House committee substitute makes the following changes to 2nd edition. Amends proposed new GS 108C-2 to modify the definitions of managing employee and owner and/or operator to conform with federal regulations.
Amends proposed new GS 108C-3(d), (f), and (h) to specify that when the North Carolina Department of Health and Human Services (NCDHHS) designates a provider as a “limited,” “moderate,” or “high” categorical level of risk, the NCDHHS must conduct the screening functions required by federal law.
Amends proposed GS 108C-3(e) to add personal care services or in-home care services to the list of provider types that are designated as moderate categorical risk.
Amends proposed GS 108C-3(g) to specify that prospective (newly enrolling) agencies providing personal care services or in-home care services are designated as high categorical risk.
Amends proposed GS 108C-5(n)(4) to make a clarifying change.
Amends proposed GS 108C-9 to delete provision specifying that the approval or acceptance of a Medicaid administrative participation or enrollment agreement by NCDHHS that grants Medicaid billing privileges or allows a provider to furnish services in accordance with federal regulations requires compliance by the provider and the NCDHHS with the terms of the Medicaid administrative participation or enrollment agreement.
Effective January 1, 2012, amends GS 108-54.2 to (1) direct the NCDHHS to adopt rules to develop, amend, and adopt medical coverage policy in accordance with the statutory requirements; and (2) to define a medical coverage policy.
Amends GS 108A-54 to authorize the NCDHHS to adopt temporary and permanent rules to implement or define the federal laws and regulations, the North Carolina State Plan of Medical Assistance, and the North Carolina State Plan of the Health Insurance Program for Children, the terms and conditions of eligibility for applicants and recipients of the Medical Assistance Program and the Health Insurance Program for Children, audits and program integrity, the services, goods, supplies, or merchandise made available to recipients of the Medical Assistance Program and the Health Insurance Program for Children, and reimbursement for the services, goods, supplies, or merchandise made available to recipients of the Medical Assistance Program and the Health Insurance Program for Children. Makes other clarifying changes.