RURAL HEALTHCARE ACCESS & SAVINGS PLAN ACT. (NEW)

View NCGA Bill Details2021
Senate Bill 408 (Public) Filed Tuesday, March 30, 2021
AN ACT TO DIRECT OVERSIGHT, STUDY, AND MODERNIZATION OF MEDICAID IN NORTH CAROLINA, TO ENSURE TAXPAYER SAVINGS, AND TO ENSURE ACCESS TO HEALTHCARE FOR WORKING NORTH CAROLINIANS.
Intro. by Burgin, Krawiec, Perry.

Status: Ref To Com On Rules and Operations of the Senate (Senate action) (Jun 29 2022)

SOG comments (2):

Long title change

Senate committee substitute to the 1st edition changed the long title. Original long title was AN ACT ESTABLISHING THE STOP ADDICTION FRAUD ETHICS (SAFE) ACT OF 2021.

 

Long title change

House committee substitute to the 2nd edition changed the long title. Previous long title was AN ACT ESTABLISHING THE STOP ADDICTION FRAUD EMERGENCY (SAFE) ACT OF 2021.

 

Bill History:

S 408

Bill Summaries:

  • Summary date: Jun 28 2022 - More information

    House committee substitute to the 3rd edition makes the following changes. 

    Section 1.2

    Regarding the directive to the Department of Health and Human Services (DHHS) to develop a Medicaid Modernization Plan (plan) by December 15, 2022, revises the required components of the plan to include proposed legislation for the health system assessments outlined in Section 1.6 of the act (was, any proposed necessary refinements to the health system assessments enacted in Section 1.6). Makes a similar revision to refer to the healthy system assessment outlined in Section 1.6 in the funding sources identified in the nonfederal share of the costs that must fund the expanded Medicaid coverage, for which DHHS's plan must include proposed legislation to discontinue the expanded coverage upon the identified sources' inability to fully fund the share of costs. 

    Section 1.5

    Eliminates the content of Section 1.5, which set hospital health advancement assessments for private acute care hospitals and public acute care hospitals for specified periods in 2023, with DHHS required to reimburse county departments of health and human services for additional costs incurred to implement the adjustments to Medicaid eligibility described in the act.

    Section 1.6

    Eliminates the previous content of the following sections of the act: Section 1.6, which revised Article 7B, GS Chapter 108A, the Hospital Assessment Act and enacted a new Part to the Article, statutorily providing for the public hospital health system assessment and the private hospital health system assessment; Section 1.7, which revised other provisions of the Hospital Assessment Act, including the calculation of modernized hospital assessments; and Section 1.8, which stated legislative intent to consult with stakeholders and the Division of Health Benefits (DHS) prior to the 2023 Regular Session to consider any necessary refinements to the health system assessment enacted in Section 1.6. Instead provides the following uncodified language.

    States legislative intent to enact legislation creating new assessments, called health system assessments, with five intended criteria. Requires the assessments to include a public hospital health system assessment and a private hospital health system assessment calculated quarterly by DHHS as a percentage of each hospital's hospital costs, with collections to fund the nonfederal share of the costs associated with expanded Medicaid coverage with county reimbursements, and assessment collection subject to specified increased receipt and intergovernmental transfer offsets. Requires setting the historical assessment shares for private and acute hospitals based on the aggregate assessment collection amount from either public acute care hospitals or private acute care hospitals, as appropriate. 

    States legislative intent to make necessary conforming changes to the Hospital Assessment Act's modernized hospital assessments, including that the assessments do not apply to newly eligible individuals, and amending the definition of federal medical assistance percentage (FMAP) to account for the applicable temporary increase of Medicaid FMAP allowed under section 9814 of ARPA. 

    States legislative intent to consult with stakeholders and DHB prior to the December 15 meeting of the Joint Legislative Committee on Medicaid Rate Modernization and Savings (Committee) to develop the health system assessments outlined in the Section. 

