Proposal Would Make Major Changes to Medicaid Reform Provisions

The North Carolina Senate Health Committee on Thursday morning passed and referred to the Senate Rules Committee a Proposed Committee Substitute to HB403 LME/MCO Claims Reporting/Mental Health Amendments that would:

  • reimburse providers 90 percent of Medicaid fee-for-service rates if they are not in the network of a Medicaid pre-paid health plan (PHP), which were created under the state’s Medicaid reform legislation passed in 2015.
  • replace the state’s Chapter 58 insurance protections for both patients and providers with new federal regulations for the PHPs.
  • integrate mental and behavioral health into the PHPs when they begin serving Medicaid patients instead of four years later as originally set out in the 2015 Medicaid reforms. Sen. Ralph Hise (R- ), who described the PCS to the committee and answered their questions, said approval of the state’s waiver from the Centers for Medicare and Medicaid Services (CMS) is still nine months away and the reform legislation allows 18 months after that approval for the PHPs to begin operation.
North Carolina Medical Society (NCMS) Senior Vice President and Associate General Counsel Chip Baggett testified before the committee on Thursday.  He told them, while the NCMS has always been supportive of integrating physical and mental health, we strongly oppose the changes to the reimbursement schedule and replacing the Chapter 58 protections with the federal regulations. Watch his testimony in the video on the right.
 
 

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