LME/MCO CLAIMS REPORTING/MENTAL HEALTH AMENDS. (NEW)

View NCGA Bill Details2015-2016 Session
Senate Bill 371 (Public) Filed Monday, March 23, 2015
AN ACT TO MODIFY CERTAIN REQUIREMENTS PERTAINING TO LOCAL MANAGEMENT ENTITIES/MANAGED CARE ORGANIZATIONS.
Intro. by Hartsell.

Status: Re-ref Com On Rules, Calendar, and Operations of the House (House Action) (Jul 1 2016)

SOG comments (2):

Change Short and Long Titles

House committee substitute to 2nd edition changed short and long titles.  Short title was LME/MCO Claims Reporting.  Long title was AN ACT TO MODERNIZE DATA COLLECTION BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES RELATED TO LME/MCO MANAGED CARE CLAIMS.

Change Long Title

Conference report changed long title of 3rd edition.  Long title was AN ACT TO MODERNIZE DATA COLLECTION BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES RELATED TO LME/MCO MANAGED CARE CLAIMS; REITERATE THE APPROVAL PROCESS FOR COUNTY DISENGAGEMENT; REFINE THE APPOINTMENT PROCESS FOR THE AREA BOARD; AMEND THE APPOINTMENT AND TERMINATION NOTICE FOR THE AREA DIRECTOR; CLARIFY THE SALARY APPROVAL PROCESS FOR EMPLOYEE SALARIES ABOVE THE ALLOWABLE AMOUNT; REMOVE THE SUNSET FOR THE PILOT PROGRAM TO STUDY THE USE OF ELECTRONIC SUPERVISION DEVICES IN CERTAIN FACILITIES; PROVIDE DIRECTION TO THE DEPARTMENT ON SINGLE‑STREAM ALLOCATION AND THE PROCESSING OF SINGLE‑STREAM ENCOUNTER CLAIMS OR OTHER NON‑MEDICAID CLAIMS THROUGH NC TRACKS; AND DEVELOP A PLAN TO EXTEND COMMUNITY GUIDE SERVICES.

Bill History:

S 371

Bill Summaries:

  • Summary date: Jun 30 2016 - More information

    Conference report makes the following changes to the 3rd edition.

    Changes the long title to AN ACT TO MODIFY CERTAIN REQUIREMENTS PERTAINING TO LOCAL MANAGEMENT ENTITIES/MANAGED CARE ORGANIZATIONS.

    Amends Section 1 of the act, which sets out the encounter data submission requirements for local management entities/managed care organizations (LME/MCOs), by deleting the proposed third requirement that required DHHS to share encounter data with the Government Data Analytics Center. Changes the date by which DHHS is required to report to the Joint Legislative Oversight Committee on Health and Human Services regarding the status of the section to on or before February 1, 2017 (previously, February 1, 2016). 

    Deletes the proposed additions to GS 122C-115.3, governing the Secretary of DHHS's approval of a county's withdrawal from an area authority on mental health, developmental disabilities, and substance abuse services operating under a 1915(b)/(c) Medicaid Waiver. The proposed language required the Secretary to adopt rules creating a process for withdrawal, as required by GS 122C-112.1(38) and SL 2012-151, and prohibited the Secretary from approving a county's withdrawal until these rules are established. 

    Enacts GS 122C-124.3, Authorization to direct mergers and acquisitions, to authorize the Secretary of DHHS to direct the merger of LME/MCOs and to direct the acquisition of an LME/MCO by another LME/MCO. Authorizes the Secretary of DHHS (Secretary) to set time lines and dates for the orderly completion of the mergers and acquisitions. Sets out 11 factors  related to each LME/MCO the Secretary must consider in directing mergers and acquisitions. Provides that the failure of an LME/MCO to comply with the Secretary's directions under the statute constitutes noncompliance for purposes of GS 122C-124.2(c) and constitutes cause for the Secretary to terminate all contracts between the DHHS and the LME/MCO. Expires June 30, 2018.

    Enacts GS 122C-147.3, LME/MCO use of funds, to authorize LME/MCOs to use funds only for purposes related to their functions and responsibilities under GS Chapter 122C, specifically including operation of the combined Medicaid Waiver program authorized under section 1915(b) and 1015(c) of the Social Security Act, or to carry out functions and responsibilities required by State law, federal law, or contract with DHHS. Establishes that a violation of the statute constitutes noncompliance for purposes of GS 122C-124.2(c). 

