Bill Summary for S 208 (2013-2014)

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Summary date: 

Mar 6 2013

Bill Information:

View NCGA Bill Details2013-2014 Session
Senate Bill 208 (Public) Filed Wednesday, March 6, 2013
A BILL TO BE ENTITLED AN ACT TO ENSURE EFFECTIVE STATEWIDE OPERATION OF THE 1915 (B)/(C) MEDICAID WAIVER.
Intro. by Tucker, Barringer.

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Bill summary

Amends GS 122C-3, adding a new subdivision that establishes that "local managment entity/managed care organization" or "LME/MCO" means an LME has been approved by the Department of Health and Human Services (Department) to operate the 1915(b)/(c) Medicaid Waiver (Waiver).

Enacts new  GS 122C-124.2, (Actions by the Secretary to ensure effective management of behavioral health services under the 1915(b)/(c) Medicaid Waiver), which provides that for LME/MCOs with which the Department has contracted to operate the Waiver for less than three years, the Secretary of the Department of Health and Human Services (Secretary) is required to provide an unqualified attestation every six months that the LME/MCOs are in compliance with the terms of the contract, SL 2011-264, as amended, and all other applicable state and federal requirements. For LME/MCOs that have been contracted by the Department to operate the Waiver for at least three years, the Secretary will provide the same unqualified attestation of compliance on an annual basis.

Each attestation by the Secretary will specifically address the following requirements:

(1) Solvency.

(2) Timeliness of provider payments.

(3) Compliance with SL 2011-264, as amended.

(4) Compliance with any contract between the LME/MCO and the Department, in regards to the delivery of services for individuals with mental illness, intellectual or other developmental disabilities, and substance abuse disorders under the Waiver.

(5) Ability to exchange billing, payment, and transaction information with LME/MCOs and providers in a way that is compliant with applicable federal standards including information transactions and data elements standards under HIPAA,  health care claims and equivalent encounter information transaction standards, and implementation specification for Electronic Data Interchange standards referenced in HIPAA (45 CFR 162.920).

If the Secretary cannot provide the attestation due to noncompliance, the Secreatary will assign the LME/MCO's contract to operate the Waiver to another LME/MCO, no later than 30 days after the attestation of compliance was due. After such assignment, the Secretary will make an orderly transfer of responsibilites from the noncompliant LME/MCO to the compliant LME/MCO.

The Secretary is required to provide a copy of each attestation of compliance to the Senate Appropriations Committee on Health and Human Services, the House Appropriations Subcommittee on Health and Human Services, the Legislative Oversight Committee on Health and Human Services, and the Fiscal Research Division.

The Secretary must complete initial attestations of compliance for all LMEs that have been approved by the Department to operate the Waiver no later than June 30, 2013, with copies of the initial attestations also requird to be sent to the above General Assembly entities.