Bill Summaries: H76 ACCESS TO HEALTHCARE OPTIONS.

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  • Summary date: Mar 29 2023 - View Summary

    AN ACT TO PROVIDE NORTH CAROLINA CITIZENS WITH GREATER ACCESS TO HEALTHCARE OPTIONS. SL 2023-7. Enacted March 27, 2023. Effective March 27, 2023, except as otherwise provided.


  • Summary date: Mar 8 2023 - View Summary

    Senate committee substitute to the 2nd edition makes the following changes.

    Deletes whereas clauses.

    Part I.

    Makes the repeal of Section 3, SL 2013-5, which bars the State from expanding the State's Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act, PL 111-148, effective on the date the act becomes law rather than January 1, 2024.

    Makes proposed GS 108A-54.3A(24), requiring the Department of Health and Human Services (DHHS) to provide Medicaid coverage to individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act, previously effective on January 1, 2024, now effective on the later of: (1) the date approved by the Centers for Medicare and Medicaid Services (CMS) for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act; or (2) the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law. Adds to the criteria for Medicaid coverage under new subsection (24) that individuals must be in compliance with any work requirements established in the State Health Plan and in rule.

    Eliminates the directive requiring DHHS to establish preventive care and wellness incentives for individuals eligible for Medicaid coverage under the provisions described in amended GS 108A-54.3A, and encouraging prepaid health plans to offer preventive care and wellness incentives to their enrollees.

    Eliminates the requirement for DHHS and all county departments of social services to begin accepting applications from, and enrolling if permissible, individuals who will be eligible for coverage under amended GS 108A-54.3A as soon as practicable but no later than December 1, 2023.

    Directs the DHHS Secretary to notify the specified NCGA division and the Revisor of Statutes of the date approved by CMS for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. 

    Revises new GS 108A-54.3B and GS 108A-54.3C by correcting a NCGA committee name. Changes the effective date of the new statutes from January 1, 2024, to mirror the effective date of new GS GS 108A-54.3A(24), being the later of: (1) the date approved by the Centers for Medicare and Medicaid Services (CMS) for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act; or (2) the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law. Adds to the criteria for Medicaid coverage under new subsection (24) that individuals must be in compliance with any work requirements established in the State Health Plan and in rule.

    Makes the establishment of the ARPA Temporary Savings Fund effective on the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law (was effective on the date the act becomes law).

    Regarding the hospital assessment to be imposed by DHHS for the fiscal quarter beginning October 1, 2023, now requires DHHS to use $4 million to provide funding to county departments of social services to support their implementation of Section 1.1 of the act, which enacts new GS 108A-54.3A(24) (previously called for the funds to be provided to county departments to support their preparing for implementation of Section 1.1). Regarding required reporting on the assessment proceeds, corrects the name of a legislative committee. Makes the provisions effective on the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law (was effective on the date the act becomes law). Sets a sunset of September 30, 2023, in the event no Current Operations Appropriations Act for 2023-24 has become law by that date.

    Revises new Part 3, Health Advancement Assessments, in Article 7B of GS Chapter 108A, as follows. Makes the provisions effective on the first day of the next assessment quarter after the act becomes law, rather than January 1, 2024.

    Amends GS 108A-147.5, which previously set the presumptive service cost component used in formulating the aggregate health advancement assessment collection amount, for the fiscal quarters beginning January 1, 2024, and each quarter beginning on or after April 1, 2024. Now sets the presumptive cost service component for (1) every quarter prior to the quarter in which new GS 108A-54.3A(24) becomes effective, setting the component at zero; (2) the quarter in which GS 108A-54.3A(24) becomes effective, setting the component at the product of $48.75 million multiplied by the number of months in the quarter in which new GS 108A-54.3A(24) is effective in any part of the month; and (3) the first quarter after the quarter in which new GS 108A-54.3A(24) becomes effective, setting the component at $146.25 million (previously the set amount for the quarter beginning January 1, 2024). Makes the greater of amounts previously set out to determine the component for every quarter beginning on or after April 1, 2024, now applicable to determine the component for the second quarter following the quarter in which new GS 108A-54.3A(24) becomes effective and every quarter thereafter.