    Makes conforming changes to GS 122C-124.4(c), concerning the consequences of noncompliance by an LME/MCO, to include new GS 122C-124.3 and GS 122C-147.3 in the specified statutory requirements that constitute noncompliance and trigger the specified actions to be taken by the Secretary.

    Amends GS 122C-118.1, concerning the structure of boards of the area authorities, to allow the boards of county commissioners within certain large multicounty areas to appoint members of the area board through a process other than as required by this section if at least three-quarters of the counties (was, two thirds of the counties) adopt a resolution to that effect. Adds that no area board can be exempt from the membership composition requirements of subsection (b) of the statute (previously, allowed the Secretary to approve an appointment process that includes the constituent counties delegating appointment authority to intermediary bodies created by counties to represent regions of a multicounty area authority). Makes technical changes. Deletes the proposed revisions to subdivision (13) of subsection (b), which adjusted the board membership requirement for hospital administrators who serve as nonvoting members and participate only in board activities that are open to the public. Adds a new subsection (d1) to require each LME/MCO, beginning on July 1, 2017, to annually notify the Secretary of (1) the membership of the area board, (2) the county residence of each member, (3) how the membership composition requirements in subsection (b) of the statute are being met, (4) the term of office of each member, and (5) the LME/MCO's compliance with training requirements for its board members.

    Directs all area boards to comply with the requirements of GS 122C-118.1(a1), as enacted by the act, no later than February 1, 2017.

    Amends GS 122C-121, which sets out provisions relating to an area director, to establish that in no instance can the salary of an area director that is higher than the maximum applicable salary range exceed more than 40% the average salary of the area directors of the remaining LME/MCOs, as determined by the Secretary. Adds that if any director's salary that is higher than the maximum of the applicable salary range and exceeds by more than 40% the average salary of the area directors of the remaining LME/MCOs, the director's salary must be reduced to achieve compliance with subsection (a1) within 60 days after a determination by the Secretary. Adds new subsection (a3) to make the total compensation provided or recommended by each area board to its area director subject to review and approval by DHHS and the Office of State Human Resources (OSHR), at least annually. Prohibits an area board from increasing compensation to an area director prior to approval by the Secretary of DHHS and the Director of OSHR. Amends proposed subsection (e) to allow the Secretary to waive the requirements of subsection (e) (requiring the appointment of an area director to be based on the recommendation of at least two candidates by a search committee) when appointment of the area director results from the merger or consolidation of LME/MCOs. Amends proposed subsection (f) to clarify that, except as a result of the merger or consolidations of LME/MCOs, the area director cannot be terminated as specified without 30 days' prior written notice to the Secretary of DHHS.

    Deletes the three proposed uncodified sections, which (1) maintained and extended the pilot program of the Department's Division of Health Service Regulation to study the use of electronic supervision devices as an alternative means of supervision during sleep hours at facilities for children and adolescents who have a primary diagnosis of mental illness or emotional disturbance, (2) required the Department's Division of Mental Health, Developmental Disabilities, and Substance Abuse Services to distribute one-twelfth of each LME/MCO's allocation each month by the last working day of the month, and (3) required the Department to develop a plan for extending Community Guide services to individuals on the Medicaid Innovations Waiver waiting list and to report to the Joint Legislative Oversight Committee on Health and Human Services on the plan by March 15, 2016.  

    Amends SL 2015-241, Section 12F.2(a), to require DHHS, Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS), to distribute not less than one-twelfth of each LME/MCO's base budget allocation (previously, continuation allocation) at the beginning of the fiscal year, less the amount of that distribution from the LME/MCO's total reimbursements for the fiscal year. Additionally requires DHHS, DMH/DD/SAS. to distribute one-twelfth of each LME/MCO's single-stream allocation on or before the last working day of each month beginning with the first month of the fiscal year and continuing monthly thereafter. Effective July 1, 2016.


  • Summary date: Sep 24 2015 - More information

    House committee substitute makes the following changes to the 2nd edition. 

