AN ACT TO MODIFY CERTAIN REQUIREMENTS PERTAINING TO LOCAL MANAGEMENT ENTITIES/MANAGED CARE ORGANIZATIONS.
Sets the following requirements for the encounter data submission requirements for local management entities/managed care organizations: (1) requires LME/MCOs to submit to the Department of Health and Human Services (DHHS) encounter data, consisting of records of claims payments made to providers, for Medicaid and state‑funded mental health, intellectual and developmental disabilities, and substance abuse disorder services using a single nationally recognized, standardized electronic format, which is specified to the LME/MCOs in advance; (2) allows DHHS to use encounter data for purposes that include setting LME/MCO capitation rates, measuring the quality of services managed by LME/MCOs, and assuring compliance with state and federal regulations, and for oversight and audit functions; and (3) prohibits requiring LME/MCOs to resubmit encounter data rejected by NCTracks or other receiving systems except those rejected for noncompliance with the standardized electronic format.
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