    Section 1.10

    Makes conforming changes to refer to receipts anticipated from the health system assessments outlined in Section 1.6 and the proposed health system assessments outlined in Section 1.6, rather than receipts from the health system assessments enacted in Section 1.6 and the health system assessments enacted in Section 1.6.

    Section 2.3

    Revises the content of required reports of the Secretary of Commerce and DHHS regarding the statewide plan and referral plan, respectively, to no longer include recommended legislation to cover any State costs identified by the Secretary for the plan's implementation. Now provides legislative intent that some or all of the costs of implementation and operation to be funded through the health system assessments outlined in Section 1.6 (was, through an increase in the health system assessments enacted in Section 1.6).


  • Summary date: Jun 28 2022 - More information

    House committee substitute deletes the content of the 2nd edition with the following.

    Section 1.1

    Creates the six-member Joint Legislative Committee on Medicaid Rate Modernization and Savings (Committee). Provides for appointment of members and chairs. Charges the Committee with two purposes, including (1) assessing whether the Department of Health and Human Services (DHHS), Division of Health Benefits (DHB) is completing three tasks related to Medicaid enrollment, beneficiary services, and management of beneficiaries by prepaid health plans (PHPs) and local management entities/managed care organizations (LME/MCOs), and (2) considering and making legislative recommendations regarding the plan to modernize Medicaid put forth by DHHS as mandated by the act, presented by the DHHS Secretary on December 15, 2022, at which time the Committee must vote on its recommendation and terminate. Details Committee meetings, voting, expenses and staffing. Authorizes the Committee to file a copy of the proposed legislation and a copy of DHHS's plan with the President Pro Tempore and the Speaker of the House. 

    Section 1.2

    Directs DHHS to develop a Medicaid Modernization Plan (plan), submit the plan to the Committee by December 15, 2022, and make a presentation on the plan at the Committee's December 15, 2022, meeting. Lists eight components the plan must contain, including (1) the adjustment to Medicaid eligibility to allow individuals described in section 1902(a)(10(A)(i)(VIII) of the Social Security Act to qualify for coverage with a start date proposed by the DHHS Secretary, excluding individuals who are not US citizens unless required by federal law; (2) proposed legislation to discontinue Medicaid coverage for these individuals if the federal share of the cost of providing coverage becomes less than 90% or the nonfederal share of the cost cannot be fully funded from four sources specified; (3) proposed legislation to enact increased hospital assessments through the Hospital Access and Stabilization Program (HASP), as mandated by the act; (4) proposed necessary refinements to the health system assessment enacted; (5) an investment of $1 billion to address the opioid, substance abuse, and mental health crisis in the State, as specified; (6) projections of savings in the existing Medicaid program from implementation of the plan; (7) specific proposals to increase access to preventative care for Medicaid enrollees; and (8) specific proposals to increase access to healthcare in rural areas of the State. Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act includes individuals who, beginning January 1, 2014, are under 65 years of age, not pregnant, not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII, and are not described in a another subclause, and whose income does not exceed 133% of the poverty line applicable to a family of the size involved. 

    Requires the NCGA to take action on or after December 16, 2022, and prior to the sine die adjournment of the 2021 NCGA, to enact legislation to implement the plan, in whole or in part. Limits legislation to the plan and HASP proposal. Prohibits implementing the plan without express legislation authorization taken on or after December 16, 2022.

    Section 1.3

    Establishes the ARPA Temporary Savings Fund as a nonreverting special fund in the Division of Health Benefits (DHB) consisting of any savings realized as a result of federal receipts arising from the enhanced federal medical assistance percentage (FMAP) available to the State under section 9814 of the American Rescue Plan Act (ARPA). Requires legislative allocation or expenditure of the funds. States legislative intent that at least $1 billion of these funds be expended on addressing mental health and substance abuse issues in the State.

