North Carolina § 108D-30 - Intent and Goals.

§ 108D-30. Intent and Goals.

It is the intent of the General Assembly to transform the State's current Medicaid and NC Health Choice programs to programs that provide budget predictability for the taxpayers of this State while ensuring quality care to those in need. The new Medicaid and NC Health Choice programs shall be designed to achieve the following goals: Ensure budget predictability through shared risk and accountability. Ensure balanced quality, patient satisfaction, and financial measures. Ensure efficient and cost-effective administrative systems and structures. Ensure a sustainable delivery system. History (2015-245, s. 1; 2019-81, s. 14(a).) Editor's Note. - Session Laws 2015-245, s. 1 was codified as this section by Session Laws 2019-81, s. 14(a)(1), effective October 1, 2019. In codifying the portions of S.L. 2015-245, as amended, that are specified in subsection (a) of this section, the Revisor of Statutes is authorized to do all of the following: (1) Replace references to DHHS with references to the Department or the Department of Health and Human Services, as appropriate. (2) Revise references to subdivision (3) of Section 4 of the session law to instead reference the codified location of the language in subdivision (3) of Section 5 of the session law. Session Laws 2020-88, s. 11, as amended by Session Laws 2021-62, s. 3.6(a), provides: "For the first five years of the initial standard benefit plan prepaid health plan capitated contracts required under Article 4 of Chapter 108D of the General Statutes, the reimbursement for durable medical equipment and supplies, orthotics, and prosthetics under managed care shall be set at one hundred percent (100%) of the lesser of the supplier's usual and customary rate or the maximum allowable Medicaid fee-for-service rates for durable medical equipment and supplies, orthotics, and prosthetics." Session Laws 2020-88, s. 12(a), provides: "The Department of Health and Human Services may contract with an Indian managed care entity (IMCE) or an Indian health care provider (IHCP), as defined under 42 C.F.R. § 438.14(a), to assist in the provision of health care or health care-related services to Medicaid and NC Health Choice beneficiaries who are members of federally recognized tribes or who are eligible to enroll in an IMCE. Contracts may include health care or health care-related services as agreed upon with the IMCE or IHCP, as approved by the Secretary of the Department of Health and Human Services and as allowed by the Centers for Medicare and Medicaid Services (CMS), including, but not limited to, the following services: "(1) Primary care case management as a primary care case managed system or entity, as described in 42 C.F.R. § 438.2. "(2) Utilization management and referrals. "(3) The management or provision of home- and community-based services under a 1915(c) waiver. "(4) The management or provision of specialized services covered by a behavioral health and intellectual/developmental disabilities (BH/IDD) tailored plan in accordance with G.S. 108D-60(8). "Coverage provided by the IMCE or IHCP may be more permissive, but no more restrictive, than Medicaid or NC Health Choice medical coverage policy adopted or amended by the Department of Health and Human Services; however, the coverage shall be in compliance with federal regulations and policies related to the receipt of federal funding for these health care or health care-related services." Session Laws 2020-88, s. 12(d), provides: "The Department of Health and Human Services is authorized to seek approval from CMS and submit any necessary State Plan Amendments and waivers, or any amendments thereto, to implement the provisions of this section."