    Amends GS 108A-147.7, which sets amounts for the State and county administration subcomponents that makeup the administration component used in formulating the aggregate health advancement assessment collection amount. For the State administration subcomponent, sets the amount for (1) every quarter in the 2022-23 and 2023-24 fiscal years at the product of $1.1 million multiplied by the number of months in the quarter in which new GS 108A-54.3A(24) is effective in any part of the month; (2) every quarter in 2024-25 at $3.3 million increased by the Consumer Price Index (CPI); and (3) every subsequent quarter increased over the prior year's quarterly amount by the CPI (previously, set at $3.3 million for quarters in 2023-24 with subsequent CPI increases thereafter). For the county administration component, sets the amount for (1) every quarter in the 2022-23 and 2023-24 fiscal years at $1.667 million multiplied by the number of months in the quarter in which new GS 108A-54.3A(24) is effective in any part of the month; (2) every quarter in 2024-25 at $7.4 million; (3) every quarter of 2025-26 at $7.8 million; and (4) every subsequent quarter increased over the prior year's quarterly amount by the CPI (previously, set at $5 million for each quarter of 2023-24, with the remainder of the schedule the same).

    Amends GS 108A-147.8, which sets the amount of the State retention component used in formulating the aggregate health advancement assessment collection amount. Sets the component for every fiscal quarter prior to the quarter in which new GS 108A-54.3A(24) becomes effective, at zero, and for the quarter in which new GS 108A-54.3A(24) becomes effective and every quarter thereafter at $10.75 million (was a flat amount at $10.75 million for each assessment quarter).

    Amends GS 108A-147.12 to set the gross premiums offset amount at zero for 2022-23 and 2023-24 (was zero for 2023-24 and 2024-25). Requires using the previously described formulas for determining the offset for the first and second, third and fourth quarters in 2024-25 and each year thereafter (was used for 2025-26 and each year thereafter). 

    Amends new GS 108A-147.7 by increasing the amount of the State administration subcomponent for each quarter of the 2023-24 and 2024-25 fiscal years as specified. Now effective upon the later of: (1) the first day of the next assessment quarter after the CMS approves the initial 42 C.F.R. § 438.6(c) preprint requesting approval of the healthcare access and stabilization program (HASP) submitted in accordance with GS 108A-148.1 or (2) the first day of the next assessment quarter after the act becomes law (rather than January 1, 2024).

    Makes new GS 143C-9-10, establishing the Health Advancement Receipts Special Fund, effective on the first day of the next assessment quarter after the act becomes law, rather than January 1, 2024.

    Revises Part 2, Modernized Hospital Assessments, of Article 7B, as follows.

    Amends GS 108A-146.12, which sets out the postpartum coverage component used in the calculation of the aggregate modernized assessment collection amount. Specifies that the amount set for each quarter of 2022-23 is for quarters prior to the quarter in which new GS 108A-53.4A(24) becomes effective. Reduces the component for each quarter in 2022-23 in which new GS 108A-53.4A(24) becomes or is effective to $4.5 million. Sets the component for each quarter of 2023-24 prior to new GS 108A-53.4A(24) being effective at $11,004,424, and each quarter of 2023-24 in which new GS 108A-53.4A(24) is or becomes effective at $4.5 million (previously provided amounts for the first and second, and then third and fourth quarters of 2023-24). Makes a technical change. Effective on the first day of the next assessment quarter after the date the Current Operations Appropriations Act for 2023-24 becomes law and applies to assessment imposed on or after that date (was, January 1, 2024).

    Amends GS 105-523(b)(2), defining the hold harmless threshold for counties with repealed local taxes, to specify that a county's Medicaid service costs do not include any costs for newly eligible individuals defined by GS 108A-145.3. Effective on the date the Current Operations Appropriations Act for 2023-24 becomes law.

    Makes the amendments to Section 2.1, SL 2021-61, and GS 108D-65(6), and the proposed repeal of Sections 9D.13A(e) and 9D.14, SL 2021-180, regarding assessment amounts, effective on the date the Current Operations Act for 2023-24 becomes law (was, January 1, 2024).

    Eliminates the $50 million appropriation for 2023-24 from the General Fund to the Division of Health Benefits (DHB) to be distributed to all counties for the administrative costs of Medicaid eligibility determinations and for inmate medical costs.

    Adds the following new content to Part I, effective on the date the Current Appropriations Act for 2023-24 becomes law.

    Authorizes DHHS to use the federally facilitated marketplace to make Medicaid eligibility determinations on a temporary basis up to 12 months after the date approved by CMS for Medicaid coverage to begin in NC for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. Requires compliance with all eligibility categories, resource limits, and income thresholds legislatively set. Authorizes DHHS to make any necessary request or enter into agreement with the federally facilitated marketplace. Expires 12 months after the date approved by CMS for Medicaid coverage to begin in North Carolina for individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act.

