MEDICAID CHILDREN AND FAMILIES SPECIALTY PLAN. (NEW)

View NCGA Bill Details2021
House Bill 144 (Public) Filed Wednesday, February 24, 2021
AN ACT AUTHORIZING THE CHILDREN AND FAMILIES SPECIALTY PLAN AS AN ADDITIONAL MEDICAID MANAGED CARE PLAN AND MAKING OTHER CHANGES TO MEDICAID MANAGED CARE STATUTES.
Intro. by Lambeth.

Status: Ref To Com On Rules, Calendar, and Operations of the House (House action) (Jun 21 2022)

SOG comments (3):

Identical bill

Identical to S 146, filed 2/24/21.

Long title change

House committee substitute to the 1st edition changed the long title.  Original title was AN ACT TO ESTABLISH STANDARDS FOR THE PRACTICE OF TELEDENTISTRY AND TO AUTHORIZE PROPERLY TRAINED DENTAL HYGIENISTS TO ADMINISTER LOCAL DENTAL ANESTHETICS UNDER DIRECT SUPERVISION OF A LICENSED DENTIST.

Long title change

Senate committee substitute to the 3rd edition changed the long title. Previous long title was AN ACT TO ESTABLISH STANDARDS FOR THE PRACTICE OF TELEDENTISTRY, TO AUTHORIZE PROPERLY TRAINED DENTAL HYGIENISTS TO ADMINISTER LOCAL DENTAL ANESTHETICS UNDER DIRECT SUPERVISION OF A LICENSED DENTIST, AND TO PERMIT CERTAIN DENTAL HYGIENISTS TO PRACTICE DENTAL HYGIENE AT SCHOOLS WITHOUT A LICENSED DENTIST BEING PHYSICALLY PRESENT.

Bill History:

H 144

Bill Summaries:

  • Summary date: Jun 14 2022 - More information

    Senate committee substitute to the 4th edition makes the following changes. 

    Section 1

    Regarding the directive for the Department of Health and Human Services (DHHS) to issue an RFP to procure a single statewide children and families specialty plan (CAF specialty plan), with services to begin no later than December 1, 2023, now allows for proposal submissions from prepaid health plans (PHPs), as defined by statutory cross-references (previously, limited submissions to entities operating a standard benefit plan or a behavioral health and intellectual/developmental disabilities tailored plan (BH IDD tailored plan) contract with DHHS at the time the RFP is issued). Maintains the limitation of one response per eligible responding entity. Eliminates the provision specifying that eligible entities under common control or ownership with one another are limited to collectively submitting one response. Makes conforming changes to new GS 108D-62, set forth in Section 12, which establishes the requirements for the CAF specialty plan, expanding eligibility to respond to DHHS's RFP to include entities that meet the definition of PHP under GS 58-93-5 or GS Chapter 108D. 

    Adds a new directive for DHHS to request approval from the Centers for Medicare and Medicaid Services (CMS) to require that a child who is automatically enrolled in the CAF specialty plan under GS 108D-62(f), which includes Medicaid recipients who are children enrolled in foster care in the State, receiving adoption assistance, or former foster care youth under 26 years of age, or those recipients' children, excluded from PHP coverage under new GS 108D-40(a)(14), may not elect to enroll instead in a standard benefit plan or a BH IDD tailored plan unless it is in the best interest of the child.

    Section 7

    Makes a technical change to new GS 108D-24.

    Section 9 and 11

    Amends GS 108D-60, which details requirements for BH IDD tailored plans. Authorizes DHHS to contract with entities operating BH IDD tailored plans under a capitated or other arrangement for the management of BH, IDD, and traumatic brain injury services for any Medicaid recipient described in new GS 108D-40(a)(14) and excluded from PHP coverage (incudes recipients who are children enrolled in foster care in the State, receiving adoption assistance, or former foster care youth under 26 years of age), until the CAF specialty plan becomes operational. Amends new GS 108D-40(a)(14) to no longer permit this described population from voluntarily enrolling in a PHP operating a standard benefit plan or a BH IDD tailored plan until the CAF specialty plan becomes operational. 

    Section 12

    Further amends new GS 108D-62, adding to subsection (g), which allows eligible CAF specialty plan enrollees to enroll with a PHP operating a standard benefit plan or, if eligible, a BH IDD tailored plan. Specifies that this option is limited by any provision of a waiver or State Health Plan amendment approved by CMS. 

    Section 14

    Further amends GS 122C-115 to allow LME/MCOs operating BH IDD tailored plans to continue to manage, under DHHS contract, BH, IDD, or traumatic brain injury services for Medicaid recipients described in new GS 108D-40(a)(14) who are excluded from PHP coverage, until the CAF specialty plan becomes operational. 