    Deletes the whereas clauses at the beginning of the act. Makes clarifying changes to the information LME/MCOs must submit. Amends the date by which the Department of Health and Human Services (Department) must report to the Joint Legislative Oversight Committee on Health and Human Services on encounter data submission requirements for local management entity/managed care organizations (LME/MCOs) from October 31, 2015, to February 1, 2016. 

    Adds new sections adding language to GS 122C-115.3 governing the Secretary (Secretary) of Health and Human Services's approval of a county's withdrawal from an area authority on mental health, developmental disabilities, and substance abuse services operating under a 1915(b)/(c) Medicaid Waiver. The new language requires the Secretary to adopt rules creating a process for withdrawal, as required by GS 122C-112.1(38) and SL 2012-151, and prohibits the Secretary from approving a county's withdrawal until these rules are established. 

    Amends GS 122C-118.1, pertaining to the structure of boards of the area authorities. The amendment allows the boards of county commissioners within certain large multicounty areas to appoint members of the area board through a process other than as required by this section if at least two thirds of the counties (was, each county) adopts a resolution to that effect. Allows the Secretary to approve an appointment process that delegates appointment authority to intermediary bodies. Adjusts the board membership requirement for hospital administrators who serve as nonvoting members who participate only in board activities that are open to the public. The amendment puts these limits on the membership of a hospital administrator only if the hospital receives reimbursement from the LME/MCO. 

    Amends GS 122C-121 (director of an area board) and GS 122C-154 (personnel) to require approval of certain salary adjustments by the Director of the Office of State Human Resources (Director) and by the Secretary (was, just the Director). Amends the statute on personnel to require an area board to submit documentation of comparable salaries in comparable operations within the region to the Director before approving a salary adjustment that is above the normal allowable salary. 

    Adds two new subsections to GS 122C-121 to require appointment of an area director based on the recommendation of a search committee with specified membership and requiring 30 days' prior written notice to the Secretary before an area director may be terminated. 

    Includes three new uncodified sections, as follows.

    The first uncodified section maintains and extends the pilot program of the Department's Division of Health Service Regulation to study the use of electronic supervision devices as an alternative means of supervision during sleep hours at facilities for children and adolescents who have a primary diagnosis of mental illness or emotional disturbance.

    The second section requires the Department's Division of Mental Health, Developmental Disabilities, and Substance Abuse Services to distribute one-twelfth of each LME/MCO's allocation each month by the last working day of the month.

    The third uncodified section requires the Department to develop a plan for extending Community Guide services to individuals on the Medicaid Innovations Waiver waiting list and requires the Department to report to the Joint Legislative Oversight Committee on Health and Human Services on the plan by March 15, 2016.  

    Makes technical changes. 

    Changes the act's short and long titles. 


  • Summary date: Apr 21 2015 - More information

    Senate committee substitute makes the following changes to the 1st edition.

    Deletes a whereas clause concerning NC Tracks.

    Adds additional requirements for encounter data submission for local management entities/managed care organizations to now include (1) requiring the Department of Health and Human Services (DHHS) to share encounter data with the Government Data Analytics Center for specified reasons, (2) requiring DHHS to work with LMEs/MCOs to ensure that the process for submitting encounter claims through NC Tracks is successful, and (3) requiring DHHS to report to the Joint Legislative Oversight Committee on Health and Human Services regarding the status of the included requirements on or before October 31, 2015. 


  • Summary date: Mar 23 2015 - More information

    Sets the following requirements for the encounter data submission requirements for local management entities/managed care organizations: (1)  requires LME/MCOs to submit to the Department of Health and Human Services (DHHS) encounter data, consisting of records of claims payments made to providers, for Medicaid and state‑funded mental health, intellectual and developmental disabilities, and substance abuse disorder services using a single nationally recognized, standardized electronic format, which is specified to the LME/MCOs in advance; (2) allows DHHS to use encounter data for purposes that include setting LME/MCO capitation rates, measuring the quality of services managed by LME/MCOs, and assuring compliance with state and federal regulations, and for oversight and audit functions; and (3) prohibits requiring LME/MCOs to resubmit encounter data rejected by NCTracks or other receiving systems except those rejected for noncompliance with the standardized electronic format. 


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