    Section 1.5

    Effective January 1, 2023, through March 31, 2023, subjects private acute care hospitals and public acute care hospitals to a 0.052% hospital health advancement assessment of its hospital costs for the fiscal quarter beginning January 1, 2023. Raises the hospital health assessment rate to 0.516% for the State fiscal quarter beginning April 1, 2023, through June 30, 2023, effective on the date of the adjustments to Medicaid eligibility described by the act; provides that no assessment can be imposed for the State fiscal quarter beginning April 1, 2023, and no county department of social services (dss) reimbursements made if the effective date occurs after June 30, 2023. For both assessment periods, requires DHHS to use $2 million of the assessment proceeds and all corresponding matching federal funds to reimburse dss for additional costs incurred to implement the adjustments to Medicaid eligibility described in the act.

    Section 1.6

    Revises the defined terms under Article 7B, GS Chapter 108A, the Hospital Assessment Act. Adds and defines Consumer Price Index, expansion nonfederal share, and newly eligible individual. Adds a new Part to the Article, statutorily providing for the public hospital health system assessment, and the private hospital health system assessment. Requires quarterly calculation and collection for each assessment. Provides for the calculation of the hospital health system assessment to be the aggregate health system assessment collection amount, multiplied by the public hospital historical assessment share or the private hospital historical assessment share, as appropriate, divided by the total hospital costs for all public acute care hospitals or private acute care hospitals holding a license on the first day of the assessment quarter, as appropriate. Formulates the health system collection amount to be the sum of the cost components, including the service cost component and administration component, minus the gross premiums tax offset component and the intergovernmental transfer offset component, as those components are formulated in the Part's provisions. Requires DHHS to reimburse a county dss with proceeds attributable to the county for costs incurred in determining eligibility for newly eligible individuals, as provided in the administration subcomponent, as well as any corresponding matching federal funds. For the quarter beginning July 1, 2023, sets the public hospital health system assessment at 0.223%, and the private hospital health system assessment at 0.445%. For the quarter beginning October 1, 2023, requires DHHS to determinate the percentages by adding or subtracting the reconciliation component, calculated as described by the act, divided by the total hospital costs of either all public acute care hospitals or private acute care hospitals holding a license on the first day of the assessment quarter, as appropriate. Effective July 1, 2023.

    Section 1.7

    Amends GS 108A-145.3 to exclude capitation payments not attributable to newly eligible individuals from the definition of paid capitation applicable to the Hospital Assessment Act. Amends GS 108A-146.9 to exclude claims attributable to newly eligible individuals from the fee-for-service component of the aggregate modern hospital assessment collection amount calculated under GS 108A-146.5.

    Amends GS 108A-146.12 to set the postpartum coverage component of the modern hospital assessment amount at $4.5 million for each quarter of the 2023-24 fiscal year. Amends GS 108A-146.13 to set the postpartum subcomponent of the intergovernmental transfer adjustment component of the modern hospital assessment amount at $1,065,000 for the 2023-24 fiscal year. Repeals Section 9D.13A(e) and Section 9D.14, SL 2021-180. Effective July 1, 2023.

    Amends Section 2.1, SL 2021-61, amending the definition of federal medical assistance percentage (FMAP) applicable to the Hospital Assessment Act, Article 7B, GS Chapter 108A, to include the applicable temporary increase of Medicaid FMAP allowed under section 9814 of ARPA. 

    Section 1.8

    States legislative intent to consult with stakeholders and DHB prior to the 2023 Regular Session to consider any necessary refinements to the health system assessment enacted in Section 1.6.

    Section 1.10

    States legislative intent to assess hospitals for the nonfederal share of a directed payment program to be called the Healthcare Access Stabilization Program (HASP), to fund hospital payments described. Directs DHHS to consult with stakeholders to develop a submission of a 42 CFR 438.6(c) preprint to the Centers for Medicare and Medicaid Services (CMS) to request approval for the payments which are to be the maximum permitted that can be funded entirely through increased hospital assessment receipts that are in addition to the receipts from the health system assessments enacted. 

