Bill Summary for H 34 (2025-2026)
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| View NCGA Bill Details | 2025-2026 Session |
AN ACT TO STRENGTHEN MEDICAID PROVIDER CONTROLS AND MAKE OTHER CHANGES TO THE MEDICAID PROGRAM.Intro. by Lambeth, Zenger, K. Hall.
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Bill summary
Senate amendment to the 3rd edition makes the following changes.
Section 3.
Changes the title of GS 108C-4.1 from "Termination for Cause" to "Grounds for adverse termination." Clarifies that the first ground for adverse termination applies when the services for the submitted claim were not actually provided to the individual. Removes the knowledge requirement from the ground for adverse termination listed as number five pertaining to falsifying medical records to support services billed to Medicaid. Modifies the ground for adverse termination listed as seven so that the evidence supporting the described conduct posing a risk to beneficiaries or the Medicaid program must be credible evidence indicating program integrity or safety concerns. Specifies that the qualifying individuals for Medicaid coverage under GS 108A-54.3A(a) must be lawfully present.