  • Summary date: Jun 2 2022 - More information

    Senate committee substitute replaces the content of the 3rd edition with the following.

    Section 1

    Directs the Department of Health and Human Services (DHHS) to issue a request for proposals to procure a single statewide children and families specialty plan (CAF specialty plan) with services to begin no later than December 1, 2023. Limits proposal submissions to entities operating a standard benefit plan or a behavioral health and intellectual/developmental disabilities tailored plan (BH IDD tailored plan) contract with DHHS at the time the request for proposals is issued, and limits those entities one response each. Specifies that eligible entities under common control or ownership with one another are limited to collectively submitting one response. Directs DHHS to define the services available and the Medicaid and NC Health Choice beneficiaries who are eligible to enroll in the children and families specialty plan, except as otherwise specified in the act.

    Section 2

    Amends and adds to the defined terms set forth in GS 108D-1, applicable to the Chapter, which governs Medicaid and NC Health Choice Managed Care Programs. Adds and defines children and families specialty plan (CAF specialty plan) as statewide capitated prepaid health plan contract under the Medicaid transformation demonstration waiver that meets all of the requirements of Article 4 of the Chapter, as amended by the act, including the requirements pertaining to the CAF specialty plan, but excluding the requirements only pertaining to BH IDD tailored plans. Makes conforming changes. Amends the definitions provided for prepaid health plans (PHPs) and standard benefit plans to account for PHP contracts to operate CAF specialty plans in addition to BH IDD tailored plans. Eliminates the term closed network.

    Sections 3 and 9

    Revises and adds to the population categories exempt from capitated PHP contracts coverage for Medicaid and NC Health Choice program aid under GS 108D-40. Regarding the exempt category described in subdivision (a)(12) for recipients with a serious mental illness, a serious emotional disturbance, a severe substance use disorder, an intellectual/developmental disability, or who have survived a traumatic brain injury and who are receiving traumatic brain injury services, who are on the waiting list for the Traumatic Brain Injury waiver, or whose traumatic brain injury otherwise is a knowable fact, until BH IDD tailored plans become operational, at which time this population will be enrolled with a BH IDD tailored plan, revises the option for the described population from voluntarily enrolling with a PHP subject to the specified conditions, to provide for the option to voluntarily enroll with PHP operating a standard benefit plan, with access limited to the plan's covered behavioral health services, except as provided for recipients being served through the Community Alternatives Program for Disabled Adults (CAP/DA) under subdivision (a)(11). Eliminates the exclusion of coverage under subsubdivision (a)(13)c. for recipients who are enrolled in the foster care system, receiving Title IV-E adoption assistance, under the age of 26 and formerly were in the foster care system, or under the age of 26 and formerly received adoption assistance, for a time determined by DHHS of up to 5 years after the capitated PHP contracts begin. Enacts a new exclusion for recipient who, until the CAF specialty plan becomes operational, are: (1) children enrolled in foster care in this State; (2) receiving adoption assistance, or (3) former foster care youth until they reach the age of 26. Adds that, starting on the date that capitated contracts for BH IDD tailored plans begin, and until the CAF specialty plan becomes operational, recipients described in this new subdivision may voluntarily enroll in a PHP operating a standard benefit plan or, if eligible under GS 108D-40(a)(12), as amended, enroll with a BH IDD tailored plan. Provides that when the CAF specialty plan becomes operational, recipients described in new subdivision (14) will be enrolled in accordance with GS 108D-62, as enacted. Makes conforming changes.

    Amends GS 108D-5.3 to allow enrollees within the described groups to request disenrollment from a PHP (was, allowed to disenroll) at any time. Revises the groups to include beneficiaries who are described in new GS 108D-40(a)(14), and amended GS 108D-40(a)(12). Eliminates inclusion of beneficiaries who are in the form foster care Medicaid eligibility category and those who receive Title IV-E adoption assistance. 

    Section 4

    Amends GS 108D-21, regarding the closed network of providers maintained by LME/MCOs to furnish mental health, intellectual or developmental disabilities, and substance abuse services to its enrollees. Defines the closed network as the network of providers that have contracted with the LME/MCO operating the combined 1915(b) and (c) waivers.

    Sections 5 through 7

    Amends GS 108D-23, regarding the closed network of providers maintained by BH IDD tailored plans. Defines closed network as the network of providers that have contracted with the entity operating a BH IDD tailored plan to furnish behavioral health, intellectual and developmental disability, and traumatic brain injury services enrollees to enrollees. 

