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.
House committee substitute to the 2nd edition makes the following changes.
Changes the effective date of the proposed additions to Section 4.5, SL 2020-4, specifying that uninsured individuals receiving Medicaid coverage for COVID-19 testing are not covered by capitated prepaid health plan contracts under Article 4 of GS Chapter 130D. Makes the changes effective July 1, 2021 (was, the date the act becomes law).
Makes a technical change to eliminate the section caption for new GS 108D-15.1, which provides for expedited contested case hearings on disputed adverse benefit determinations by a managed care entity.
Eliminates the proposed addition of 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). Also eliminates the proposed addition of 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. Makes conforming deletions.
Eliminates the proposed changes to GS 108D-35, authorizing 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.
Adds the following content.
Amends GS 108D-60 to authorize DHHS to contract with entities operating Behavioral Health and Intellectual/Developmental Disability (BH IDD) tailored plans under a capitated or other arrangement for the management of behavioral health, intellectual and developmental disability, and traumatic brain injury services for any recipients excluded from prepaid health plan (PHP) contracts under specified subdivisions of GS 108D-40(a), with population categories identified including medically needy Medicaid recipients, members of federally recognized tribes, participants in the North Carolina Health Insurance Premium Payment (NC HIPP) program, and those being served through the Community Alternatives Program for Children (CAP/C) or the Community Alternatives Program for Disabled Adults (CAP/DA), among others. Amends GS 122C-115, granting authority for such entities to continue to manage the named services for these described recipients under any contract with DHHS in accordance with GS 108D-60.
Directs that, when a county disengages and realigns area authorities, a portion of the risk reserve and other funds of an area authority must be transferred to the area authority with which a county is realigning, with the transferred amount determined by DHHS pursuant to a formula developed pursuant to the requirements and limitations specified. Exempts the development and application of the formula from statutory rulemaking requirements; however, requires DHHS to accept public comment on the proposed formula. Requires area authorities to provide DHHS with necessary financial information for determination of the transfer amount. Requires DHHS to post the formula on its website and provide notice to all area authorities and the specified NCGA committees and division. Directs DHHS to report to the specified NCGA committees and division by October 15, 2021, on any formulas developed and any funds transferred during the previous quarter. Requires quarterly reporting beginning January 15, 2022, through April 15, 2026, on any funds transferred as a result of disengagements during the previous quarter. Requires a final quarterly report on June 30, 2026. Effective when the act becomes law and applies to disengagements approved by DHHS with an effective date on or after September 1, 2021; expires June 30, 2026.
Changes the proposed revisions to Section 11 of SL 2020-88, regarding the rate floor for durable medical equipment and supplies and orthotics and prosthetics under managed care, by setting the reimbursement rate at 100% of the lesser of the supplier's usual and customary rate or the maximum allowable Medicaid fee-for-service rates, for the first five years (was, the lesser of the supplier's usual and customary rate or the maximum allowable Medicaid fee-for-service rates, for the first three years). Makes the changes effective July 1, 2021 (was, effective on the date the act becomes law).
Changes the effective date for the proposed changes to GS 108D-5.3(b)(1) and GS 108D-40(a)(5) (providing for the enrollment and disenrollment of beneficiaries who meet the federal definition of Indian), and the proposed repeal of GS 108D-40(a)(5a) and conforming proposed changes to GS 122C-115(e) (eliminating the exclusion of eligible recipients who are enrolled in a DHHS-contracted Indian managed care entity from the populations capitated PHP contracted are automatically required to cover). Makes the changes effective July 1, 2021 (was, effective on the date the act becomes law).
Changes the effective date of the proposed changes to GS 108D-35, specifying that capitated PHP contracts do not cover services documented in an individualized family service plan under the federal Individuals with Disabilities Education Act that are provided and billed by a Children's Development Services Agency or by such Agency's contracted provider of those services. Makes the changes effective July 1, 2021 (was, effective on the date the act becomes law).
Changes the act's long title.
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