    Amends GS 108A-25 to require county departments to accept Medicaid eligibility determinations made by the federally facilitated marketplace if legislative authorization has been given and upon direction of the DHHS Secretary.

    Enacts GS 108A-25.1A(b1) to make county departments not financially liable for the erroneous issuance of Medicaid benefits and Medicaid claims payments resulting from a failure or error attributable solely to the federally facilitated marketplace. 

    Amends GS 108A-70.36, which sets the scope of Part 10, Medicaid Eligibility Decision Processing Timelines, Article 2, making the Part's provisions not apply to any eligibility determinations made by the federally facilitated marketplace that have been legislatively authorized. 

    Amends GS 108A-55.3 to require applicants for medical assistance benefits show only one rather than two of the listed documents to prove residency. Makes technical changes.

    New Part IA. lists sections of the act that expire on June 30, 2024, if no Current Operations Appropriations Act for 2023-24 has become law by that date: Section 1.4 (enacting Part 4, Article 7B, GS Chapter 108A); Section 1.6(a), (f), and (g) (amending GS 108A-145.3, effective and implementing provisions); and Section 1.7(a) through (j) and (q) (amending various GS Chapter 108A sections and effective provisions). 

    Part II.

    Regarding the directive for DHHS to develop a workforce development program in collaboration with named entities, requires collaboration with the NC Chamber (was Chamber of Commerce). Concerning required reporting on the plan and workforce development assistance, corrects a NCGA committee name. Makes technical changes.

    Allows for the notice required of DHB to Medicaid applicants and certain recipients about the Health Insurance Marketplace and contact information for the NC Navigators Consortium to be electronic. Regarding required reporting, corrects an NCGA committee name.

    Corrects the NCGA committee name regarding required reporting by DHB when entering into negotiations with CMS relating to work requirement planning.

    Eliminates all previous sections establishing and pertaining to the Doctors and Nurses in Rural Areas Forgivable Loan Pilot Program.

    Makes the remaining sections of Part II. of the act effective on the date the Current Operations Appropriations Act for 2023-24 becomes law. Sunsets the provisions on June 30, 2024, if no Current Operations Appropriations Act for 2023-24 has become law by that date (was the later of July 1, 2023, or the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law).

    Enacts the following new content.

    Part III.

    Section 3.1, effective on the date the act becomes law and applies to activities occurring on or after that date, provides as follows.

    Revises defined terms applicable to certificates of need (CON) laws in Article 9, set forth in GS 131E-176, as follows. Changes the threshold criteria for diagnostic center to include a facility, program, or provider in which the total cost of all medical diagnostic equipment used by the facility which costs more than $10,000 or more exceeds $3 million (currently, the cost threshold is set at $1.5 million). Removes psychiatric facilities and chemical dependency treatment facilities from the definition of health service facility; makes conforming deletions from the term health service facility bed. Changes the threshold criteria for replacement equipment to include equipment that costs less than $3 million (was $2 million) as described; requires annually adjusting the threshold beginning September 30, 2023 using the Medical Care Index of the CPI as specified. 

    Amends GS 131E-184 by exempting from certificate of need review a new institutional health service if it receives prior written notice from the proposing entity to allow a licensed home care agency to provide early and periodic Screening, Diagnosis, and Treatment services to children up to 21 years of age in compliance with federal Medicaid requirements; applicable to all licensed child care agencies whether or not Medicare-certified. Repeals subsections (c) and (d) of the statute, relating to CON review exemptions for certain psychiatric beds or chemical dependency or substance abuse service facilities, now excluded from the definition of hospital service facility and beds. Replaces the set threshold amounts referenced in subsections (e), (f), and (g), to instead refer to "monetary" thresholds relating to capital expenditures and replacement equipment costs.

    Makes conforming changes to GS 148-19.1 to eliminate the CON exemption for chemical dependency or substance abuse service facilities for inmates and offenders.

    Establishes that no person is required to obtain a CON under Article 9, GS Chapter 131E prior to converting health service facility beds that obtained a CON prior to the date the act becomes law into chemical dependency treatment facility beds or psychiatric beds; or increasing the number of health service facility beds that obtained CON approval prior to the date the act becomes law as chemical dependency treatment facility beds or psychiatric beds.

    Section 3.2 provides the following, effective two years from the date DHHS issues the first directed payment under HASP pursuant to GS 108A-148.1, and applies to activities occurring on or after that date. Directs the DHHS Secretary to notify the Revisor upon issuance of the first directed payment under HASP and the date of issuance. Sunsets the provisions on June 30, 2025, if DHHS has not made any HASP payments by that date.