    Enacts GS 108D-24, requiring the entity operating the CAF specialty plan to develop and maintain a closed network of providers only for the provision of intensive in-home services, multi-systemic therapy, residential treatment services, and services provided in private residential treatment facilities. Adds that the closed network is the network of providers that have contracted with the entity operating the CAF specialty plan to furnish the services specified to enrollees.

    Amends GS 108D-22, which requires each PHP to develop and maintain a provider network that meets access to care requirements for its enrollees, to except the CAF specialty plan networks set out in new GS 108D-24 in addition to the existing exception for the BH IDD tailored plan networks set out in GS 108D-23.

    Section 8

    Amends GS 108D-35 to require all capitated PHP contracts to cover substance abuse comprehensive outpatient treatment program services, substance abuse intensive outpatient program services, and social setting detoxification services. Adds to Medicaid services capitated contracts are prohibited from covering to include those covered by LME/MCOs under an approved 1915(i) waiver. Makes organizational changes and authorizes the Revisor to make necessary technical changes to statutory references to reflect organizational changes made by the act to Article 4 of the Chapter. 

    Section 10

    Corrects a statutory cross-reference in GS 108D-45, to refer to the nature of contracts for standard benefit plans required under GS 108D-65(6) (was, GS 108D-65(3)). Eliminates the exemption for the statute's limitation on the number of contracts for BH IDD tailored plans described in GS 108D-60.

    Section 11

    Amends GS 108D-60, governing BH IDD tailored plans, to revise subdivision (a)(10), which requires automatic enrollment with an entity operating a BH IDD tailored plan for recipients described in GS 108D-40(a)(12), to now exclude recipients also described in new GS 108D-40(a)(14) who are to be enrolled under GS 108D-62, as enacted. Enacts a new subdivision, (a)(11), to exclude recipients described in GS 108D-40(a)(12) from having an option to voluntarily enroll with a PHP operating a standard benefit plan or the CAF specialty plan while receiving services offered to: recipients enrolled in the Innovations waiver; recipients enrolled in the Traumatic Brain Injury waiver; recipients residing in or receiving respite services at an intermediate care facility for individuals with intellectual/developmental disabilities; recipients enrolled in and being served under Transitions to Community Living; and recipients receiving State-funded residential services, including group living, family living, supported living, and residential supports. Makes a conforming change to subdivision (a)(10).

    Section 12

    Enacts GS 108D-62, defining CAF specialty plan and setting forth nine defined terms for the statute. Establishes the following requirements of a CAF specialty plan: requiring plans to result from RFPs issued by DHHS submitted by eligible PHPs under contract with DHHS; requiring operating entities to authorize, pay for, and manage all Medicaid and NC Health Choice services covered under the plan; requiring operating entities to operate care coordination functions and provide whole-person, integrated care across healthcare and treatment settings and foster care placements for enrollees; requiring operating entities to be the single point of care management accountability; and requiring DHHS to establish requirements for CAF specialty plan operations that address four considerations, including continuity of care and support across health care settings, changes in placement, and when the child transitions into the former foster youth Medicaid eligibility category. Requires the CAF specialty plans to cover the behavioral health, intellectual and developmental disability, and traumatic brain injury services excluded from standard benefit plan coverage under GS 108D-35(1), excluding five listed services, including innovation waiver services and Traumatic Brain Injury waiver services.

    Describes six categories of Medicaid and NC Health Choice recipients for eligible for CAF specialty plan enrollment, including recipients described in new GS 108D-40(a)(14) and their children, for as long as the parent remains enrolled unless the elects otherwise; adults identified on an open child protective services in-home family services agreement case and any minor children living in the same home; adults identified in an open Eastern Band of Cherokee Indians Department of Public Health and Human Services Family Safety program case and any children living in the same home; the minor siblings of a child in foster care who lived in the same home as that child at the time of the child's removal and with whom household reunification efforts are ongoing; recipients who have a child temporarily in foster care who meet three specified criteria; and any other recipients who have had involvement with the child welfare system and whom DHHS has determined would benefit from enrollment in the CAF specialty plan. Establishes three categories of recipients excluded from the CAF specialty plan, including recipients who are excluded from PHP coverage under GS 108D-40(a). 

    Establishes CAF specialty plan enrollment is voluntary except as follows. Provides for automatic enrollment in the CAF specialty plan of Recipients described in GS 108D-40(a)(14) and their children unless they are also recipients who have a child temporarily in foster care and meet the three described criteria, whereby enrollment is voluntary. Requires recipients eligible to enroll in the CAF specialty plan have the option to enroll with a PHP operating a standard benefit plan or, if eligible under GS 108D-40(a)(12), a BH IDD tailored plan, and specifies the effects of such enrollment. Allows for recipients enrolled in foster care, as described in GS 108D-40(a)(14)(i), who exit the custody of the county department of social services to elect to remain enrolled in the CAF specialty plan for 12 months after the date the recipient exits custody. Allows, in the case of recipients who achieve reunification, a parent, a caretaker relative, a custodian, a guardian, or a minor sibling with whom the recipient reunifies to elect to remain enrolled in the CAF specialty plan as long as the recipient remains enrolled.

