AN ACT TO MODERNIZE AND STABILIZE NORTH CAROLINA'S MEDICAID PROGRAM THROUGH FULL‑RISK CAPITATED HEALTH PLANS TO BE MANAGED BY A NEW DEPARTMENT OF MEDICAL BENEFITS.
House committee substitute makes the following changes to the 2nd edition.
Expands the building blocks of the Medicaid transformation as directed in Section 1 of this act to include allowing the provider-led capitated health plans (a health-care system in which a medical provider is given a set fee per patient regardless of the treatment required) authorized in this act to work in collaboration with the LME/MCOs created in SL 2011-264 (established requirements for the statewide expansion of the 1915(b)(c) Medicaid waiver) to serve the Medicaid population.
Directs the Division of Medical Assistance (DMA) and the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SA) of the Department of Health and Human Services (DHHS) to conduct an integrated care study to examine issues related to the development of a demonstration pilot to test the feasibility of a single payment to an entity that would cover a full array of Medicaid services for Medicaid recipients with intellectual and developmental disabilities (I/DD) who are currently enrolled under the 1915(c) North Carolina Innovations Waiver (was, directed DMA to establish a pilot program that provided for a single payment for the full array of services to Medicaid recipients with intellectual and developmental disabilities enrolled under 1915(c)).
Directs the DHHS Divisions to study the benefits of and any challenges to establishing a demonstration pilot. Also directs the Divisions to work collaboratively on the study with the NC Council for Developmental Disabilities and the NC Center for Excellence for Integrated Care, and to consult with local management entities that have been approved to operate as managed care organizations (LME/MCOs), I/DD provider organizations, I/DD advocacy organizations, the North Carolina Hospital Association, the North Carolina Medical society, the North Carolina Providers Council, Benchmarks, and self-advocates currently working with the Divisions. Requires the Divisions to submit the results of this collaborative study to the Joint Legislative Oversight Committee on Health and Human Services prior to the convening of the 2015 General Assembly.
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