    Further amends GS 131E-176 to define qualified urban ambulatory surgical facility as a licensed facility that has a single specialty or multispecialty ambulatory surgical program and is located in a county with a population greater than 125,000. Excludes qualified urban ambulatory surgical facilities from health service facility. Also excludes qualified urban ambulatory surgical facilities as a new institutional health service otherwise meeting the threshold criteria in subdivision b. Revises the definition of special ambulatory surgical program.

    Adds qualified urban ambulatory surgical facility to the defined terms in Part 4, Article 5, GS Chapter 131E, Ambulatory Surgical Facility Licensure. Defines the term by statutory cross-reference. 

    Enacts GS 131E-147.5 to require at least 4% of every qualified urban ambulatory surgical facility's total earned revenue to be attributed to self-pay and Medicaid revenue. Provides for calculation. Requires annual reporting to DHHS the percentage of the facility's earned revenue that is attributed to self-pay and Medicaid revenue. 

    Section 3.3 provide the following, effective three years from the date DHHS issues the first directed payment under HASP pursuant to GS 108A-148.1, and applies to activities occurring on or after that date. Directs the DHHS Secretary to notify the Revisor upon issuance of the first directed payment under HASP and the date of issuance. Sunsets the provisions on June 30, 2025, if DHHS has not made any HASP payments by that date.

    Further amends GS 131E-176 to provide that no facility, program, or provider can be deemed a diagnostic center solely by virtue of having a magnetic resonance imaging scanner in a county with a population greater than 125,000, including but not limited to physicians' offices, clinical labs, radiology centers, or mobile diagnostic programs. Also provides that magnetic resonance imaging scanners in counties with a population greater than 125,000 are not major medical equipment. Limits the scope of including the acquisition of magnetic resonance imaging scanners as new institutional health services to only those scanners acquired in counties with a population of 125,000 or less.

    Includes a severability clause. 

    Changes the act's catchall effective date provision to the date the act becomes law (was, the date that the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law). Eliminates the provision that provided that if by December 31, 2023, no Current Operations Appropriations Act for the 2023-24 fiscal year has become law, then the act expires.

    Changes bill headings throughout.


  • Summary date: Feb 15 2023 - View Summary

    House amendments to the 1st edition make the following changes.

    Amendment #1 adds the requirement that if there is any indication that work requirements as a condition of participation in the Medicaid program may be authorized by the Centers for Medicare and Medicaid Services (CMS), then the Department of Health and Human Services, Division of Health Benefits (DHB), must negotiate with CMS to develop a plan for those work requirements and to obtain approval of that plan. Requires DHB, within 30 days of entering into negotiations with CMS, to provide written notification to the specified NCGA committee and division of the negotiations. Requires DHB to report to those same entities, within 30 days of approval by CMS of a plan for work requirements as a condition of participation in the Medicaid program, on the details of the approved work requirements, including the approved date of implementation of the requirements.

    Amendment #2 appropriates $50 million for 2023-24 from the General Fund to the DHB to be distributed to all counties for the administrative costs of Medicaid eligibility determinations and for inmate medical costs. Effective the later of July 1, 2023, or the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law.

    Requires funds to be distributed on a per capita basis, with each county receiving at least $100,000. Specifies that the provisions of GS 143C-5-2 (Order of appropriations bills) do not apply to this act.

    Amendment #3 adds the following. Establishes the Doctors and Nurses in Rural Areas Forgivable Loan Pilot Program to be administered by the State Education Assistance Authority (Authority) to provide forgivable loans to eligible students who agree to practice medicine or nursing on a full-time basis in a rural area (an NC county designated by the NC Rural Center as a rural county). Defines an eligible student as either of the following types of students enrolled in an eligible postsecondary institution (as defined) in the 2024-25 academic year as a first-year student in a program of study approved by the Authority for students to receive funds under the Forgivable Education Loans for Service Program related to the following degrees: (1) a student enrolled in a medical school for purposes of becoming a licensed physician or (2) a student enrolled in an associate, bachelor, masters, or doctoral degree program in nursing for purposes of becoming a licensed nurse.

    Requires the Authority to establish the criteria for initial and continuing eligibility for participation in the program, including at least: (1) requiring loan recipients to be NC residents attending an eligible postsecondary institution; (2) standards necessary to ensure only qualified persons receive a loan, including priority for applicants from rural areas; and (3) to the extent funds provided pursuant to this section are insufficient to award forgivable loans to all interested, eligible students, the Authority may establish a lottery process to select recipients.

