TO ESTABLISH REQUIREMENTS FOR THE DEPARTMENT OF HEALTH AND HUMAN SERVICES AND LOCAL MANAGEMENT ENTITIES WITH RESPECT TO STATEWIDE EXPANSION OF THE 1915(B)/(C) MEDICAID WAIVER.
Directs the Department of Health and Human Services (DHHS) to proceed with the statewide restructuring of the management responsibilities for the delivery of services for individuals with mental illness, intellectual and developmental disabilities, and substance abuse disorders through expansion of the 1915(b)/(c) Medicaid Waiver. Attests that it is the intent of the General Assembly that the expansion of the 1915(b)/(c) Medicaid Waiver be completed by July 1, 2013, and to establish a system capable of managing all public resources that may become available for mental health, intellectual and developmental disabilities, and substance abuse services including federal funding and all other public funding sources.
Enumerates the tasks and responsibilities to be undertaken by DHHS in implementing the restructuring and expansion authorized in this provision. Provides that those tasks and responsibilities include (1) establishing accountability for the development and management of a local system that ensures easy access to care, the availability and delivery of necessary services and continuity of care and (2) phasing out the current CAP-MR/DD Waiver as well as the utilization management functions currently performed by public and private contractors as the 1915(b)/(c) Medicaid Waiver expands statewide.
Directs DHHS to prepare and publish a Request for Applications (RFA) for use by Local Management Entities (LMEs) to apply for approval to operate a 1915(b)/(c) Waiver. Directs that the RFA must specify operational requirements that will result in replication of the Piedmont Behavioral Health (PBH) demonstration project. Requires DHHS to select the LMEs that have met the minimum criteria for Waiver operations under the RFA requirements by August 1, 2011.
Directs DHHS by April 1, 2011, to require LMEs that have not been approved to operate a 1915(b)/(c) Medicaid Waiver by January 1, 2013, to merge with or be aligned through an interlocal agreement with an LME that has been approved by DHHS to operate a 1915(b)/(c) Medicaid Waiver. Provides additional governance regarding LMEs that fail to comply with this requirement.
Provides that county governments are not financially liable for overspending or cost overruns associated with an area authority’s operation of a Medicaid Waiver.
Delineates additional deadlines and objectives to be met by DHHS in order to accomplish its task of restructuring management responsibilities through expansion of the Medicaid Waiver.
Directs DHHS in coordination with the Division of MH/DD/SA, the Division of Medical Assistance, LMEs, and PBH to submit to the appropriate Oversight Committee of the General Assembly, by October 1, 2011, a strategic plan identifying specific strategies and agency responsibilities for the achievement of the objectives and deadlines set out in this section. Requires DHHS to submit status reports to the General Assembly on the restructuring and expansion authorized in this section on January 1, 2012; April 1, 2012; October 1, 2012; February 1, 2013; and October 1, 2013.
Amends GS 122C-115(a) to provide that, beginning July 1, 2012, the catchment area of an area authority or a county program must have a minimum population of at least 300,000, and increases the required population to at minimum 500,000 as of July 1, 2013 (was, a catchment area had to contain either a population of at least 200,000 or a minimum of six counties). Provides that, effective July 1, 2012, DHHS is to reduce the administrative funding for LMEs that do not comply with the minimum population requirement of 300,000 to the level of funding provided to LMEs with a population of 300,000. Also provides that, effective July 1, 2013, DHHS is to reassign management responsibilities for Medicaid funds and state funds away from LMEs that are not in compliance with the minimum population requirement of 500,000 to fully compliant LMEs.
Makes conforming changes to GS 122C-115.3(a) and GS 150B-1(d).
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