Bill Summary – FastDemocracy

FILED SENATE
                                                                                         Apr 2, 2019
                          GENERAL ASSEMBLY OF NORTH CAROLINA
                                                                 S.B. 537
                                      SESSION 2019           PRINCIPAL CLERK
     S                                                                    D
                               SENATE BILL DRS15161-MR-60*
     Short Title:   Establish New Payment Methodology/ACHs.                                     (Public)
     Sponsors:      Senators Hise, Krawiec, and Bishop (Primary Sponsors).
     Referred to:
 1                                       A BILL TO BE ENTITLED
 2   AN ACT TO EXAMINE AND ESTABLISH A NEW PAYMENT METHODOLOGY FOR
 3       ADULT CARE HOMES PROVIDING CARE TO NORTH CAROLINA MEDICAID
 4       BENEFICIARIES THAT PROMOTES HEALTH AS WELL AS FAIR AND
 5       REASONABLE COMPENSATION FOR THE SERVICES PROVIDED.
 6               Whereas, approximately 30,000 adults reside in North Carolina's adult care homes;
 7   and
 8               Whereas, the average age of an adult care home resident is over 75 years old; and
 9               Whereas, adult care homes provide care to some of North Carolina's most vulnerable
10   senior citizens; and
11               Whereas, adult care homes have not had a rate increase for State and county special
12   assistance since 2009; and
13               Whereas, the General Assembly recognizes that with Medicaid managed care there
14   are opportunities to explore new programs and payment methodologies that can provide a stable
15   and reliable funding stream to ensure access, choice, and quality of care within adult care homes;
16   Now, therefore,
17   The General Assembly of North Carolina enacts:
18               SECTION 1. It is the intent of the General Assembly to provide funding to adult
19   care homes in the State in a manner that recognizes the importance of a stable and reliable funding
20   stream to ensure access, choice, and quality of care within the adult care home segment of the
21   care continuum. In furtherance of this intent, and as the North Carolina Medicaid program
22   transitions to a managed care delivery system, the Department of Health and Human Services is
23   directed to establish and convene a workgroup to evaluate reimbursement options under managed
24   care for adult care homes that considers all funding streams and to develop a service definition
25   or definitions under managed care that may accomplish this intent. The workgroup shall consist
26   of adult care home industry representatives and other relevant stakeholders. In development of
27   the service definition, the workgroup shall include all of the following components:
28               1)      Support for alternative payment models, including pay-for-performance
29                       initiatives, available under the State's 1115 Medicaid waiver and Medicaid
30                       transformation.
31               2)      Best practices for long-term services and supports.
32               3)      Efficient payment methodologies.
33               SECTION 2. No later than October 1, 2020, the Department of Health and Human
34   Services shall submit a report on the new service definition to the Joint Legislative Oversight
35   Committee on Health and Human Services, the Joint Legislative Oversight Committee on
36   Medicaid and NC Health Choice, and the Fiscal Research Division. After submission of this
                                    *DRS15161-MR-60*
    General Assembly Of North Carolina                                           Session 2019
1   report, DHHS shall submit to the Centers for Medicare and Medicaid Services any amendments
2   to the NC Medicaid State Plan necessary to implement the new service definition.
3             SECTION 3. This act is effective when it becomes law.
    Page 2                                                                DRS15161-MR-60*
Statutes affected: 
Edition 2: 8-53.8, 55B-2, 55B-14, 90-21.41, 90-270.48A, 122C-263.1, 143B-957, 90-113.31A, 90-113.32, 90-113.40, 90-113.30, 90-113.31B, 90-113.33, 90-113.34, 90-113.37A, 90-113.38, 90-113.40B, 90-113.41A, 90-113.42, 90-113.43, 90-113.44, 90-113.46, 108A-57, 108A-74, 110-139, 143-548, 122C-171, 7B-309, 122C-183, 143B-166
Edition 3: 8-53.8, 55B-2, 55B-14, 90-21.41, 90-270.48A, 122C-263.1, 143B-957, 90-113.31A, 90-113.32, 90-113.40, 90-113.30, 90-113.31B, 90-113.33, 90-113.34, 90-113.37A, 90-113.38, 90-113.40B, 90-113.41A, 90-113.42, 90-113.43, 90-113.44, 90-113.46, 108A-57, 108A-74, 110-139, 143-548, 122C-171, 7B-309, 122C-183, 143B-166
Ratified: 8-53.8, 55B-2, 55B-14, 90-21.41, 90-270.48A, 122C-263.1, 143B-957, 90-113.31A, 90-113.32, 90-113.40, 90-113.33, 90-113.30, 90-113.31B, 90-113.34, 90-113.37A, 90-113.38, 90-113.40B, 90-113.41A, 90-113.42, 90-113.43, 90-113.44, 90-113.46, 108A-57, 108A-74, 110-139, 143-548, 7B-309, 122C-183, 143B-166, 131D-10.6, 122C-3, 122C-4, 122C-55, 122C-77, 122C-216, 122C-251, 122C-261, 122C-294, 113A-12, 142-15.16, 116-37
SL 2019-240: 8-53.8, 55B-2, 55B-14, 90-21.41, 90-270.48A, 122C-263.1, 143B-957, 90-113.31A, 90-113.32, 90-113.40, 90-113.33, 90-113.30, 90-113.31B, 90-113.34, 90-113.37A, 90-113.38, 90-113.40B, 90-113.41A, 90-113.42, 90-113.43, 90-113.44, 90-113.46, 108A-57, 108A-74, 110-139, 143-548, 7B-309, 122C-183, 143B-166, 131D-10.6, 122C-3, 122C-4, 122C-55, 122C-77, 122C-216, 122C-251, 122C-261, 122C-294, 113A-12, 142-15.16, 116-37