    Requires promissory notes have an interest rate established by the Authority that does not exceed 10% and is in relation to the current interest rate for non-need-based federal loans made pursuant to Title IV of the Higher Education Act of 1965, as amended. Sets out the loan amounts, with amounts varying for degrees in Doctor of Medicine, Doctor in Nursing, Masters in Nursing, Bachelor in Nursing, and Associate in Nursing. Requires forgiving loans based on the amount received by the eligible student for each year that the recipient works as a licensed physician or nurse practicing on a full-time basis in a rural area, up to the total amount initially awarded to the recipient. Requires the Authority to establish any other necessary criteria for loan forgiveness for qualifying employment. Requires the Authority to collect cash repayments when service repayment is not completed.

    Requires the Authority to report annually while loans are held or forgiven by the Authority, beginning by December 1, 2024, to the specified NCGA committees on the program and loans that are awarded, including specified information on the forgivable loans awarded by the Authority, placement and repayment rates, and on recommendations to expand the program and increase the number of licensed physicians and nurses practicing in rural areas.

    Appropriates $14.4 million for 2023-24 from the General Fund to the UNC Board of Governors to be allocated to the Authority to provide forgivable loans to an estimated 200 eligible students in accordance with the program. Requires the funds to remain available until expended. Allows the Authority to use up to $200,000 of the funds for administrative costs.

    Effective the later of July 1, 2023, or the date the Current Operations Appropriations Act for the 2023-24 fiscal year becomes law.

    Specifies that the provisions of GS 143C-5-2 (Order of appropriations bills) do not apply to this act.


  • Summary date: Feb 8 2023 - View Summary

    Includes whereas clauses.

    Part I.

    Repeals Section 3, SL 2013-5, which bars the State from expanding the State's Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act, PL 111-148, as amended, for which the enforcement was ruled unconstitutional by the U.S. Supreme Court, and bars State entities from attempting to expand the Medicaid eligibility standards provided in SL 2011-145, as amended, or elsewhere in State law, unless directed by the NCGA. Effective January 1, 2024, amends GS 108A-54.3A to enact new subdivision (24), requiring the Department of Health and Human Services (DHHS) to provide Medicaid coverage to individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act. Section 1902(a)(10)(A)(i)(VIII) of the Social Security Act includes individuals who, beginning January 1, 2014, are under 65 years of age, not pregnant, not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII, and are not described in a another subclause, and whose income does not exceed 133% of the poverty line applicable to a family of the size involved. Makes coverage available through an Alternative Benefit Plan established by DHHS consistent with federal requirements, unless the individual is exempt from mandatory enrollment in the Plan under 42 CFR 440.315. 

    Requires DHHS to establish preventive care and wellness incentives for individuals eligible for Medicaid coverage under the provisions described in amended GS 108A-54.3A. Specifies the types of care and activities that the incentives are to cover. Requires DHHS to consider the methods and types of incentives used by other states for this population. Encourages prepaid health plans to offer preventive care and wellness incentives to their enrollees.

    Requires DHHS and all county departments of social services to begin accepting applications from, and enrolling if permissible, individuals who will be eligible for coverage under amended GS 108A-54.3A as soon as practicable but no later than December 1, 2023.

    Enacts GS 108A-54.3B. States legislative intent to fully fund the nonfederal share of the cost of NC Health Works, meaning the provision of Medicaid coverage to the individuals described in new GS 108A-54.3A(24), through a combination of (1) increases in revenue from the gross premium tax due to NC Health Works; (2) increases in intergovernmental transfers due to NC Health Works, excluding any State retention; (3) the hospital health assessment under Part 3, Article 7B, GS Chapter 108A, excluding State retention; and (4) savings to the State attributable to the NC Health Works corresponding to General Fund budget reductions to other State programs. Directs DHHS to annually report, beginning in 2025, to the specified NCGA committee, division, and the Office of State Budget and Management (OSBM), as specified. Requires expeditiously discontinuing coverage for the individuals described in new GS 108A-54.3A(24) if the nonfederal share of the cost cannot be fully funded through the described sources. Requires the DHHS Secretary to notify the specified NCGA committee, division, and OSBM of such a determination, and post notice to its website including the proposed effective date of the discontinuation of coverage. Also requires the DHHS Secretary to submit necessary documentation to the Centers for Medicare and Medicaid Services (CMS). Enacts GS 108A-54.3C to require expeditious discontinuation of Medicaid coverage if the federal medical assistance percentage for Medicaid coverage provided to the individuals described in new GS 108A-54.3A(24) falls below 90%. Requires the DHHS Secretary to fulfill identical requirements as those for a discontinuation due to insufficient funds from identified sources in GS 108A-54.3B. Effective January 1, 2024.

