Protect Yourself and Your Patients In the New Medicaid System

The North Carolina Medical Society (NCMS) has steadfastly held that the protections for physicians and patients laid out in state law under Chapter 58 must be carried forward in the new Medicaid managed care system. A bill currently under consideration by the North Carolina House of Representatives, HB 156, however, does not include these essential protections.

This bill would require Medicaid Prepaid Health Plans to obtain a license from the Department of Insurance and lists minimum requirements for the application process. It also contains language on penalties, enforcement, management agreements, fees, fiduciary responsibilities, continuation of services and suspension of licenses. But currently, the bill does not contain any of the Chapter 58 patient and provider protections. NCMS continues to actively work to ensure that these protections are included moving forward.

Please reach out to your legislator and insist that the Chapter 58 protections, which are crucial to the success of Medicaid managed care, be included in this bill.

 
 

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2 Comments

  • Elaine Ellis

    Thanks for your question about Chapter 58 – it is indeed very complex. You can rest assured that the NCMS advocacy staff, which includes attorneys well-versed in Chapter 58 provisions, will handle the details with legislators. In the meantime, they advise NCMS members to focus on Chapter 58 provisions like prompt pay, notice of contract or fee schedule changes and other pieces not covered by the Federal Medicaid Mega Rule. If you would like more detail on what the current bill, HB156, includes –or not – we have a summary on our blog http://www.ncmedsoc.org/medicaid-php-licensurefood-services/. Hope this helps!

  • R. B. Gelot M.D.

    I am a physician, not an insurance attorney. I can’t read the whole book on Chapter 58, let alone first page. Kindly and briefly, in a nutshell, what do I need to know as a practicing physician regarding chapter 58 insurance regulations?

 
 

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