AN ACT MODIFYING CERTAIN MEDICAID-RELATED PROVISIONS OF THE 2020 COVID-19 RECOVERY ACT, UPDATING THE MEDICAID PROGRAM BENEFICIARY APPEALS PROCESSES, INCREASING THE AMOUNT OF ALLOWABLE THERAPEUTIC LEAVE UNDER THE MEDICAID PROGRAM, CLARIFYING THE CODIFICATION OF BEHAVIORAL HEALTH SERVICES COVERED BY STANDARD BENEFIT PLANS, AUTHORIZING COVERAGE OPTIONS FOR BEHAVIORAL HEALTH SERVICES FOR POPULATIONS NOT COVERED BY PREPAID HEALTH PLAN CONTRACTS, REVISING THE TRANSFER OF AREA AUTHORITY FUND BALANCES, REMOVING THE RATE FLOOR FOR DURABLE MEDICAL EQUIPMENT, AND MAKING VARIOUS TECHNICAL CORRECTIONS TO THE STATUTES GOVERNING THE NORTH CAROLINA MEDICAID PROGRAM.
Senate committee substitute adds the following content to the 1st edition.
Adds peer support services, substance abuse comprehensive outpatient treatment program services, and substance abuse intensive outpatient program services to the services that all capitated PHP contracts governed by Article 4 must cover under GS 108D-35(1). Makes organizational changes to organize the subdivision's provisions into sub-subdivisions.
Additionally adds social setting detoxification services or clinically managed residential withdrawal services to the mandated coverage under GS 108D-35(1), effective upon the approval by the Centers for Medicare and Medicaid Services (CMS) of NC Medicaid coverage for such services, on the effective date of the allowed coverage. Requires the Secretary of the Department of Health and Human Services to notify the Revisor of Statutes of the effective date allowed by CMS upon receipt of approval. Repeals this provision if CMS approval is not granted by June 30, 2023.
Further amends GS 108D-35, organizing its provisions into subsections (a) and (b). Adds a new subsection (c) to authorize DHHS to determine whether services for Medicaid program applicants can be covered by a capitated contract during any period of time prior to eligibility determination (currently prohibited by subdivision (6) of the statute). Makes conforming changes.
Makes a technical change to the heading given to Section 3.5 of the act.
Amends Section 11 of SL 2020-88, which establishes a rate floor for durable medical equipment under managed care at 100% of the Medicare fee-for-service rates for durable medical equipment for the first three years of the initial standard benefit plan prepaid health plan (PHP) capitated contracts under Article 4, GS Chapter 108D. Revises the provision to instead set the reimbursement for durable medical equipment and supplies and orthotics and prosthetics under managed care to be the lesser of the supplier's usual and customary rate or the maximum allowable Medicaid fee-for-service rates for durable medical equipment and supplies and orthotics and prosthetics, applicable to the first three years of the initial standard benefit plan PHP capitated contracts.
Amends GS 108D-23, now requiring entities operating Behavioral Health and Intellectual/Developmental Disability (BH IDD) tailored plans to develop and maintain a closed network of providers (was, closed provider networks) only for the provision of behavioral health, intellectual and developmental disability, and traumatic brain injury services.
Changes the act's long title.
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