    Section 13

    Amends GS 122C-3, which sets forth defined terms for the Mental Health, Developmental Disabilities, and Substance Abuse Act, adding CAF specialty plan to the Chapter's defined terms. Amends LME/MCO to provide for capitated PHP contracts under Article 4, GS Chapter 108D, as amended (rather than only specifying BH IDD tailored programs under the Article). 

    Section 14

    Amends GS 122C-115 to include recipients described in new GS 108D-40(a)(14) in the directives relating to LME/MCO responsibilities to manage Medicaid services before PHP plans under Article 4, GS Chapter 108A are operational. 

    Section 15

    Enacts GS 122C-115.5, authorizing an area authority to operate a CAF specialty plan under contract with DHHS so long as the area authority has a statewide catchment. Prohibits counties from withdrawing from or declining to participate in the statewide catchment area of the CAF specialty plan. 

    Changes the act's titles. 


  • Summary date: May 5 2021 - More information

    House committee substitute amends the 2nd edition as follows. Amends the act's short title by removing the reference to teledentistry. 


  • Summary date: Mar 9 2021 - More information

    House committee substitute amends the 1st edition as follows.

    Makes technical changes to a statutory cross-reference in proposed GS 90-30.2.

    Adds a new section amending GS 90-233, which governs the practice of dental hygiene. Expands the conditions in which certain described dental hygienists meeting specified experience requirements can perform dental hygiene functions without a licensed dentist physically present, to include performing dental hygiene services in schools. Makes conforming changes to the act's long title. 


  • Summary date: Feb 24 2021 - More information

    Section 1

    Amends GS 90-29 to exclude registered dental hygienists qualified to administer local anesthetics from the practice of dentistry. Expands the practice of dentistry to include individuals who, by use of electronic or digital means, own, manage, supervise, control or conduct any enterprise wherein any act otherwise defined as the practice of dentistry is done, attempted to be done, or represented.

    Enacts GS 90-30.2 authorizing teledentistry services to be delivered by a licensed dentist or licensed dental hygienist who is under the supervision of a licensed dentist. Requires informed consent of the patient or authorized person to be obtained prior to rendering teledentistry services and to be reflected in the patient's records, as specified. Allows for the transmission of data, electronic images, and related information appropriate to provide teledentistry services. Provides guidelines for patient care and explicitly authorizes evaluations to be conducted by a licensed dentist using teledentistry modalities. Details the determination of the encounter location for services provided. Mandates confidentiality consistent with HIPPA and other confidentiality laws and regulations regarding medical records. Additionally, requires patient records to be kept in the same manner as in-person dental records, as specified. Requires licensed dentists prescribing medication, lab services or dental lab services through teledentistry to adhere to applicable law and current standards of care, including appropriate documentation. Requires compliance with the NC Controlled Substance Reporting System, as appropriate. 

    Expands grounds for disciplinary action by the State Board of Dental Examiners (Board) authorized by GS 90-41 to include (1) allowing fee-splitting for the use of teledentistry services, and (2) limiting a patient's right or ability to raise grievances or file complaints with any appropriate oversight body.

    Section 2

    Expands the definition given for dental hygiene in GS 90-221 to include the administration of local anesthetics by infiltration and block techniques by certified dental hygienists under the direct supervision of a licensed dentist. Adds direct supervision to the defined terms used in Article 16, the Dental Hygiene Act. 

    Enacts GS 90-225.2 to establish clinical instruction requirements for licensed dental hygienists to qualify to administer local anesthetics. Requires instruction by lecture and lab or clinical formats at UNC School of Dentistry, ECU School of Dental Medicine, or a program accredited by the Council on Dental Accreditation (CODA), or similar federally approved organization. Requires at least a 30-hour session composed of 16 didactic hours and 14 clinical hours, with instruction by a dentist with a DDS or DMD degree. Sets standards for class ratios and scoring. Requires awarding a certificate upon successful completion.

    Enacts GS 90-225.3 to establish requirements for the Board to approve licensed dental hygienists to administer local anesthetics, including completing the required education and training, and practicing under the supervision of a licensed dentist for the preceding two years. Requires two hours of continuing education annually, as specified. Details further authorities of the Board regarding additional education and training when applicants cannot satisfy the specified requirements. 

    Applies to licenses granted or renewed on or after October 1, 2021. 

    Authorizes the Board to adopt temporary implementing rules.


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