Bill Summaries: H655 (2019-2020 Session)

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  • Summary date: Apr 10 2019 - View summary

    Includes whereas clauses.

    Part I.

    Requires the Department of Health and Human Services (DHHS) to design the NC Health Care for Working Families program (program), providing coverage to residents of the state who (1) meet all federal Medicaid citizenship and immigration requirements; (2) are not eligible for Medicaid under the currently established North Carolina eligibility criteria; (3) have a modified adjusted gross income that does not exceed 133% of the federal poverty level; (4) are not entitled to or enrolled in Medicare Part A or Part B benefits; and (5) are between the ages of 19 and 64.

    Requires that the benefit package be similar to the coverage provided under North Carolina's 2017 Essential Health Benefits Benchmark Plan and the Blue Cross and Blue Shield of North Carolina Blue Options Preferred Provider Organization Plan and requires it to comply with applicable federal requirements governing Alternative Benefits Plans. Requires program participants to pay an annual premium that is set at 2% of the participant's household income. Failure to pay within 90 days results in suspension from the program; sets out conditions under which participation may be reactivated. Requires DHHS to adopt rules related to premiums, including exemptions, from the requirements; sets out criteria for the premiums exemptions. Requires DHHS to develop cost-effective methods of accepting participant contributions that facilitate the participant's ability to make the contribution.  

    Requires co-payments to be comparable with those applied under the NC Medicaid State Plan. Requires DHHS to establish preventive care and wellness activities for the program. Requires DHHS to establish employment activities for program participants that adhere to federal guidance and are aligned with the work requirements of the Able-Bodied Adults Without Dependents policy under the Supplemental Nutrition Assistance Program as much as possible, with six categories of individuals exempted from the mandatory employee activities.

    Requires the program to be built on defined measures and goals for risk-adjusted health outcomes, quality of care, patient satisfaction, access, and costs, with components subject to accountability measures. 

    Limits the sources of funding for the program to federal funds, participant contributions, and State and county funds.

    Requires coverage to begin upon the earlier of (1) 120 days after the approval by the Center for Medicare and Medicaid Services of all State Plan amendments or amendments to the 1115  demonstration waiver submitted under this Section or (2) July 1, 2020.

    Sets out six conditions under which the program will not be implemented or will be terminated.

    Requires DHHS to report to the specified NCGA committee by October 1, 2019, with a design proposal for the program; specifies items that must be included in the report.

    Part II.

    Enacts new Article 3, Rural Access to Healthcare Grants, in GS Chapter 108B. Establishes the North Carolina Rural Access to Healthcare Grant Fund in the Department of Health and Human Services, Division of Central Management, Office of Rural Health (Office), to provide grants to qualified applicants for any of 10 eligible activities, including health care provider recruitment to rural areas, expansion of telehealth into rural areas, infant mortality reduction efforts, and expansion of mental health services into rural areas. Defines a qualified applicant as an individual or entity that meets criteria for applying for funds distributed under the Rural Access to Healthcare Grant Program, as established by the Office. Requires the Office to define the term rural. Limits grants to no more than $1 million. Prohibits grant recipients from applying for an additional grant until five years from the date of the first grant. Sets out issues the Office must consider when awarding grants. Allows the Office to require grantee to make annual reports.

    Provides that if H114 (an act to subject prepaid health plans licensed by the Department of Insurance to the gross premium tax) becomes law, then it is the NCGA's intent to appropriate funds to the North Carolina Rural Access to Healthcare Grant Fund in an amount that represents the amount of revenue from the gross premiums tax attributable to capitation payments received by prepaid health plans as a result of the implementation of the NC Health Care for Working Families program.