    Establishes the ARPA Temporary Savings Fund as a nonreverting special fund in the Division of Health Benefits (DHB) consisting of any savings realized as a result of federal receipts arising from the enhanced federal medical assistance percentage (FMAP) available to the State under section 9814 of the American Rescue Plan Act (ARPA). Requires legislative allocation or expenditure of the funds. Expires 10 years after the date this act becomes law.

    Enacts new Part 4, Healthcare Access and Stabilization Program, in Article 7B (Hospital Assessment Act) of GS Chapter 108A, providing as follows. Provides that the healthcare access and stabilization program (HASP) is a directed payment program that provides acute care hospitals with increased reimbursements funded through assessments. Requires DHHS to submit a specified preprint requesting approval for the HASP program that includes any required demonstration for the financing of the nonfederal share of the HASP program costs; prohibits DHHS from making any HASP-directed payments before CMS approval of the initial preprinting. Prohibits DHHS from requesting any date of service for claims eligible for reimbursement through the HASP program earlier than July 1, 2022. Requires DHHS to continue to submit any necessary documentation requesting continued approval for the HASP program in the time and manner required by CMS. Requires the state funds required to make HASP directed payments to be derived from HASP components of the hospital assessments under Article 7B subject to the specified limitations. Prohibits DHHS, as a part of the preprint submission for the 2022-23 State fiscal year, from requesting any amount of HASP hospital reimbursements that is (1) greater than the maximum allowable under the specified federal provision or (2) less than an annual estimated total dollar amount of $3.2 billion for services provided to not newly eligible individuals.

    Provides that for the State fiscal quarter beginning October 1, 2023, each acute care hospital, except for critical access hospitals, is subject to an assessment of a percentage of its hospital costs. Requires DHHS to impose this assessment in accordance with the procedures for hospital assessments under Part 1 of Article 7B of GS Chapter 108A. Requires DHHS to calculate the hospital assessment percentage by dividing $12.8 million by the total hospital costs for all acute care hospitals except for critical access hospitals. Requires DHHS to use $4 million from the assessment proceeds to provide funding to county departments of social services to support the counties in preparing to implement Section 1.1 of this act (repealing Section 3 of SL 2013-5 and enacting GS 108A-54.3A(24). This provision expires December 31, 2023.

    Requires DHHS, by March 1, 2024, to report to the specified NCGA committee and division on the amount of the proceeds from the assessment that DHHS provided to each county department of social services and the date that those proceeds were provided to each county department of social services.

    Amends GS 108A-145.3, which sets out the definitions for terms as they are used in Article 7B, to add and define actual nonfederal expenditures, consumer price index: all urban consumers, consumer price index: medical care, current quarter, FMAP for newly eligible individuals, HASP directed payments, healthcare access and stabilization program (HASP), IGT, newly eligible individual, nonfederal share for newly eligible individuals, and nonfederal share for not newly eligible individuals.

    Enacts new Part 3, Health Advancement Assessments, in Article 7B of GS Chapter 108A, providing as follows. Effective January 1, 2024. Makes the public hospital health advancement assessments imposed under this Part applicable to all public acute care hospitals. Requires the assessment to be assessed as a percentage of each public acute care hospital's hospital costs, with the percentage calculated quarterly. Requires the percentage for each quarter to equal the aggregate health advancement assessment collection amount calculated under new GS 108A-147.3 multiplied by the public hospital historical assessment share and divided by the total hospital costs for all public acute care hospitals holding a license on the first day of the assessment quarter. Makes the private hospital health advancement assessment imposed under this Part applicable to all private acute care hospitals. Requires the assessment to be assessed as a percentage of each private acute care hospital's hospital costs, with the percentage calculated quarterly. Requires the percentage for each quarter to equal the aggregate health advancement assessment collection amount calculated under new GS 108A-147.3 multiplied by the private hospital historical assessment share and divided by the total hospital costs for all private acute care hospitals holding a license on the first day of the assessment quarter.

