House committee substitute to the 2nd edition makes the following changes.
Regarding the management of benefits under the NC Health Care for Working Families program (program) by Prepaid Health Plans, changes the cross-reference provided to define Prepaid Health Plans from SL 2015-245 (Medicaid Transformation and Reorganization), to GS 108D-1 (amended by SL 2019-81).
Regarding participant contributions under the program, extends the period given for participants to make premium contributions before suspension is triggered, from 90 days to 120 days of the due date of the contribution.
Adds immunizations to the preventative care and wellness activities the Department of Health and Human Services (DHHS) is required to include under the program.
Modifies the exemptions set forth for DHHS's mandatory employment activities to now more specifically include individuals living in the home with, and serving as the primary caregiver for, a dependent minor child, a disabled or medically frail adult child, or a disabled parent, disabled spouse, or other disabled and medically frail relative (was, individuals caring for a dependent minor child, an adult disabled child, or a disabled parent).
Modifies and adds to the contingencies of the program's implementation. Prohibits DHHS from implementing the program and requires that DHHS cease all activities related to implementation if the program approved by the Center for Medicare and Medicaid Services (CMS) fails to materially (was, substantially) comply with the program components required by the act. Now prohibits DHHS from providing program coverage until all program components can be implemented in the event the State is enjoined, stayed, or otherwise prohibited from implementing any program component approved by CMS. Additionally, prohibits all activities related to implementation, except for continuing to seek federal approval of the program, if legislation is not enacted to ensure premium tax is levied upon capitation payments received by Prepaid Health Plans in the same manner the tax is applied to gross premiums from business done in the State for all other health care plans and contracts of insurance provided by insurers or health maintenance organizations subject to the tax under GS 105-228.5. Finally, prohibits implementation and all related activities in the event the program approved by CMS does not allow for participant contributions collected by the State to be treated as State funds eligible for federal matching funds.
Extends the date by which DHHS must submit its design proposal for the program to the specified NCGA committee, from October 1, 2019, to March 1, 2020.
Adds a new requirement for DHHS to quarterly publish specified information regarding program eligibility and participation on its website, beginning October 1, 2020, and until the initial approval term of the approval by CMS of the program.
Amends new GS 108B-32 to also include activities that decrease or eliminate healthcare disparities in those eligible to be funded by a grant from the NC Rural Access to Healthcare Grant Fund.
Adds a new contingency provision to provide that proposed Article 3, Rural Access to Healthcare Grants, of GS Chapter 108B, is effective only if legislation is enacted to ensure that premium tax is levied upon capitation payments received by Prepaid Health Plans in the same manner the tax is applied to gross premiums from business done in the State for all other health care plans and contracts of insurance provided by insurers or health maintenance organizations subject to the tax under GS 105-228.5.
Removes the provision making the entire act contingent on the passage of H 966, 2019 Appropriations Act.
Summary date: Sep 18 2019 - More information
Summary date: Jul 9 2019 - More information
House committee substitute to the 1st edition makes the following changes.
Amends the sources of funding for the NC Health Care for Working Families program, to provide that the State and county share of costs not covered by federal funds or participant contributions will be funded through intergovernmental transfers, gross premiums tax revenue, and hospital assessments (was, intergovernmental transfers and health care-related assessments, including but not limited to, hospital assessments).
Requires that if the program approved by the Center for Medicare and Medicaid services fails to substantially comply with the program components (was, fails to comply with any of the program components) required by this act, then the NC Health Care for Working Families program must not be implemented and the Department of Health and Human Services must stop all implementation activities. Provides that if legislation to ensure that the State and county share of costs not covered by federal funds, participant contributions, or increased gross premiums tax revenue (was, federal funds or participant contributions only) will be funded through a new hospital assessment (was, through health care-related assessments) is not enacted, then the NC Health Care for Working Families program must not be implemented and DHHS must continue to seek federal approval for the program but must stop all other implementation activities until the necessary legislation is enacted.
Amends proposed GS 108B-31, Rural Access to Healthcare Grant Fund, by adding that an appropriation under the statute is a statutory appropriation. Requires the Director of the Budget, when developing the base budget, to include the following appropriations to the North Carolina Rural Access to Healthcare Grant Fund (Grant Fund): (1) $25 million for 2020-21, (2) $30 million for 2021-22, and (3) $50 million for 2022-23 and every fiscal year thereafter.
