Senate committee substitute to the 3rd edition makes the following changes.

Section 1

Makes technical changes to the proposed changes to GS 108D-1, now using the terms behavioral health and intellectual/developmental disabilities tailored plan or BH IDD tailored plan (was, Behavioral Health and Individuals with Developmental Disabilities Tailored or BH IDD Tailored Plan) and standard benefit plan (rather than standard plan). Additionally, modifies the definition of prepaid health plan (PHP) to now define the term to mean a PHP that is under a capitated contract with the Department of Health and Human Services (DHHS) for the delivery of Medicaid and NC Health Choice services, or a local management entity/managed care organization that is under a capitated contract with DHHS to operate a BH IDD tailored plan (previously, defined as a PHP or a local management entity/managed care organization operating a BH IDD tailored plan). Makes further technical changes.

Amends new Article 1A, Disenrollment and Prepaid Health Plans (PHP), of GS Chapter 108D, to no longer allow for beneficiaries under the age of 26 who formerly received Title IV-E adoption assistance to disenroll from a PHP at any time. Makes technical changes.

Amends the proposed changes to Article 2, Enrollee Grievances and Appeals, of GS Chapter 108D, as follows. Eliminates the proposed changes to GS 108D-13, which required reinstatement of benefits by a PHP for a Medicaid enrollee under certain circumstances. Amends the proposed changes to GS 108D-14, concerning expedited managed care entity level appeals, to require a managed care entity to presume an expedited appeal is necessary when the expedited appeal is made by a network provider as an enrollee's authorized representative or when the network provider has otherwise indicated to the managed care entity that an expedited appeal is necessary (previously, only presumed necessary when requests are made by a network provider as an enrollee's authorized representative). Similar to the changes to GS 108D-13, eliminates the proposed changes that required reinstatement of benefits by a PHP for a Medicaid enrollee under certain circumstances. Makes conforming changes to GS 108D-15, and further amends the statute to no longer mandate that the Office of Administrative Hearings dismiss a contested case if the enrollee accepts an offer of mediation and then fails to attend mediation without good cause.

Makes the following changes to new Article 3, Managed Care Entity Provider Networks, of GS Chapter 108D. Requires each LME/MCO operating the combined 1915(b) and (c) waivers to develop and maintain (rather than maintain and utilize) a closed network of providers to furnish MH/IDD/SA services to its enrollees. Requires entities operating BH IDD Tailored Plans to develop and maintain (rather than utilize) closed provider networks only for the provision of behavioral health, intellectual and developmental disability, and traumatic brain injury services. 

Section 6

Makes technical changes to GS 108A-70.9A. Regarding contested Medicaid cases, amends GS 108A-70.9B to no longer mandate the Office of Administrative Hearings to dismiss a contested case if the enrollee accepts an offer of mediation and then fails to attend mediation without good cause (similar to GS 108D-15, as amended).

Section 9

Modifies GS 122C-3 to make conforming terminology changes, now defining behavioral health and intellectual/developmental disabilities tailored plan. Makes further technical changes. Adds prepaid health plan to the defined terms, defining the term by statutory cross-reference to GS 108D-1.

Section 9A

Amends GS 122C-55, as amended, concerning client confidentiality. Defines client, and amends the definition of facility and area facility as used in the statute to include a PHP. Makes conforming changes to make the confidentiality parameters applicable to PHPs. Provides for disclosure of confidential client information when the area authority or PHP determines the disclosure is necessary to develop, manage, monitor, or evaluate the area authority's or PHP's network of qualfiied providers, as provided in specified state law, including new Article 3 of GS Chapter 108D, the State Plan, rules of the DHHS Secretary, and contracts between the facility and DHHS (previously, did not include contracts between the facility and DHHS).

Section 12

Modifies the proposed changes to Section 4 of SL 2015-245, as amended, concerning services covered by PHPs, to exclude Medicaid services covered by the LME/MCO under combined 1915(b) and (c) waivers and provides that they cannot be covered under a standard benefit plan (was, a BH IDD Tailored Plan). Makes conforming changes. Also excludes receiving behavioral health, intellectual and developmental disability, or traumatic brain injury services that are covered by LME/MCOs under the combined 1915(b) and (c) waivers and that are not covered through a standard benefit plan under the specified provisions of the law.

Section 13A

Makes clarifying changes to Section 6 of SL 2015-245.

Section 14

Makes technical changes to the directive requiring the Revisor of Statutes to codify specified portions of SL 2015-245 into a new Article 4, Prepaid Health Plans, GS Chapter 108D. 

Sections 15 and 16

Makes further technical changes.