Bill Summary for S 294 (2023-2024)
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AN ACT TO REDUCE MATERNAL MORBIDITY AND MORTALITY THROUGH THE IMPLEMENTATION OF RATE INCREASES FOR OBSTETRICS MATERNAL BUNDLE PAYMENTS FOR PREGNANCY CARE AND ADDITIONAL MEDICAID ADD-ON RATES AND COVERED SERVICES.Intro. by Burgin, Chaudhuri, Krawiec.
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Identical to H 321, filed 3/9/23.
Requires the Department of Health and Human Services (Department), Division of Health Benefits (DHB) to increase the Medicaid rate paid for obstetrics maternal bundle payments for pregnancy care to at least 71% of the Medicare rate. In order to incentivize the use of group prenatal care visits by Medicaid beneficiaries, requires DHB to develop an add-on rate to the relevant capitated rates or payments that include prenatal care services, to include amounts sufficient to make payments to providers that achieve a level of Medicaid beneficiary participation in group prenatal care visits. Authorizes DHB to determine the level of patient participation required for a provider to receive these provider payments. Permits the provider payments to be used by a provider to establish incentives for Medicaid beneficiary patients to attend group prenatal care visits. Requires the rate increases to be implemented as soon as practicable.
Requires DHB to seek approval from the Centers for Medicare and Medicaid Services (CMS) to implement Medicaid coverage of certain healthcare services provided by a doula. Requires DHB to develop the parameters of services to be covered, including: (1) updating applicable clinical coverage policies; (2) developing appropriate reimbursement for covered services provided by a doula; and (3) determining provider credentialing requirements for participation in the NC Medicaid program. Requires the coverage to be implemented as soon as practicable upon approval by CMS. Requires DHB to report to the specified joint NCGA committee on the details of the Medicaid coverage of healthcare services provided by a doula, the specific reimbursement for these services, and the estimated recurring cost to the State of providing this coverage, by no later than March 1, 2024.
Appropriates from the General Fund to DHB $2,800,000 in recurring funds for each year of the 2023-2025 fiscal biennium to implement the Medicaid-related changes outlined above. Specifies that the funds will provide a State match for $5,500,000 in recurring federal funds for each year of the 2023-2025 fiscal biennium, and that those federal funds are appropriated to DHB to pay for costs associated with the Medicaid-related changes outlined above. Effective July 1, 2023.