A BILL TO BE ENTITLED AN ACT TO ENSURE EFFECTIVE STATEWIDE OPERATION OF THE 1915 (B)/(C) MEDICAID WAIVER. Enacted June 12, 2013. Section 4(a) of this act becomes effective January 1, 2014. The remainder is effective June 12, 2013.
Summary date: Jun 13 2013 - More information
Summary date: Jun 3 2013 - More information
House amendment #1makes the following changes to the 4th edition.
Amends new GS 122C-124.2 to provide that the independent review as specified in this section is to be provided by an External Quality Review Organization meeting certain requirements, beginning on February 1, 2014.
Assigns responsibility tothe Secretary of Health and Human Services (Secretary)as part of the the Secretary's duties in reassigninga contract to a compliant LME/MCO and overseeing the transfer of operations and contracts, to arrange for the service providers to be reimbursed from the remaining fund balance or risk reserve of the noncompliant local management entity/ managed care organization (LME/MCO), or from other funds of the Department of Health and Human Services (DHHS)if necessary, for all proper, authorized, and valid claims for services rendered that were not previously paid by the noncompliant LME/MCO.
Provides that with regards to the dissolution of a noncompliant LME/MCO, all of its assets, including any balance in its risk reserve are to be transferred to the compliant LME/MCO after reimbursements havebeen made to service providers under subdivision (1) of this subsection. Further clarifies the authorized use of risk reserve funds. Requires the Secretary to guarantee any needed riskreserves for the compliant LME/MCO arising from any additional assumedrisks until the compliant LME/MCO has established 15% risk reserves. Declares that any LME/MCO dissolved by the Secretary under this section may be dissolved at any time during the fiscal year.
Provides that adding one or more counties to an existing catchment area requiresthe adoption of a resolution to that effect by a majority of the area board and the approval of the Secretary (was, adoption of a resolution by the majority of the area board).
Amends GS 122C-115.3(e) to providefor the transfer of anyfund balance available to an area authority at the time of its dissolution, not used to pay liabilities, to the area authority contracted to operate the 1915(b)/(c) Medicaid Waiver in the catchment area of the dissolved authority (was, not used to pay liabilities pursuant to subsection (g) of this section). Provides that if the fund balance transfer is insufficient to constitute 15% of the anticipated operational expenses arising from the assumption of responsibilities from the dissolved area authority, then the Secretary is to guarantee the operational reserves for the area authority assuming the responsibilities under the 1915(b)/(c) Medicaid Waiver until the assuming authority has reestablished 15% operational reserves.
House amendment #2 makes the following changes to the 4th edition.
Makes the effective date for changes to GS 122C-115(a) January 1, 2014. Makes a conforming change to provide that except as specifically provided, this act is effective when it becomes law.
Summary date: May 28 2013 - More information
House committee substitute makes the following changes to the 3rd edition.
Makes technical changes to the whereas clauses.
Amends GS122C-3, providing that an LME/MCO is defined as an LME/MCO that is under contract with the Department of Health and Human Services (Department) to operate the combined Medicaid Waiver program.
Amends GS 122C-124.2(a), providing that the required certification by the Secretary of compliance with the requirements of GS 122C-124.2(b) must be based on an internal and external evaluation by an approved independent External Quality Review Organization (EQRO) (previously, did not require the certification to be based on any specified criteria).
Amends GS 122C-124.2(b), establishing requirements for the Secretary's certification, which were previously provided for in GS 122C-124.2(a) of the 3rd edition. Makes technical and clarifying changes to those requirements. Also, in determining adequate provision against insolvency, deletes the provision that the ratio of assets to liabilities does not include sources of funds that are not Medicaid funds. More precisely defines the intradepartmental monitoring team that reviews financial reports to determine whether adequate provisions against insolvency were taken.
Amends GS 122C-124.2(c), establishing the actions required to be taken by the Secretary when a certificate of compliance for an LME/MCO cannot be issued due to noncompliance with requirements (1)-(3) of subsection (b) (previously provided for in GS 122C-124.2(b) of the 3rd edition), providing that the Secretary must provide a written notice of noncompliance to the LME/MCO and, not later than 10 days after the notice of noncompliance has been issued, the Secretary must assign the LME/MCO's contract to operate the Medicaid Waiver to a compliant LME/MCO and oversee the transfer of the operations and contracts from the noncompliant LME/MCO to the compliant LME/MCO in accordance with the provisions of GS 122C-124.2(e).
