Overview of the Senate Budget

Overview of the Senate Budget

SB 257 – Appropriations Act of 2017

Medicaid Overview:
Funds for Medicaid Management Information System/Analytics Re-procurement

Provides funding to enhance the NC Tracks system and procures a take-over vendor for the Medicaid Management System (MMIS) and the Reporting and Analytics contract. This is a requirement to continue Center for Medicare and Medicaid Services (CMS) certification and receive federal match funding.
FY 17-18 – $1.3 million
FY 18-19 – $2.2 million

Medicaid Transformation Reserves:

Rural and Free Care:
Community Health Grant Program Changes

Awards grants on a competitive basis to federally qualified health centers, and other nonprofit organizations with at least 80 percent patient population of uninsured patients/Medicaid/Medicare/Children’s Health Insurance Program.

Rural Health Loan Repayment Programs

Combines The Physician Loan Repayment Program, The Psychiatric Loan Repayment Program and The Loan Repayment Initiative at State Facilities.
The funds also could be used to expand the Program to include eligible providers who use telemedicine in rural and underserved areas.
$3,200,000 recurring in FY 2017-2018
$3,200,000 recurring in FY 2018-2019

Certificate of Need:

Ophthalmologists would not be required to obtain a certificate of need license if they meet certain criteria.
The NC Department of Health and Human Services (NCDHHS) would exempt from CON the construction, development, acquisition or establishment of an ambulatory surgical facility if these requirements were met:
- Applicant is a physician or group of physicians that makes an effort to enter into a joint venture with a hospital;
- The ambulatory surgical facility has an agreement with a hospital for hospital privileges;
- The ambulatory surgical facility has capability to transfer a patient to a hospital emergency room immediately.
NCDHHS would also exempt from CON a community hospital with 200 acute care beds or fewer for the following:
- Development of a new institutional health service;
- Construction of a new health service facility;
- Acquisition of major medical equipment.

Repeal Certificate of Need Laws

This portion of the budget bill would repeal the certificate of need laws on January 1, 2025.

Traumatic Brain Injury Funding:
Traumatic Brian Injury (TBI) Funding

$2.4 million for FY 2017-2018.
$2.4 million for FY 2018-2019.
- $359,218 would be used to fund contracts with Brain Injury Associations, Carolinas Rehabilitation or other providers.
- $796,934 would be used for residential support for individuals with severe TBI.
- $1.2 million would be used to support individuals with submitted requests.

Adult and Pediatric Traumatic Brain Injury Pilot

$150,000 in nonrecurring funds for FY 2017-2018
$300,000 in nonrecurring funds for FY 2018-2019
The purpose of the program would be to increase compliance with treatment guidelines for severe TBI to reduce patient mortality, improve recovery and reduce long-term costs.

Health IT:
Health Information Exchange (HIE)

Establish a successor HIE Network where providers of Medicaid services have electronic health record systems by June 1, 2018.
Establish a mandatory connectivity to HIE Network by June 1, 2019.
Change “daily” required submissions to “data” required submissions.
$3 million in nonrecurring funds would be used to support all activities related to upgrading the data exchange technical environment.
$1 million in recurring funds would be used to provide ongoing maintenance.

Controlled Substances Reporting System Improvements

Improve the security, functionality and security capabilities of the Controlled Substances Reporting System (CSRS) to assist providers and dispensers with their workflows.
Funding would be used to pay for contractual hours to develop and implement software via existing public-private partnerships with the Government Data and Analytics Center (GDAC) for the performance of advanced analytics within the CSRS.
$150,000 of recurring funds for each year of the 2017-2019 biennium, shall be used to match federal funds.

Graduate Medical Education:
Graduate Medical Education Funding/Cape Fear Valley Medical Center

$3 million nonrecurring to support the establishment of residency programs affiliated with Campbell University School of Medicine.
This nonrecurring amount is equal to the total amount of lost Medicare payments issued to the Cape Fear Valley Medical Center prior to its reclassification by CMS as a rural hospital.

Concerns:
Portions of SB 629 – Balance Billing:
Greater Transparency in Health Care Services Billing

This portion of the bill states that upon notice from the insured the insurer would determine whether a health care provide is able to meet the needs of that patient, is reasonably available without unreasonable delay in reference to the patient’s location and medical needs.
This provision also requires notices when a patient admits to receive emergency services, schedules nonemergency services or seeks prior authorization from an insurer.

Medicaid Provider Fee:
Provider Application and Re-credentialing Fee

This section states that providers that enroll in the Medicaid program shall submit a $100 application fee that is left open to be charged whenever a provider re-credentials.

Bar on State Funding to Providers Who Perform Abortions:
Limitation on Use of State Funds

This portion states that no state funds shall be allocated to any provider who performs abortions. This would not prevent NCDHHS from paying any State Health Plan provider or Medicaid provider for services authorized under the State Health Plan or State Medicaid Plan.

Medicaid Claims:
Notice of Program Reimbursement as a Basis for Recoupment of Overpayments

This provision adds a written notice of NCDHHS’ final determination of the total amount of reimbursement.
This portion also states NCDHHS may suspend provider payment if the provider owes NCDHHS an amount identified on a notice of program of reimbursement.

Repayment Claims Review Modifications

If a provider fails to meet the 70 percent clean claims rate minimum, this may result in a termination action.
This would result in the exclusion of the provider from future participation in the Medicaid program.