Bill Summary for S 208 (2013-2014)
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View NCGA Bill Details | 2013-2014 Session |
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
Senate committee substitute makes the following changes to the 1st edition.
Directs the Secretary of the Department of Health and Human Services (Secretary) to certify (was, provide an unqualified attestation) every six months that any Local Management Entity/Managed Care Organization (LME/MCO) with which the Department of Health andHuman Services has contracted to operate the 1915(b)(c) Medicaid Waiver for less than three years, is in compliance with the requirements of subdivisions (1) through (3) of subsection (a) of new GS 122C-124.2. Requires the Secretary to certify that an LME/MCO is in compliance with the three subdivisions of subsection (a) annually, when the contract is for at least three years.
Requires that the Secretary's written certification include the Secretary's signature, and clearly and unequivocally state that the Secretary has determined that the LMC/CMO is in full compliance with all of the listed requirements. Elaborates onthe requirements with which the LME/MCO must be in full complianceproviding the following:(1) have made adequate provisions against the risk of insolvency with respect to capitation payments for Medicaid enrollees and the Secretary must certify that the LME/MCO has made adequate provision against insolvency if certainspecifiedconditionsare true; and (2) the LME/MCO must be making timely provider payments, andtheSecretaryis tocertify that the payments are being made in a timely fashion if there are no consecutive three-month periods during which the LME/MCO paid less than 90% of clean claims for covered services within the 30-day period following the receipt of the claims.Omits provision requiring the Secretary to certify in the annual evaluation that the LME/MCO is in compliance with DHHS regarding management responsibilities for the delivery of services for individuals with mental illness, intellectual or other developmental disabilities, and substance abuse disorders under the 1915(b)(c)Medicaid Waiver.
Provides procedural process to be followed if the Secretary determines that an LME/MCO is not in compliance with a requirement other thanthose specified in subdivisions (1) through (3) of subsection (a) of this section. Provides that nothing in subsection (c) is to be construed to confer liability onDHHS for the noncompliance of an LME/MCO.
Makes some additional clarifying changes and technical corrections. Replaces references to the Secretary making "attestations of compliance" with regards to an LME/MCO with the terms "certification" or "certification of compliance."
Amends the date for the Secretary to complete an initial certification of compliance for each LME/MCO to no later than August 1, 2013 (was, June 30, 2013).
Provides that notwithstanding any provision of law to the contrary, all requirements specified in SL 2011-264, as amended by Section 13 of SL 2012-151, remain in effect until repealed in whole or in part by an act of the General Assembly.