Bill Summary for S 488 (2023-2024)

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Summary date: 

Apr 3 2023

Bill Information:

View NCGA Bill Details2023-2024 Session
Senate Bill 488 (Public) Filed Monday, April 3, 2023
Intro. by Burgin, Krawiec, Corbin.

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Bill summary

Identical to H 440, filed 3/22/23.

Sets forth the General Assembly’s intent to assist in increasing the hourly wages by an average of $6.50 per hour above the NC industry average hourly rate for direct care workers who provide services to Medicaid beneficiaries receiving services through the North Carolina Innovations waiver program, termed "Innovations direct care workers." Directs Department of Health and Human Services, Division of Health Benefits (DHB), to provide a rate increase to providers who provide services to Medicaid beneficiaries receiving services through the North Carolina Innovations waiver program who are either (1) enrolled in the Medicaid program or (2) approved financial managers or financial support agencies billing for waiver service hours provided by direct care workers hired by employers of record or managing employers under a self-directed option in accordance with Medicaid Clinical Coverage Policy 8-P: North Carolina Innovations. Requires the wage increase to be effectuated through a directed payment in accordance with 42 C.F.R. § 438.69(c) (pertaining to special contract provisions for certain delivery system and provider payments). Requires all Local Management Entities/Managed Care Organizations (LME/MCOs) to implement the wage increase, even when the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan (BH IDD Plan) becomes fully operational and implemented.  Directs DHB to determine the amount of the directed payment under this section in consultation with relevant stakeholders. Defines Innovations direct worker. Specifies that the directed payment will be effective on the effective date of the directed payment preprint approved by the Centers for Medicare and Medicaid Services.

Requires providers who employ Innovations direct care workers to attest and provide verification to the relevant LME/MCO that at least 75% of the funding that results are being used to increase the rate of pay paid to its Innovations direct care workers.  Authorizes DHB to set standards for documentation required for verification (such as payroll-based journals) for LME/MCOs to use. Requires providers receiving a rate increase under this section to keep documentation of the use of that rate increase and make the documentation available upon request by DHB or by the relevant LME/MCO. Allows DHB to recoup part or all of the funds if it determines that a provider did not use at least 75% of the resulting funding to increase the rate of pay paid to Innovations direct care worker employees.

Requires DHB to amend the Medicaid State Plan so that the reimbursement methodology used for services provided through the North Carolina Innovations waiver program and for intermediate care facilities for individuals with intellectual disabilities (ICF/IID) level group homes computes, on an annual basis, the impact of medical and wage inflation on the costs to providers providing services to Medicaid beneficiaries who receive services through the Innovations waiver program or who reside in an ICF/IID level group home. Specifies that, beginning with the 2025-26 fiscal year, the reimbursement methodology will annually adjust the rates for the services provided through the Innovation waiver and for ICF/IIDs. Requires DHB to make the corresponding adjustments to the capitation amounts paid to local management entities/managed care organizations (LME/MCOs), prepaid health plans operating a BH IDD tailored plan, or both, as appropriate. Directs DHB to consider the feasibility of developing and implementing a provider or payroll assessment mechanism for providers that provide services to Medicaid beneficiaries receiving services through the Innovation waiver.

Effective July 1, 2023, appropriates from the General Fund to DHB $90 million in recurring funds for each year of the 2023-25 fiscal biennium. Specifies that these funds will provide a State match for $174 million in recurring federal funds for each year of the 2023-25 fiscal biennium, and directs that those federal funds are appropriated to DHB.