Amends GS 122C-124.2(d), setting out the steps the Secretary must take when, at any time, a determination is made that an LME/MCO is not in compliance with a requirement of the Medicaid Waiver contract other than those specified in subsection (b) (previously provided for in GS 122C-123.2(c)), including requiring the Secretary to prepare and deliver notice of the noncompliance, allow the noncompliant LME/MCO 30 days to respond and cure any defect, and make a final determination on the issue of noncompliance. If an LME/MCO is still determined to be noncompliant, the Secretary is required to reassign its contract to a compliant LME/MCO and oversee the transfer of operations and contracts.
Enacts new GS 122C-124.2(e), specifying the actions the Secretary must take when transferring management, responsibilities, operations, and contracts of a noncompliant LME/MCO to a compliant LME/MCO, providing that the Secretary must ensure that there is no interruption in the provision of services to recipients by doing the following:
(1) Arranging for service providers to be paid for authorized services previously rendered.
(2) Effectuating an orderly transfer of management responsibilities from the noncompliant LME/MCO to the compliant LME/MCO.
(3) Overseeing the dissolution of the noncompliant LME/MCO and transferring its assets and risk reserve to the complaint LME/MCO. The Secretary must also satisfy any liabilities if there are insufficient assets to satisfy the liabilities of the noncompliant LME/MCO.
(4) Directing the dissolution of the noncompliant LME/MCO and notifying the board of county commissioners in each of its constituent counties of the dissolution.
Enacts new GS 122C-124.2(g), providing definitions, for use in this section, for contract and compliant local management entity/managed care organization.
Amends GS 122C-112.1(a) by adding a new subdivision (39) to the list of powers and duties of the Secretary, providing that the Secretary must develop and use a standard contract for all LME/MCOs for operation of the Medicaid Waiver.
Amends GS 122C-115(a), eliminating the authority of a county to provide mental health, developmental disabilities, and substance abuse services through a county program. Adds new subsection (a3), which provides that a county can disengage from an LME/MCO and realign with another multicounty area authority operating under the Medicaid Waiver with the approval of the Secretary. Directs the Secretary to adopt rules to establish the process for county disengagement and provides minimum standards that the rules must meet for a realignment. Requires adoption of a resolution by a majority of area board members to add counties to the existing catchment area (was, by agreement).
Makes conforming changes to GS 122C-115.3, Dissolution of area authority. Also establishes that any fund balance available to an area authority at the time of its dissolution not utilized for the payment of liabilities upon dissolution is to be transferred to the LME/MCO in the area authority's catchment area.
Amends GS 122C-118.1(a), eliminating the requirement that a resolution of county commissioners to appoint members to an area board must be unanimous as well as a deadline for the resolution.
Amends GS 122C-118.1, adding new subsection (f), providing that if an area authority adds one or more counties to its existing catchment area, the expanded catchment area must be represented through membership on the area board as provided in GS 122C-118.1(a), Structure of area board, with or without adding members to the board.
Enacts new GS 122C-118.2, Establishment of county commissioner advisory board, providing for such advisory boards for each catchment area, consisting of one county commissioner from each county in the catchment area, designated by the board of commissioners of each county. The function of the board will be to serve as the chief advisory board to the area authority and its director on matters relating to the delivery of services for individuals with mental illness, intellectual or other development disabilities, and substance abuse disorders in the catchment area. Sets out the method for the designation of board members.
Amends GS 122C-142(a), making conforming changes.
Amends GS 150B-1(e), adding a new subdivision (21), which provides that the right to a contested case hearing under the Administrative Procedures Act does not apply to actions taken by the Secretary under the new GS 122C-124.2.
Summary date: Apr 2 2013 - More information
Senate amendment #1 makes the following changes to the 2nd edition.
Deletes liability clauses in GS 122C-124.2(b) and (c) which provided that nothing in these subsections will be construed to make the Department liable for any debts of the noncomplaint LME/MCO.
Summary date: Mar 28 2013 - More information
Senate committee substitute makes the following changes to the 1st edition.
Directs the Secretary of the Department of Health and Human Services (Secretary) to certify (was, provide an unqualified attestation) every six months that any Local Management Entity/Managed Care Organization (LME/MCO) with which the Department of Health andHuman Services has contracted to operate the 1915(b)(c) Medicaid Waiver for less than three years, is in compliance with the requirements of subdivisions (1) through (3) of subsection (a) of new GS 122C-124.2. Requires the Secretary to certify that an LME/MCO is in compliance with the three subdivisions of subsection (a) annually, when the contract is for at least three years.
