AN ACT TO SUPPORT IMPROVEMENT IN THE ACCURACY OF MEDICAID ELIGIBILITY DETERMINATIONS.
Amends GS 108A-25(b) to provide that the program of medical assistance established in that statute shall be administered by the Department of Health and Human Services (DHHS) (currently, by county departments of social services). Provides that Medicaid eligibility administration may be delegated to the county departments of social services.
Directs DHHS to report by November 1, 2017, to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice (Oversight Committee) on progress regarding the accuracy of county Medicaid eligibility determinations. Provides requirements for the report's contents.
Amends GS Chapter 108A, Article 2 (Programs of Public Assistance) to add new Part 11 (Medicaid Eligibility Determinations Accuracy and Quality Assurance). Provides that the part applies to federally recognized Native American tribes that have assumed responsibility for the Medicaid program as if they were county departments of social services.
Directs the DHHS Division of Central Management and Support to annually audit, beginning January 1, 2019, all county departments of social services for compliance with the Medicaid eligibility determination accuracy standards adopted under new GS 108A-70.47 and the quality assurance standards under new GS 108A-70.48.
Directs DHHS to adopt Medicaid eligibility determination accuracy standards and quality assurance minimum standards, by rule, in consultation with the State Auditor, and to require county departments of social services to comply with them.
Directs DHHS and any county department of social services that fails to meet the standards to enter into a joint corrective action plan to improve the accurate processing of applications. Provides requirements for the joint corrective action plan, including the length of the plan and performance requirements that constitute successful completion of the plan. Provides for DHHS to temporarily assume Medicaid eligibility administration for any county department of social services that fails to meet the performance requirements under the joint corrective action plan, upon 90 days' notice of DHHS's intent to do so. Provides for DHHS responsibilities regarding Medicaid eligibility in the county during temporary assumption of Medicaid eligibility administration, the county's continued financial obligations during that time, and for DHHS to work with the county department of social services to develop a plan for the county department to resume performing Medicaid eligibility administration more accurately. Provides for termination of DHHS's temporary assumption of Medicaid eligibility administration upon determining that the county department can perform the administration accurately and with proper quality assurance.
Directs DHHS to submit a report by March 1, 2020, and annually thereafter, to the Oversight Committee, the Fiscal Research Division, and the State Auditor. Provides six requirements for the report's contents, regarding county departments of social services and compliance with the accuracy and quality assurance standards.
Amends GS 150B-23(a5) to make a conforming change.
Directs DHHS to collaborate with the State Auditor to develop a plan of implementation for the annual audits required above. Provides six requirements for the plan, including an audit schedule and methodology. Directs DHHS to submit a copy of the plan to the Oversight Committee with any proposed recommendations, suggested legislation, or funding requests.
Authorizes DHHS to adopt and amend rules to implement new GS Chapter 108A, Article 2, Part 11, and accompanying directives.
Enacts new GS 108A-25.1A (Responsibility for errors). Provides that county departments of social services are financially responsible for the State and federal shares of erroneous issuance of Medicaid benefits and claim payments that result from the county's action requiring payment of Medicaid claims for ineligible individuals, dates, or amounts. Provides that the county is not financially responsible for errors attributable solely to the State. Applies to errors identified on or after the date the bill becomes law.
Directs DHHS to design and implement statewide a training and certification program for caseworkers using NC Families Accessing Services Through Technology (NC FAST), and to require all caseworkers inputting data or making determinations for eligibility for State programs through NC FAST to be certified within 18 months of the training's eligibility. Directs DHHS to include verification of certification compliance in the audits required under new GS 108A-70.46. Directs DHHS to submit a report on the training and certification program by March 1, 2018, to the Oversight Committee, the Joint Legislative Oversight Committee on Health and Human Services, and the fiscal Research Division. Provides requirements for the report.
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