A BILL TO BE ENTITLED
AN ACT to eNSURE EFFECTIVE STATEWIDE OPERATION OF THE 1915 (b)/(c) MEDICAID waiver.
Whereas, S.L. 2011‑264, as amended by Section 13 of S.L. 2012‑151, required the Department of Health and Human Services (Department) to restructure the statewide management of the delivery of services for individuals with mental illness, intellectual and developmental disabilities, and substance abuse disorders through the statewide expansion of the 1915(b)/(c) Medicaid Waiver; and
Whereas, local management entities (LMEs) that are awarded contracts to operate the 1915(b)/(c) Medicaid Waiver must maintain fidelity to the Piedmont Behavioral Health (PBH) demonstration model; and
Whereas, these LMEs are acting as Medicaid vendors and the Department must ensure that they are compliant with the provisions of S.L. 2011‑264, as amended by Section 13 of S.L. 2012‑151, as well as all applicable federal, State, and contractual requirements; Now, therefore,
The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 122C‑3 is amended by adding a new subdivision to read:
"(20c)	"Local management entity/managed care organization" or "LME/MCO" means an LME that has been approved by the Department to operate the 1915(b)/(c) Medicaid Waiver."
SECTION 2.  Article 4 of Chapter 122C of the General Statutes is amended by adding a new section to read:
"§ 122C‑124.2. Actions by the Secretary to ensure effective management of behavioral health services under the 1915(b)/(c) Medicaid Waiver.
(a)	For LME/MCOs with whom the Department has contracted to operate the 1915(b)/(c) Medicaid Waiver for less than three years, the Secretary shall provide an unqualified attestation every six months that the LME/MCO is in compliance with (i) the terms of its contract with the Department, (ii) S.L. 2011‑264, as amended by Section 13 of S.L. 2012‑151, and (iii) all other applicable State and federal requirements. For LME/MCOs with whom the Department has contracted to operate the 1915(b)/(c) Medicaid Waiver for at least three years, the Secretary shall provide this unqualified attestation of compliance in writing on an annual basis. The Secretary shall specifically address the following requirements in each attestation:
(1)	Solvency.
(2)	Timeliness of provider payments.
(3)	Compliance with the requirements of S.L. 2011‑264, as amended by Section 13 of S.L. 2012-151.
(4)	Compliance with the provisions of any contract in effect between the LME/MCO and the Department with respect to management responsibilities for the delivery of services for individuals with mental illness, intellectual or other developmental disabilities, and substance abuse disorders under the 1915(b)/(c) Medicaid Waiver.
(5)	The ability to exchange billing, payment, and transaction information with LME/MCOs and providers in a manner that complies with all applicable federal standards, including but not limited to all of the following.
a.	Standards for information transactions and data elements specified in 42 U.S.C. 1302d‑2 of the Healthcare Insurance Portability and Accountability Act (HIPAA), as from time to time amended.
b.	Standards for health care claims or equivalent encounter information transaction specified in HIPAA regulations in 45 C.F.R. 162.1102, as from time to time amended.
c.	Implementation specifications for Electronic Data Interchange standards published and maintained by the Accredited Standards Committee (ASC X12) and referenced in HIPAA regulations in 45 C.F.R. 162.920.
(b)	If the Secretary is unable to provide an LME/MCO with the unqualified attestation of compliance required by subsection (a) of this section on the date the attestation is due because the LME/MCO is noncompliant, then the Secretary shall assign the LME/MCO's contract to operate the 1915(b)/(c) Medicaid Waiver to another LME/MCO no later than thirty days after the Secretary's unqualified attestation of compliance was due for the LME/MCO. Upon assigning a contract pursuant to this subsection, the Secretary shall effectuate an orderly transfer of management responsibilities from the noncompliant LME/MCO to a compliant LME/MCO, including the responsibility of paying providers for covered services, in order to ensure uninterrupted provision of medically necessary services to Medicaid recipients.(c)	The Secretary shall provide a copy of each unqualified attestation of compliance completed in accordance with this section to the Senate Appropriations Committee on Health and Human Services, the House Appropriations Subcommittee on Health and Human Services, the Legislative Oversight Committee on Health and Human Services, and the Fiscal Research Division."
SECTION 3.  By no later than June 30, 2013, the Secretary of Health and Human Services shall complete an initial unqualified attestation of compliance, in accordance with G.S. 122C‑124.2(a), for each LME that has been approved by the Department to operate the 1915(b)/(c) Medicaid Waiver and provide a copy of the attestation to the Senate Appropriations Committee on Health and Human Services, the House Appropriations Subcommittee on Health and Human Services, the Legislative Oversight Committee on Health and Human Services, and the Fiscal Research Division.
SECTION 4.  This act is effective when it becomes law.