    Directs DHHS to submit the request within 60 days of the date the section becomes law, whereby DHHS must submit the preprint to the specified NCGA committee and division. Requires DHHS to continue working to obtain CMS approval if CMS denies the initial submission. Requires DHHS to submit a copy of the approved preprint to the Committee and specified NCGA committee and division. 

    Deems the hospital reimbursement increase approved effective upon the enactment of the legislative language necessary to fund the portion of the nonfederal share of the reimbursement increase that will not be funded through intergovernmental transfers, through increased hospital assessments. States legislative intent to consult with stakeholders and DHB prior to the Committee's December 15 meeting to develop such language, including any necessary changes to the modernized hospital assessments under Part 2, Article 7B, GS Chapter 108A, and the health system assessments enacted.

    States legislative intent, upon approval of the preprint, to enact increases to the hospital assessments under Article 7B, GS Chapter 108A, that meet detailed criteria, including that the increased assessments at minimum apply to all private acute care hospitals, and the proceeds of the increased assessments and federal funds are limited to specified uses and restrictions. 

    Section 2.1

    Directs the Secretary of Commerce to develop a plan to create a seamless, statewide, comprehensive workforce development program (statewide plan) in collaboration with 13 listed stakeholders, and any others the Secretary deems appropriate. Authorizes contracting with third-party entities in the development and implementation of the statewide plan. Requires coordination of efforts and resources across State agencies for statewide availability of workforce development opportunities. Enumerates five required components of the statewide plan, including identification of currently existing workforce development programs for unemployed or low-wage workers and any gas for improvement of the program, identification of the specific labor force needs within the state, and inclusion of six identified services offered in the plan. 

    Section 2.2

    Requires the DHHS to collaborate with the Department of Commerce (Department) to develop a method to assist individuals enrolled in the Medicaid program and other relevant social service programs with accessing appropriate workforce development services; develop a referral plan for assessing the current employment status and any barriers to employment; and determine the best method to provide social service beneficiaries an initial assessment and consultation with a workforce development case manager. Allows contracting with third-party entities or PHPs to provide these services, and authorizes the use of incentives to PHPs with regard to the services. 

    Section 2.3

    Requires the Secretary of Commerce to report to the specified NCGA committees regarding the statewide plan by March 1, 2023. States required components of the report. 

    Requires DHHS to report to the specified NCGA committees regarding the referral plan and employment barriers for social service beneficiaries by March 1, 2023. State required content of the report. 

    Requires DHHS to collaborate with the Department to quadrennially report to the NCGA, beginning December 1, 2023, to the specified NCGA committees and division five data points described regarding social service beneficiaries, workforce development program participation, and employment/reemployment. 

    Section 2.4

    Directs DHB to enter into negotiations with CMS to develop a plan and obtain CMS approval to condition Medicaid participation upon work requirements, if any indication exists that such conditional requirements may be authorized by CMS. Requires notification of the specified NCGA committee and division within 30 days of entering such negotiations. Requires submission of a report to the specified NCGA committee and division within 30 days of CMS approval of such a plan.

    Amends the act's titles.


  • Summary date: May 5 2021 - More information

    Senate committee substitute deletes the content of the 1st edition and replaces it with the following.

    Titles the act as the "Stop Addiction Fraud Emergency Act of 2021" or the "SAFE Act of 2021."

    Enacts new Article 5H, Stop Addiction Fraud Emergency Act, in GS Chapter 90, providing as follows. Establishes three prohibited acts of any treatment facility, recovery residence, or third party contracted or paid to provide advertising, marketing, or referral services to any treatment facility or recovery residence, punishable as a Class G felony, including offering or soliciting money, goods, services, or anything else of value in any form of split-fee arrangement to induce patient referrals, or soliciting money, goods, services, or anything else of value in any form of split-fee arrangement in return for the acceptance or acknowledgement of treatment from a treatment facility, or aiding or abetting in such conduct. Excludes a discount, payment, waiver of payment, or payment practice that is expressly authorized by specified federal law or rule adopted thereunder, or a reasonable contingency management technique or other reasonable motivational incentive that is part of the treatment provided. Excludes from the scope of the Article licensed hospitals and organized hospital authorities. Defines recovery residence as an unlicensed shared living environment that is intended to be free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders. Defines treatment facility as a facility, program, person, or entity licensed under one of the specified administrative rules. Defines patient and referral

    Effective December 1, 2021. Makes conforming changes to the act's titles. 


