Bill Summaries: H662 (2017-2018 Session)

  • Summary date: Apr 6 2017 - View summary

    Sets forth the legislative intent. Directs the Department of Health and Human Service (DHHS) to design a Carolina Cares health coverage program for NC residents in accordance with the act. Clarifies that it is the intent of the General Assembly that coverage under the Carolina Cares program is to be offered coincident with the implementation of Medicaid transformation and Prepaid Health Plans operating under the 1115 demonstration waiver, as provided for in SL 2015‑245, as amended. Allows DHHS to modify the 1115 demonstration waiver for Medicaid transformation submitted on June 1, 2016, to include the Carolina Cares program.

    Directs that NC residents must meet four criteria to be covered by the Carolina Cares program: (1) the resident is not eligible for Medicaid under the currently established North Carolina Medicaid program eligibility criteria, (2) the resident's modified adjusted gross income (MAGI) does not exceed 133% of the federal poverty level, (3) the resident is not entitled to or enrolled in Medicare Part A or Medicare Part B benefits, and (4) the resident is an adult who is no younger than age 19 and no older than age 64. Directs DHHS to define residency in a manner consistent with the residency requirements of NC's Medicaid State Plan.

    Directs DHHS  to design the benefit package to be similar to the coverage provided under specified Plans, and requires the package to comply with applicable federal requirements governing Alternative Benefit Plans. Directs the benefit package to focus on preventative care and participant wellness. Establishes that Prepaid Health Plans is to manage the benefits for the population covered by the Carolina Cares program through capitated contracts. 

    Details participant contributions under the Carolina Cares program, including provisions relating to premium requirements and exemptions from premium requirements. Details additional requirements of the Carolina Cares program, including co-payments, preventative care and wellness activities, and mandatory employment activities. 

    Requires the Carolina Cares program to built upon defined measures and goals for risk-adjusted health outcomes, quality of care, patient satisfaction, access, and cost. Requires each component to be subject to specific accountability measures, including penalties.

    Details three sources of funding for the Carolina Cares program, federal funds, participant contributions, and state funds. Directs that the program is not to be implemented if the funding from these sources is insufficient. 

    Directs DHHS to submit a Carolina Cares program design proposal, with a strategy for obtaining approval for federal funding for the program, to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice by January 1, 2018. Sets out other report requirements. Additionally, directs DHHS to submit either a copy of the draft demonstration waiver under Section 1115 of the Social Security Act necessary to effectuate the Carolina Cares program or a draft of any modifications to the 1115 demonstration waiver for Medicaid transformation that was submitted on June 1, 2016.