Bill Summary for S 496 (2011-2012)

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Summary date: 

Jun 6 2011

Bill Information:

View NCGA Bill Details2011-2012 Session
Senate Bill 496 (Public) Filed Thursday, March 31, 2011
Intro. by Pate.

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Bill summary

Senate committee substitute makes the following changes to 1st edition. Rewrites proposed GS 108C-2 to include adverse determination, managing employee, and owner and/or operator as defined terms. Removes Affordable Care Act and payment suspension as defined terms, and makes other clarifying changes. Amends proposed GS 108C-3(c) by removing Transplants and Transplant-related services and vision providers from the list of limited risk provider types. Amends GS 108C-3(e) to remove from the moderate risk category the following providers: 1) revalidating agencies providing behavioral health services and 2) revalidating agencies providing HIV case management. Makes other clarifying and technical changes. Removes proposed provisions GS 108C-3(k)-(n), relating to Department of Health and Human Services’ (DHHS) verification and confirmation of provider licensure, revalidation of licensure, and inspection of providers. Directs DHHS to return the provider to the original risk category not later than 12 months after completion of the provider repayment.
Amends proposed GS 108C-4 to remove the definition provisions. Removes several provisions related to criminal history checks, except that DHHS must conduct criminal history record checks of provider applicants and enrolled providers in accordance with federal law and regulation. Provides that DHHS must honor civil and criminal settlement agreements entered into with a provider or any person with a 5% or greater direct or indirect ownership interest in the provider within 10 years of the effective date of the act.
Amends GS 108C-5 to detail reasons DHHS may suspend payment to providers, suspension procedures, and audit procedures. Effective when the act becomes law, and applies to audits instituted on or after that date and to final overpayments, assessments, or fines due on or after that date.
Deletes all provisions of proposed GS 108C-6 and replaces them with a new GS 108C-6 providing that DHHS may establish a registry of billing agents, clearinghouses, and/or alternate payees that submit claims on behalf of providers and to charge a fee to recover the costs of maintaining the registry in accordance with federal law and implementing regulations. Provides procedure for registration. Effective January 1, 2012.
Enacts new GS 108C-7 providing a provider may be required to undergo prepayment claims review by DHHS. Details the procedure for prepayment claims review.
Enacts new GS 108C-8 providing that, absent specified circumstances, DHHS is not to pursue recovery of Medicaid or Health Choice overpayments owed to the state for any total amount less than $150.
Enacts new GS 108C-9 detailing the application procedure for provider enrollment in North Carolina Medicaid or North Carolina Health Choice.
Enacts new GS 108C-10 providing that a provider must notify DHHS at least 30 calendar days prior to the effective date of any change of ownership. Details the instances that constitute a change of ownership under the act. Provides that assigned Medicaid administrative participation or enrollment agreements are subject to all applicable statutes, regulations, and the terms and conditions under which they were originally issued. Prohibits DHHS from requiring a provider to accept an assigned Medicaid administrative participation or enrollment agreement upon change in ownership as a condition of enrollment.
Enacts new GS 108C-11 to require a provider cooperate with all activities, announced or unannounced, conducted by DHHS. Directs DHHS to make attempts to examine documentation without interfering with the clinical activities of the provider while conducting activities on the provider’s premises.
Enacts new GS 108C-12 detailing the appeals process for a Medicaid provider or applicant to appeal an adverse determination made by DHHS.
Rewrites GS 150B-1(d)(9) to provide that DHHS is exempt from the rule making procedures under the Article when adopting new or amending existing medical coverage policies under the State Medicaid Program pursuant to GS 108A-54.2. Rewrites GS 150B-(1)(e) to remove the exemption from the contested case provisions of the following: (1) Medicaid providers appealing a denial or reduction in reimbursement for community support services and (2) community support services providers appealing decisions by the LME to deny or withdraw the provider’s endorsement.
Makes other clarifying and organizational changes. Deletes provisions authorizing the Division of Medical Assistance and other entities to study the criminal history record and other employment background checks among all providers and health care licensing boards. Unless otherwise noted, act is effective when it becomes law. Changes title to AN ACT RELATING TO REQUIREMENTS OF MEDICAID AND HEALTH CHOICE PROVIDERS.