, spike protein, preservative free, 100 mcg/0.5ml dosage, for Moderna: Immunization administration byi intramuscular injection of severe acute  91301  $0.00 SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine,  intramuscular use.  repratorysyndrome coronavirus 2 preservative free, 100 mcg/0.5ml dosage; first dose. respiratory syndrome coronavirus 2 preservative free, 100 mcg/0.5ml dosage; second dose.  0011A $ 50.00 (SARS-COV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein,  Moderna: Immunization administration byi intramuscular injection of severe acute 50.00 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein,  0012A $  Janssen COVID-19 Vaccine (Johnson and. 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