    Sets out provisions detailing the process for calculating the aggregate health advancement assessment collection amount. Provides that the aggregate health advancement assessment collection amount is an amount of money calculated quarterly by adjusting the total nonfederal receipts for health advancement calculated under the statute by (1) subtracting the health advancement presumptive IGT adjustment component calculated under the specified new statute, (2) adding the positive or negative health advancement IGT actual receipts adjustment component calculated under the specified new statute, and (3) subtracting the positive or negative IGT share of the reconciliation adjustment component calculated under the specified new statute. Provides that the total nonfederal receipts for health advancement is an amount of money calculated quarterly by adding all of the following: (1) the presumptive service cost component calculated under the specified new statute; (2) the HASP health advancement component calculated under the specified new statute; (3) the administration component calculated under the specified new statute; (4) the State retention component under the specified new statute; and (5) the positive or negative health advancement reconciliation adjustment component calculated under the specified new statute. Sets out the statutes detailing these components.

    Requires in new GS 108A-147.13, except as provided below, the proceeds of the health advancement assessments imposed under this Part, and all corresponding matching federal funds, to be used only to fund: (1) medicaid actual nonfederal expenditures for newly eligible individuals, including HASP directed payments; (2) administrative expenditures for newly eligible individuals; and (3) administrative expenditures related to the HASP program. Requires DHHS to use an amount of the proceeds of the health advancement assessments that is equal to the county administration subcomponent of the administration component to provide funding to county departments of social services to support the counties in determining eligibility for newly eligible individuals. Limits the amount of the proceeds of the health advancement assessments that may be used for administrative expenses attributable to providing Medicaid coverage to newly eligible individuals and administrative expenditures associated with the HASP program, to an amount equal to the sum of the State administration subcomponent of the administration component for each quarter of the State fiscal year, and all corresponding matching federal funds. Requires DHHS to use an amount from the proceeds of the health advancement assessments equal to the State retention component and all corresponding matching federal funds, for Medicaid program costs.

    Enacts new GS 143C-9-10 establishing the Health Advancement Receipts Special Fund (Fund) established as a nonreverting special fund in DHHS. Requires DHHS, each fiscal quarter, to deposit in the Fund funds equal to the total nonfederal receipts for health advancement for that quarter, minus the State retention component for that quarter, and plus the positive or negative gross premiums tax offset amount for that quarter. Requires DHHS to use the funds in the Fund only for purposes described in GS 108A-147.13. Effective January 1, 2024.

    States the NCGA’s intent to appropriate recurring funds to DHHS, Division of Health Benefits, equaling the total of the gross premiums tax offset amount.

    Amends new GS 108A-147.7 by increasing the amount of the State administration subcomponent for each quarter of the 2023-24 fiscal year. Effective upon the later of: (1) the first day of the next assessment quarter after the CMS approves the initial 42 C.F.R. § 438.6(c) preprint requesting approval of the healthcare access and stabilization program (HASP) submitted in accordance with GS 108A-148.1 or (2) January 1, 2024. Applies to assessments imposed on or after the effective date.

    Requires the Secretary of the Department of Health and Human Services to notify the Fiscal Research Division and the Revisor of Statutes of the date that CMS approves of the initial 42 C.F.R. § 438.6(c) preprint requesting approval of the HASP program  submitted in accordance with GS 108A-148.1, as enacted by this act. Provides that if, by June 30, 2025, the Department of Health and Human Services has not received approval of that preprint, then subsection (e) of this section (which further amends GS 108A-147.7) expires on that date.

    Amends the following statutes in Part 2, Modernized Hospital Assessments, of Article 7B.

    Refers to the hospital assessments as the hospital modernized assessment in the following: GS 108A-146.1, GS 108A-146.3, and GS 108A-146.5.

    Amends GS 108A-146.5 to amend the calculation of the aggregate modernized assessment collection amount to now be the amount of money calculated by subtracting the modernized intergovernmental transfer adjustment component from the total modernized nonfederal receipts and then adding the positive or negative amount of the modernized IGT actual receipts adjustment component. Amends the components of the modernized nonfederal receipts to include the modernized HASP component. Enacts new GS 108A-146.10 setting out the calculation of the modernized HASP component. Enacts new GS 108A-146.14 setting out the process for calculating the modernized IGT actual receipts adjustment component.

    Amends the following components of the calculation of the aggregate modernized assessment collection amount. Amends GS 108A-146.7 to amend the managed care component, amends GS 108A-146.9 by amending the fee-for service component, and amends GS 108A-146.11 by amending the graduate medical education component. Deletes the existing provisions of GS 108A-146.13 which sets out the calculation of the intergovernmental transfer adjustment component and replaces it with the calculation of the modernized presumptive IGT adjustment component.

    Amends GS 108A-146.15 by expanding upon the allowable uses of the process of the assessment and corresponding matching federal funds, to include HASP-directed payments attributable to hospital reimbursements for not newly eligible individuals.

