Source: https://lrs.sog.unc.edu/bill-summaries-lookup/H/1087/2015-2016%20Session/H1087
Timestamp: 2019-10-18 23:22:39
Document Index: 547505094

Matched Legal Cases: ['art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10', 'art 10']

Bill Summaries: H1087 (2015-2016 Session) | Legislative Reporting Service
»Bill Summaries: H1087 (2015-2016 Session)
Bill Summaries: H1087 (2015-2016 Session)
Bill H 1087 (2015-2016)
Requires the Department of Health and Human Services, Division of Medicaid Assistance (DHHS) to submit a report annually for the 2015-16 fiscal year, to be summited by November 2, 1026, and 2016-17 fiscal year, to be submitted by November 1, 2017, to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice, the Joint Legislative Oversight Committee on Health and Human Services, and the Fiscal Research Division, containing the following information: the annual statewide percentage of Medicaid applications processed in a timely manner for the fiscal year, the statewide average number of days to process Medicaid applications for each month in the fiscal year, the annual percentage of Medicaid applications processed in a timely manner by each county department of social services for the fiscal year, the average number of days to process Medicaid applications for each month for each county department of social services, the number of months during the fiscal year that each county department of social services met the timely processing standards in new Part 10 of Article 2 of GS Chapter 108A, the number of months during the fiscal year that each county department of social services failed to meet the timely processing standards in new Part 10 of Article 2 of GS Chapter 108A, a description of all corrective action activities conducted by DHHS and county departments of social services in accordance with new GS 108A-70.36., and a description of how DHHS plans to assist county departments of social services in meeting timely processing standards for Medicaid applications, for every county in which the performance metrics for processing Medicaid applications in a timely manner do not show significant improvement compared to the previous fiscal year.
Enacts Medicaid Eligibility Processing Timeliness Statutes
Enacts new Part 10, Medicaid Eligibility Decision Processing Timeliness, to Article 2 of GS Chapter 108A, Programs of Public Assistance of Social Services.
Enacts GS 108A-70.31 to establish that if a federally recognized Native American tribe within the state has assumed responsibility for the Medicaid program pursuant to GS 108A-25E, then new Part 10 of Article 2 of GS Chapter 108A applies to the tribe in the same manner as it applies to the county departments of social services.
Enacts GS 108A-70.32 to require the county department of social services to render a decision on an individual’s application for Medicaid within 45 calendar days from the date of application, except for applications in which a disability determination has already been made or is needed where the county department of social services must render a decision on an individual’s eligibility within 90 calendar days from the date of application.
Enacts GS 108A-70.33 to require the counties to comply with timely processing standards, which are the average processing time standards and the percentage processed timely standards set forth in new GS 108A-70.34 and new GS 108A-70.35. Directs the Department of Health and Human Services (Department) to monitor county department of social services' compliance with these standards in accordance with new Part 10. Provides that for purposes of Part 10, processing time is the number of days between the date of application and the date of disposition of the application, except in cases where an eligibility determination is dependent upon receipt of information related to one or more of the following circumstances of subsubsections (1) through (7) of subsection (b): medical expenses sufficient to meet a deductible, the applicant's need for institutionalization, the applicant's plan of care for the home- and community-based waivers, the disability decision made by the Disability Determination Services Section of the Division of Vocational Rehabilitation of the Department, medical records needed to determine emergency dates for nonqualified aliens, the applicant's application or other information from the federally facilitated marketplace, and the applicant's application or other information in connection with an application for a Low Income Subsidy for Medicare prescription drug coverage. Provides that in those cases where an eligibility determination is dependent upon receipt of information related to one or more of the listed circumstances, processing time excludes the number of days between the date when the county determines all eligibility criteria other than the above listed criteria and the date when the county receives the information related to that criteria.