Requires that the Secretary's written certification include the Secretary's signature, and clearly and unequivocally state that the Secretary has determined that the LMC/CMO is in full compliance with all of the listed requirements. Elaborates onthe requirements with which the LME/MCO must be in full complianceproviding the following:(1) have made adequate provisions against the risk of insolvency with respect to capitation payments for Medicaid enrollees and the Secretary must certify that the LME/MCO has made adequate provision against insolvency if certainspecifiedconditionsare true; and (2) the LME/MCO must be making timely provider payments, andtheSecretaryis tocertify that the payments are being made in a timely fashion if there are no consecutive three-month periods during which the LME/MCO paid less than 90% of clean claims for covered services within the 30-day period following the receipt of the claims.Omits provision requiring the Secretary to certify in the annual evaluation that the LME/MCO is in compliance with DHHS regarding management responsibilities for the delivery of services for individuals with mental illness, intellectual or other developmental disabilities, and substance abuse disorders under the 1915(b)(c)Medicaid Waiver.
Provides procedural process to be followed if the Secretary determines that an LME/MCO is not in compliance with a requirement other thanthose specified in subdivisions (1) through (3) of subsection (a) of this section. Provides that nothing in subsection (c) is to be construed to confer liability onDHHS for the noncompliance of an LME/MCO.
Makes some additional clarifying changes and technical corrections. Replaces references to the Secretary making "attestations of compliance" with regards to an LME/MCO with the terms "certification" or "certification of compliance."
Amends the date for the Secretary to complete an initial certification of compliance for each LME/MCO to no later than August 1, 2013 (was, June 30, 2013).
Provides that notwithstanding any provision of law to the contrary, all requirements specified in SL 2011-264, as amended by Section 13 of SL 2012-151, remain in effect until repealed in whole or in part by an act of the General Assembly.
Summary date: Mar 6 2013 - More information
Amends GS 122C-3, adding a new subdivision that establishes that "local managment entity/managed care organization" or "LME/MCO" means an LME has been approved by the Department of Health and Human Services (Department) to operate the 1915(b)/(c) Medicaid Waiver (Waiver).
Enacts new GS 122C-124.2, (Actions by the Secretary to ensure effective management of behavioral health services under the 1915(b)/(c) Medicaid Waiver), which provides that for LME/MCOs with which the Department has contracted to operate the Waiver for less than three years, the Secretary of the Department of Health and Human Services (Secretary) is required to provide an unqualified attestation every six months that the LME/MCOs are in compliance with the terms of the contract, SL 2011-264, as amended, and all other applicable state and federal requirements. For LME/MCOs that have been contracted by the Department to operate the Waiver for at least three years, the Secretary will provide the same unqualified attestation of compliance on an annual basis.
Each attestation by the Secretary will specifically address the following requirements:
(2) Timeliness of provider payments.
(3) Compliance with SL 2011-264, as amended.
(4) Compliance with any contract between the LME/MCO and the Department, in regards to the delivery of services for individuals with mental illness, intellectual or other developmental disabilities, and substance abuse disorders under the Waiver.
(5) Ability to exchange billing, payment, and transaction information with LME/MCOs and providers in a way that is compliant with applicable federal standards including information transactions and data elements standards under HIPAA, health care claims and equivalent encounter information transaction standards, and implementation specification for Electronic Data Interchange standards referenced in HIPAA (45 CFR 162.920).
If the Secretary cannot provide the attestation due to noncompliance, the Secreatary will assign the LME/MCO's contract to operate the Waiver to another LME/MCO, no later than 30 days after the attestation of compliance was due. After such assignment, the Secretary will make an orderly transfer of responsibilites from the noncompliant LME/MCO to the compliant LME/MCO.
The Secretary is required to provide a copy of each attestation of compliance to the Senate Appropriations Committee on Health and Human Services, the House Appropriations Subcommittee on Health and Human Services, the Legislative Oversight Committee on Health and Human Services, and the Fiscal Research Division.
The Secretary must complete initial attestations of compliance for all LMEs that have been approved by the Department to operate the Waiver no later than June 30, 2013, with copies of the initial attestations also requird to be sent to the above General Assembly entities.
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