Bill Summary for H 144 (2021-2022)
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AN ACT AUTHORIZING THE CHILDREN AND FAMILIES SPECIALTY PLAN AS AN ADDITIONAL MEDICAID MANAGED CARE PLAN AND MAKING OTHER CHANGES TO MEDICAID MANAGED CARE STATUTES.Intro. by Lambeth.
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Senate committee substitute to the 4th edition makes the following changes.
Regarding the directive for the Department of Health and Human Services (DHHS) to issue an RFP to procure a single statewide children and families specialty plan (CAF specialty plan), with services to begin no later than December 1, 2023, now allows for proposal submissions from prepaid health plans (PHPs), as defined by statutory cross-references (previously, limited submissions to entities operating a standard benefit plan or a behavioral health and intellectual/developmental disabilities tailored plan (BH IDD tailored plan) contract with DHHS at the time the RFP is issued). Maintains the limitation of one response per eligible responding entity. Eliminates the provision specifying that eligible entities under common control or ownership with one another are limited to collectively submitting one response. Makes conforming changes to new GS 108D-62, set forth in Section 12, which establishes the requirements for the CAF specialty plan, expanding eligibility to respond to DHHS's RFP to include entities that meet the definition of PHP under GS 58-93-5 or GS Chapter 108D.
Adds a new directive for DHHS to request approval from the Centers for Medicare and Medicaid Services (CMS) to require that a child who is automatically enrolled in the CAF specialty plan under GS 108D-62(f), which includes Medicaid recipients who are children enrolled in foster care in the State, receiving adoption assistance, or former foster care youth under 26 years of age, or those recipients' children, excluded from PHP coverage under new GS 108D-40(a)(14), may not elect to enroll instead in a standard benefit plan or a BH IDD tailored plan unless it is in the best interest of the child.
Makes a technical change to new GS 108D-24.
Section 9 and 11
Amends GS 108D-60, which details requirements for BH IDD tailored plans. Authorizes DHHS to contract with entities operating BH IDD tailored plans under a capitated or other arrangement for the management of BH, IDD, and traumatic brain injury services for any Medicaid recipient described in new GS 108D-40(a)(14) and excluded from PHP coverage (incudes recipients who are children enrolled in foster care in the State, receiving adoption assistance, or former foster care youth under 26 years of age), until the CAF specialty plan becomes operational. Amends new GS 108D-40(a)(14) to no longer permit this described population from voluntarily enrolling in a PHP operating a standard benefit plan or a BH IDD tailored plan until the CAF specialty plan becomes operational.
Further amends new GS 108D-62, adding to subsection (g), which allows eligible CAF specialty plan enrollees to enroll with a PHP operating a standard benefit plan or, if eligible, a BH IDD tailored plan. Specifies that this option is limited by any provision of a waiver or State Health Plan amendment approved by CMS.
Further amends GS 122C-115 to allow LME/MCOs operating BH IDD tailored plans to continue to manage, under DHHS contract, BH, IDD, or traumatic brain injury services for Medicaid recipients described in new GS 108D-40(a)(14) who are excluded from PHP coverage, until the CAF specialty plan becomes operational.