AN ACT TO PROHIBIT THE REGULAR BUSINESS PRACTICE OF WAIVING REQUIRED MEDICAID AND HEALTH CHOICE RECIPIENT CO-PAYMENTS BY CERTAIN PROVIDERS. Enacted June 19, 2013. Effective October 1, 2013.
Bill Summaries: S137 PROHIBIT CO-PAY WAIVER/MEDICAID PROVIDERS.
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Tracking:
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Summary date: Jun 24 2013 - View Summary
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Bill S 137 (2013-2014)Summary date: Jun 4 2013 - View Summary
House committee substitute to the 2nd edition makes the following changes. Amends GS 108C-13 to refer to providers as permitted providers throughout the statute.
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Bill S 137 (2013-2014)Summary date: Apr 24 2013 - View Summary
Senate committee substitute makes the following changes to the 1st edition.
Changes long title.
Deletes the entirety of the provisions of the 1st edition.
Enacts new GS 108C-13 (Certain waivers of Medicaid and Health Choice co-payments prohibited), establishing that providers permitted pursuant to GS 90-85.21 or GS 90-85-21A cannot waive the collection of co-payments owed by Medicaid or Health Choice recipients with the intent to induce recipients to purchase, lease, or order items or services from the provider.
A medical provider that does so will be found in violation of this subsection unless the co-payment in question was waived, in full or partially, for any of the following reasons: (1) the waiver is authorized, (2) the provider decides on an individual basis that the collection of the co-payment amount would place a substantial financial hardship on the recipient, (3) the provider has made a good faith effort to collect the co-payment but the reasonable efforts fail, or (4) the provider is a health care facility regulated pursuant to GS Chapter 131E or GS Chapter 122C or is owned or operated by the State.
A violation under this subsection will result in a suspension or termination of the provider's participation in Medicaid and Health Choice.
Effective October 1, 2013, applying to acts committed on or after that date.
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Bill S 137 (2013-2014)Summary date: Feb 26 2013 - View Summary
Amends GS 108A-63 (Medical Assistance Provider Fraud) making it illegal for any provider under the Medicaid Program (Medicaid) to knowingly and willfully execute, solicit, receive, or attempt to execute, by scheme or artifice, a waiver of co-payments owed by recipients of medical assistance under Medicaid, with the intent to induce recipients to purchase, lease, or order items or services. Also makes other quid pro quo arrangements for items or services under Medicaid illegal.
A medical provider that does so will be found in violation of this subsection unless the co-payment in question was waived, in full or partially, for any of the following reasons: (1) the waiver is authorized under Medicaid, (2) the provider decides on an individual basis that the collection of the co-payment amount would place a substantial financial hardship on the recipient, or (3) the provider has made a good faith effort to collect the co-payment but the reasonable efforts fail. A conviction under this subsection will result in a suspension or termination of the provider's participation in Medicaid.
Makes conforming changes.
Effective December 1, 2013, and applies to acts and offenses committed on or after that date.