AN ACT TO REQUIRE FURTHER REPORTING FROM THE DEPARTMENT OF HEALTH AND HUMAN SERVICES RELATED TO TRANSFORMATION OF THE MEDICAID AND NC HEALTH CHOICE PROGRAMS AND TO MODIFY CERTAIN PROVISIONS OF THE MEDICAID TRANSFORMATION LEGISLATION.
Conference report makes the following changes to the 3rd edition.
Amends Section 4 of SL 2015-245, concerning the structure of the transformed Medicaid and NC Health Choice programs as described in Section 1 of SL 2015-245, by making the following changes to subdivision (2). Defines provider-led entity or PLE to be an entity that (1) a majority of the entity's ownership is held by an individual or entity that has as its primary business purpose the ownership or operation of one or more capitated contracts described in subdivision (3) of the statute (previously, did not specify capitated contracts) or Medicaid and NC Health Choice providers; (2) a majority of the entity's governing body is composed of individuals who are licensed in the State as physicians, physician assistants, nurse practitioners, or psychologists and have experience treating beneficiaries of the North Carolina Medicaid program (previously, did not have experience requirement); and (3) holds a PHP license issued by the Department of Insurance. Additionally, amends subdivision (4), concerning services covered by PHPs, to include behavioral health services for Medicaid recipients currently covered by the local management entities/managed care organizations (LME/MCOs) for four years after the date capitated contracts begin (previously, are to be excluded from the capitated contracts for at least four years after the date capitated contracts begin).
Amends SL 2015-245 (Medicaid Transformation and Reorganization), Section 22A, to authorize DHHS, notwithstanding SL 2015-241 (2015 Appropriations Act), as amended, which requires a reduction within the Division of Medical Assistance (DMA), to establish, maintain, or adjust all Medicaid program components, except for eligibility categories and income thresholds, within the appropriated and allocated budget for the Medicaid program, provided that the total Medicaid expenditures, net of agency receipts, do not exceed the authorized budget for the Medicaid program, in accordance with GS 108A-54(e). Additionally, provides that if DHHS intends to maintain any program components authorized in Section 22A(a) (as enacted by the act), then no later than 60 calendar days after the act becomes law, DHHS is required to request that the Office of State Budget and Management (OSBM) certify that there are sufficient recurring Medicaid funds to maintain the program component. Establishes that, if OSBM does not certify by the end of the 30-day period that there are sufficient recurring Medicaid funds to maintain the program component, then DHHS must implement reduction required by SL 2015-241, as amended.
Provides that new Section 2(j) of the act is effective when the act becomes law, and the remainder is retroactively effective June 1, 2016.
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