Removes the provision that provided that if H114 (an act to subject prepaid health plans licensed by the Department of Insurance to the gross premium tax) became law, then it was the NCGA's intent to appropriate funds to the North Carolina Rural Access to Healthcare Grant Fund in an amount that represents the amount of revenue from the gross premiums tax attributable to capitation payments received by prepaid health plans as a result of the implementation of the NC Health Care for Working Families program.
Provides that the funds appropriated to the Grant Fund are intended to represent a portion of the amount of revenue from the gross premium tax attributable to capitation payments received by prepaid health plans as a result of the implementation of the NC Health Care for Working Families program.
Adds that the act is effective only if H966, 2019 Appropriations Act, becomes law.
Summary date: Apr 10 2019 - More information
Includes whereas clauses.
Requires the Department of Health and Human Services (DHHS) to design the NC Health Care for Working Families program (program), providing coverage to residents of the state who (1) meet all federal Medicaid citizenship and immigration requirements; (2) are not eligible for Medicaid under the currently established North Carolina eligibility criteria; (3) have a modified adjusted gross income that does not exceed 133% of the federal poverty level; (4) are not entitled to or enrolled in Medicare Part A or Part B benefits; and (5) are between the ages of 19 and 64.
Requires that the benefit package be similar to the coverage provided under North Carolina's 2017 Essential Health Benefits Benchmark Plan and the Blue Cross and Blue Shield of North Carolina Blue Options Preferred Provider Organization Plan and requires it to comply with applicable federal requirements governing Alternative Benefits Plans. Requires program participants to pay an annual premium that is set at 2% of the participant's household income. Failure to pay within 90 days results in suspension from the program; sets out conditions under which participation may be reactivated. Requires DHHS to adopt rules related to premiums, including exemptions, from the requirements; sets out criteria for the premiums exemptions. Requires DHHS to develop cost-effective methods of accepting participant contributions that facilitate the participant's ability to make the contribution.
Requires co-payments to be comparable with those applied under the NC Medicaid State Plan. Requires DHHS to establish preventive care and wellness activities for the program. Requires DHHS to establish employment activities for program participants that adhere to federal guidance and are aligned with the work requirements of the Able-Bodied Adults Without Dependents policy under the Supplemental Nutrition Assistance Program as much as possible, with six categories of individuals exempted from the mandatory employee activities.
Requires the program to be built on defined measures and goals for risk-adjusted health outcomes, quality of care, patient satisfaction, access, and costs, with components subject to accountability measures.
Limits the sources of funding for the program to federal funds, participant contributions, and State and county funds.
Requires coverage to begin upon the earlier of (1) 120 days after the approval by the Center for Medicare and Medicaid Services of all State Plan amendments or amendments to the 1115 demonstration waiver submitted under this Section or (2) July 1, 2020.
Sets out six conditions under which the program will not be implemented or will be terminated.
Requires DHHS to report to the specified NCGA committee by October 1, 2019, with a design proposal for the program; specifies items that must be included in the report.
Enacts new Article 3, Rural Access to Healthcare Grants, in GS Chapter 108B. Establishes the North Carolina Rural Access to Healthcare Grant Fund in the Department of Health and Human Services, Division of Central Management, Office of Rural Health (Office), to provide grants to qualified applicants for any of 10 eligible activities, including health care provider recruitment to rural areas, expansion of telehealth into rural areas, infant mortality reduction efforts, and expansion of mental health services into rural areas. Defines a qualified applicant as an individual or entity that meets criteria for applying for funds distributed under the Rural Access to Healthcare Grant Program, as established by the Office. Requires the Office to define the term rural. Limits grants to no more than $1 million. Prohibits grant recipients from applying for an additional grant until five years from the date of the first grant. Sets out issues the Office must consider when awarding grants. Allows the Office to require grantee to make annual reports.
Provides that if H114 (an act to subject prepaid health plans licensed by the Department of Insurance to the gross premium tax) becomes law, then it is the NCGA's intent to appropriate funds to the North Carolina Rural Access to Healthcare Grant Fund in an amount that represents the amount of revenue from the gross premiums tax attributable to capitation payments received by prepaid health plans as a result of the implementation of the NC Health Care for Working Families program.
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