Bill Summary for H 525 (2015-2016)

Summary date: 

Apr 2 2015

Bill Information:

View NCGA Bill Details2015-2016 Session
House Bill 525 (Public) Filed Wednesday, April 1, 2015
AN ACT TO MODERNIZE AND STABILIZE NORTH CAROLINA'S MEDICAID PROGRAM THROUGH FULL-RISK CAPITATED HEALTH PLANS TO CREATE AN INDEPENDENT BOARD TO GOVERN THE MEDICAID AND NC HEALTH CHOICE PROGRAMS.
Intro. by Burr, Collins, Pendleton, Blackwell.

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Bill summary

Identical to S 696, filed 3/26/15.

States the General Assembly's intent to transform the State's Medicaid program from a traditional fee‑for‑service system into a system that provides budget predictability for the taxpayers of this state while ensuring quality care to those in need. Requires that the new Medicaid program be designed to: (1) provide budget predictability, (2) slow the rate of cost growth, (3) provide whole‑person integrated care, (4) achieve cost‑savings through efficient reductions in programmatic costs, (5) create more efficient administrative structures, (6) provide accountability for budget and program outcomes, (7) improve health outcomes for the state's Medicaid population, and (8) maintain access to care for the state's Medicaid population. Specifies nine principal building blocks of the reform and sets out a timeline by which specified milestones for Medicaid reform must be met. Requires the Health Benefits Authority to develop, with stakeholder input, a detailed plan for Medicaid reform that meets the listed goals, includes the building blocks, and meets the time line. Specifies 15 elements that must be included in the plan. Requires the Health Benefits Authority to report to the General Assembly by April 15, 2016, on its strategic plan for Medicaid reform. Specifies actions for when the plan cannot reasonably be completed by April 15, 2016. Requires semiannual reports beginning September 1, 2016, and every six months thereafter until a final report on September 1, 2021, to the General Assembly on the state's progress toward completing Medicaid reform. Specifies that reports are due to the Joint Legislative Oversight Committee on the Health Benefits Authority. Requires the Health Benefits Authority to work with the Centers for Medicare & Medicaid Services (CMS) to attempt to preserve existing levels of funding generated from Medicaid‑specific funding streams to the extent that the levels of funding may be preserved. Specifies actions if such Medicaid‑specific funding cannot be maintained as currently implemented, if such Medicaid‑specific funding streams cannot be preserved through the reform process, or if revenue would decrease.

Transfers the Division of Medical Assistance (DMA) of the Department of Health and Human Services (DHHS) to the Health Benefits Authority. Effective October 1, 2015. 

Enacts new Part 36, Health Benefits Authority (Authority), in Article 3 of GS Chapter 143B, to operate the Medicaid and NC Health Choice programs. Specifies the Authority's duties. Sets out requirements for the Health Benefits Authority Board (Board). Specifies that Board members serve as fiduciaries for the Medicaid and NC Health Choice programs. Gives the Board 17 specified powers, including administering and operating the Medicaid and NC Health Choice programs, employing the Medicaid Director, entering into contracts for the administration of the Medicaid and NC Health Choice programs, as well as managing such contracts, and supervising the county departments of social services in their administration of eligibility determinations. Lists exemptions from state law that apply to the Authority. 

Establishes cooling off periods for certain Authority employees and makes violations a Class 3 misdemeanor with a fine of no less than $1,000 and no more than $5,000. 

Establishes the Medicaid Reserve Account (Account) to provide for unexpected budgetary shortfalls within the Medicaid and NC Health Choice programs that result from program expenditures in excess of the amount appropriated for the Medicaid and NC Health Choice programs by the General Assembly and which continue to exist after the Health Benefits Authority makes its best efforts to control costs through midyear budget corrections. Sets minimum and maximum target balances for the Account. Specifies events that trigger conditions under which the Authority may access the Account. 

Sets out provisions for Board start up, Board member compensation, and the continuation of administrative arrangements.

Requires the Department of Health and Human Services to, no later than August 1, 2015, report on the allocation of Medicaid costs to Divisions outside of the Division of Medical Assistance as well as to other state departments or agencies, to the members of the Board of the Health Benefits Authority, and to the Joint Legislative Oversight Committee on Health and Human Services.

Requires the Department of Health and Human Services (DHHS) to submit the appropriate State Plan Amendments (SPAs) to change the single state agency designations for the Medicaid and NC Health Choice programs to be the Health Benefits Authority rather than DHHS. Requires the SPAs to have effective dates of October 1, 2015. Specifies other requirements related to the submission of the SPAs.

Transfers all rules and policies exempted from rule making related to the Medicaid and NC Health Choice programs. Also transfers existing contracts. Effective October 1, 2015. 

Sets out other provisions concerning the transfer to the Authority.

Enacts new Article 23B in GS Chapter 120, establishing the 14-member Joint Legislative Oversight Committee (Committee) on the Health Benefits Authority to examine budgeting, financing, administrative, and operational issues related to the Medicaid and NC Health Choice programs and to the Health Benefits Authority of the Department of Health and Human Services. Requires the Committee to consist of seven members of the Senate appointed by the President Pro Tempore of the Senate, at least two of whom are members of the minority party, and seven members of the House of Representatives appointed by the Speaker of the House of Representatives, at least two of whom are members of the minority party. Sets out additional terms governing the Committee's organization and powers. Requires the Authority to give a copy of the report to the cochairs of the Committee whenever the Authority is required by law to report to the General Assembly or to any of its permanent, study, or oversight committees or subcommittees. Repeals GS 120-208.1(a)(2)b, thereby removing the Division of  Medical Assistance from those agencies to be examined by the Joint Legislative Oversight Committee on Health and Human Services. Effective October 1, 2015. 

Specifies recodification of laws related to Medicaid and NC Health Choice. Enacts new GS 108E-2-1 to provide that eligibility categories and income thresholds are set by the General Assembly, and the Authority must not alter the eligibility categories and income thresholds from those authorized by the General Assembly. Enacts new GS 108E-2-2 providing that counties determine eligibility in accordance with GS Chapter 108A. Makes conforming changes. Effective October 1, 2015. 

Provides that funds are appropriated from the General Fund in an amount sufficient to pay for the act's requirements. 

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