    Effective January 1, 2024, amends GS 108A-146.12 by amending the amount of the postpartum coverage component for the specified quarters of the 2023-24 fiscal year.

    Amends Section 2.1 of SL 2021-61, effective January 1, 2024. Provides that for any quarter in which the State receives the temporary increase of Medicaid FMAP (federal medical assistance percentage) allowed under (1) section 6008 of the Families First Coronavirus Response Act or (2) section 9814 of the American Rescue Plan Act of 2021, the FMAP for purposes of Article 7B of GS Chapter 108A shall be the federal share of North Carolina Medicaid service costs as calculated by the federal Department of Health and Human Services in accordance with section 1905(b) of the Social Security Act in effect at the start of the applicable assessment quarter, plus the applicable temporary increase, expressed as a decimal.

    Repeals the following sections of SL 2021-180: (1) Section 9D.13A(e), which set, for the assessment quarter that begins on April 1, 2024, the home and community-based services component at $40,350,000 and the home and community-based services subcomponent at $9,563,000; (2) Section 9D.14, which made changes concerning allowing a parent to retain medicaid eligibility while a child is temporarily served by the foster care system. Effective January 1, 2024.

    Amends GS 108D-65(6)a to refer to the report prepared by the Office of the Actuary instead of the Office of the Actuary for nonexpansion states. Effective January 1, 2024.

    Part II.

    Requires the Secretary of Commerce, by December 1, 2024, to develop a plan to create a seamless, statewide, comprehensive workforce development program, bringing together new opportunities with the current workforce development opportunities within the Department of Commerce, Department of Labor, and other State agencies. Requires the plan to be developed in collaboration with the 13 named stakeholders. Allows contracting with third-party entities in the development and implementation of the plan. Requires the Secretary to strive to ensure that all workforce development opportunities are available to participants statewide by coordinating efforts and resources across State agencies. Specifies five components of the plan. Requires the Secretary of Commerce, by December 1, 2024, to report to the specified NCGA committees on the plan. Specifies items that must be included in the report.

    Requires the Department of Commerce to collaborate with DHHS in developing a method by which to assist individuals enrolled in the North Carolina Medicaid program and other relevant social service programs with accessing appropriate workforce development services. Requires DHHS to develop a plan for assessing the current employment status and any barriers to employment of newly enrolled Medicaid beneficiaries and newly enrolled participants in other relevant social service programs. Requires DHHS and Commerce to determine the best method by which Medicaid beneficiaries and beneficiaries of other relevant social service programs will be provided an initial assessment and consultation with a workforce development case manager, or other similar professional, to ensure that interested individuals can participate in the state’s workforce development programs. Allows contracting with third-party entities or prepaid health plans to assist in providing these services and allows consideration of the use of incentives to prepaid health plans with regard to these services. Requires DHHS by December 1, 2024, to report to the specified NCGA committee on the method determined to be best to provide the required initial assessment and consultation with a workforce development case manager, or other similar professional. Specifies items to be included in the report. Requires DHHS and Commerce, beginning February 1, 2025, and for five years thereafter, to report annually to the specified NCGA committees on specified information related to those Medicaid beneficiaries and participants in other relevant social service programs and their participation in workforce development services and programs.

    Sets out the NCGA’s finding that awareness of, and assistance with, enrollment in health benefit coverage on the federal Health Insurance Marketplace will alleviate the false perception that the loss of Medicaid coverage equals an immediate loss of access to healthcare. Requires DHHS, Division of Health Benefits (DHB), to work with the NC Navigators Consortium to develop a mechanism by which a Medicaid recipient who is transitioning from qualifying for the Medicaid program to qualifying for premium or cost-sharing assistance for health insurance obtained on the Health Insurance Marketplace, or who could reasonably be determined to be eligible, will be assisted with that transition by a qualified Navigator or similar professional. Requires, at a minimum, that by January 1, 2024, DHB provide all Medicaid applicants written notification about the Health Insurance Marketplace that includes the NC Navigators Consortium’s contact information. Requires the notification to also be provided to all Medicaid recipients, with the stated exceptions. Requires DHB to report by March 1, 2024, to the specified NCGA committee on details of the mechanism that has been developed for providing assistance, and details on the required written notification.

    Part III.

    Provides that the act is effective on the date that the Current Operations Appropriations Act for the 2023-2024 fiscal year becomes law. If, by December 31, 2023, no Current Operations Appropriations Act for the 2023-2024 fiscal year has become law, then this act expires.