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  • Summary date: Mar 30 2015 - View Summary

    States the General Assembly's intent to transform the state's health care purchasing methods from a traditional fee‑for‑service system into a value‑based system that provides budget predictability while ensuring quality care. Requires the new purchasing program to be designed to: (1) provide budget predictability and stability, (2) achieve cost savings through improved population health, (3) appropriately value primary care as the foundational level of health care required by all North Carolinians, (4) jointly incentivize patients and providers in pursuit of better health, and (5) improve access and choice for beneficiaries in a market‑driven environment. Provides that once reform is fully implemented, the state's budget variability must be limited to the variations in enrollment numbers and patient mix for the capitated populations. Sets out requirements for the 11 principal building blocks of purchasing reform including provisions for Patient Population, Primary Care Medical Homes, At‑Risk Provider‑Led Organizations (ARPLOs), Plan Administrators, Licensed Commercial Health Insurers, and Cooperation between ARPLOs and LME/MCOs. Sets out definitions as used in the act. 

    Requires the Department of Health and Human Services (DHHS) to develop, with stakeholder input, a detailed plan for purchasing reform that meets the goals listed above and includes the building blocks listed in the act. Requires that the plan provide for strategic changes to the Patient Population and include 15 specified elements. 

    Requires DHHS, by April 15, 2015, to report to the General Assembly on its strategic plan for the Medicaid reforms. Specifies actions that must be taken if a detailed plan cannot reasonably be completed by April 15, 2015. 

    Requires beginning September 1, 2015, and every six months thereafter until a final report on September 1, 2020, the DHHS and other administrators to report to the General Assembly on the state's progress toward completing transformation in the Patient Population. Specifies that reports are due to the Joint Legislative Oversight Committee on Medical Benefits.

    Requires DHHS to work with the Centers for Medicare & Medicaid Services (CMS) to attempt to preserve existing levels of funding generated from Medicaid‑specific funding streams, such as assessments, to the extent that the levels of funding may be preserved. Requires that if Medicaid‑specific funding cannot be maintained as currently implemented, then DHHS must advise the General Assembly of the modifications necessary. 

    Enacts new Article 23B in GS Chapter 120, establishing the 14-member Joint Legislative Oversight Committee on Primary Care and Medical Benefits (Committee). Requires the Committee to examine budgeting, financing, administrative, and operational issues related to: (1) the reform of purchasing primary care for Medicaid and the State Health Plan; (2) monitoring the effectiveness of engagement strategies and outcomes produced by authorized primary care medical homes, ACO, and Commercial Plans; (3) review of criteria for establishing minimum benefits to be provided by primary care medical homes and the value of periodic payments made to providers; and (4) review effectiveness and financial performance of the State Health Plan in conjunction with the Treasurer's office and the State Health Plan Board of Directors. Sets out provisions governing Committee membership and organization. Sets out the Committee's powers. Requires that when DHHS is required by law to report to the General Assembly or to any of its permanent, study, or oversight committees or subcommittees on matters affecting DHHS, then DHHS must give a copy of the report to the cochairs of the Committee. 

    Repeals GS 120-208.1(a)(2)b, taking away the power of the Joint Legislative Oversight Committee on Health and Human Services to examine issues relating to services provided by the DHHS Division of Medical Assistance.

    Makes conforming changes to GS 120-208.1. Effective September 1, 2015.

    Requires any reports by DHHS or the Division of Medical Assistance on Medicaid due during the 2014-15 fiscal year to be made to the Joint Legislative Oversight Committee on Primary Care. Effective September 1, 2015.

    Requires DHHS to manage the consolidation of LME/MCOs to no more than six, and no less than four, regional entities effective January 1, 2017. Requires DHHS to designate the surviving entity for each region by October 1, 2015. Specifies data that DHHS must take into consideration in making the determination of the surviving entity.

    Except as otherwise provided, this act is effective when it becomes law.