  • Summary date: Mar 30 2021 - More information

    Titles the act as the "Stop Addiction Fraud Ethics Act of 2021" or the "SAFE Act of 2021."

    Enacts new Article 5H, Stop Addiction Fraud Ethics Act, in GS Chapter 90, providing as follows. Requires any marketing or advertising materials published or provided by any treatment provider, treatment facility, recovery residence, or third party providing services to any treatment provider, treatment facility, or recovery residence to convey accurate and complete information, in plain language that is easy to understand. Requires the materials to include: (1) information about the types and methods of services provided or used, and information about where they are provided, using the specified categories of treatment and levels of care; (2) the average lengths of stay at the treatment facility during the preceding 12-month period for each category of treatment and level of care; (3) the treatment facility's name and brand; and (4) a brief summary of any financial relationships between the treatment facility and any publisher of marketing or advertising. Defines treatment facility as a facility or program that is, or is required to be, licensed, accredited, or certified to provide substance use disorder treatment services. Defines treatment provider as a person or entity that is, or is required to be, licensed, accredited, or certified to provide substance use disorder treatment services; specifies that the term includes treatment facilities. Defines recovery residence as a shared living environment that is, or is intended to be, free from alcohol and illicit drug use and centered on peer support and connection to services that promote sustained recovery from substance use disorders. Requires operators of a recovery residence or licensed residential treatment facility that also provides separately licensed outpatient substance use disorder services to clearly label each facility and service separately in any marketing or advertisements, and distinguish the recovery residence or licensed residential treatment facility from the licensed outpatient substance use disorder services. 

    Makes it illegal for any treatment provider, treatment facility, recovery residence, or third party providing services to those entities to: (1) make a materially false or misleading statement, or provide false or misleading information, about the nature, identity, or location of substance use disorder treatment services or a recovery residence, in advertising materials, on a call line, on an internet website, or in any other marketing materials or (2) make a false or misleading statement about the treatment provider's status as an in-network or out-of-network provider; the credentials, qualifications, or experiences of persons providing treatment or services; or the rate of recovery or success in providing services. Also makes it illegal for any person or entity to: (1) provide, or direct another to provide, false or misleading information about the identity of, or contact information for, any treatment provider; (2) include false or misleading information about the internet website of any treatment provider, or to surreptitiously direct or redirect the reader to another internet website; (3) suggest or imply a relationship with a treatment provider exists, unless there is consent to such a relationship; and (4) make a materially false or misleading statement about substance use disorder treatment services. Violations are an unfair or deceptive trade practice. A person or entity who knowingly commits a violation is guilty of a Class G felony; each violation is a separate offense.

    Makes it a Class G felony for any person or entity (including a treatment provider, treatment facility, recovery residence, or third party providing services to any of those persons or entities) to: (1) offer or pay anything of value or engage in any split-fee arrangement, to induce the referral of a patient or patronage to or from a treatment provider or laboratory; (2) solicit or receive anything of value, or engage in any split-fee arrangement, in return for referring a patient or patronage to or from a treatment provider or laboratory; (3) solicit or receive anything of value, or engage in any split-fee arrangement, in return for the acceptance or acknowledgment of treatment from a health care provider or health care facility; or (4) aid or abet any conduct that violates these provisions. Excludes any discount, payment, waiver of payment, or payment practice that is expressly authorized under the specified federal law, and a reasonable contingency management technique or other reasonable motivational incentive that is part of the treatment provided by an accredited, licensed, or certified treatment provider. Each violation is a separate offense. Specifies that liability exists regardless of whether a person has actual knowledge of this statute or specific intent to commit a violation. 

    Effective January 1, 2022.


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