Provides that processing times are excluded from the calculation of the average processing time and percent processed timely for the following types of cases listed in subsection (c): newborns who are automatically enrolled based on their mother's eligibility, applications for individuals who are presumptively eligible for Medicaid, active cases in which an individual who is eligible for one program is transferred to another program regardless of whether the transfer occurs between allowable or nonallowable program categories, cases in which an individual transfers from an open case to another case including establishing a new administrative case for the individual, actions to post eligibility to a terminated or denied case within one year of the termination or denial, cases that are reopened because they were terminated in error or because reopening of the terminated case is allowed by policy, and cases in which the eligibility decision was appealed and the decision was reversed or remanded.
Allows the Department, in its discretion, to exclude days, other than those required by subsection (b) of the statute, from the calculation of processing time if the Department determines that the delay was caused by circumstances outside the control of county departments of social services. Also allows the Department to, in its discretion, exclude types of cases, other than those described in subsection (c) of the statute, from the calculation of processing time. Directs that, when the Department exercises its discretion pursuant to subsection (d), the Department's determination regarding circumstances outside the control of county departments of social services and the Department's decision to exclude types of cases are to be applied uniformly to all county departments of social services.
Enacts new GS 108A-70.34 to establish that the average processing time is calculated by finding the processing time for each case that received a disposition during a given month and finding the average of those processing times, and that the standard for average processing time is 90 days for cases in which the individual has applied for the Medicaid Aid to the Disabled category (M-AD) and 45 days for all other cases.
Enacts new GS 108A-70.35 to establish that the percentage processed timely is the percentage of cases that received a timely disposition in a given month, and the percentage processed timely is calculated by expressing the number of cases during a given month with a processing time equal to or less than the standard set in GS 108A-70.32 as a percentage of the total cases receiving a disposition during that month. Provides for when the deadline for meeting the timely decision standard in GS 108A-70.32 falls on a weekend or holiday. Authorizes the Department to adopt rules to establish a percentage standard for each county department of social services that will be the percentage processed timely standard for that county department of social services. Provides that until the Department adopts rules establishing percentage standards for each county, the percentage processed timely standards are those established in 10A NCAC 23C .0203 as of April 2016.
Enacts new GS 108A-70.36 to direct the Department and the county department of social services to enter into a joint corrective action plan to improve the timely processing of applications if, for any three consecutive months or for any five months out of a period of 12 consecutive months, a county department of social services fails to meet either the average processing time standard or the percentage processed timely standard or both standards. Requires the joint corrective action plan to specifically identify (1) the duration of the joint corrective action plan, not to exceed 12 months, and if a county department of social services shows measurable progress in meeting the performance requirements in the joint corrective action plan, then the duration of the joint corrective action plan may be extended by six months, but in no case may a joint corrective action plan exceed 18 months, (2) a plan for improving timely processing of applications that specifically describes the actions to be taken by the county department of social services and the Department, (3) the performance requirements for the county department of social services that constitute successful completion of the joint corrective action plan, and (4) acknowledgement that failure to successfully complete the joint corrective action plan will result in temporary assumption of Medicaid eligibility administration by the Department, in accordance with new GS 108A-70.37.
Enacts new GS 108A-70.37 to provide that, if a county department of social services fails to successfully complete its joint corrective action plan, the Department is to give the county department of social services, the county manager, and the board of social services or the consolidated human services board created pursuant to GS 153A-77(b) at least 90 days’ notice that the Department intends to temporarily assume Medicaid eligibility administration, in accordance with subsection (b). Requires the notice to include specified information, including the date on which the Department intends to temporarily assume administration of Medicaid eligibility decisions.
Provides that if a county department of social services fails to successfully complete its joint corrective action plan, the Department is to temporarily assume Medicaid eligibility administration for the county upon giving notice. Establishes that during a period of temporary assumption of Medicaid eligibility administration, (1) the Department must administer the Medicaid eligibility function in the county, (2) the county department of social services is divested of Medicaid administration authority, (3) the Department must direct and oversee the expenditure of all funding for the administration of Medicaid eligibility in the county, (4) the county must continue to pay the nonfederal share of the cost of Medicaid eligibility administration and cannot withdraw funds previously obligated or appropriated for Medicaid eligibility administration, (5) the county must pay the nonfederal share of additional costs incurred to ensure compliance with the timely processing standards required by Part 10, (6) the Department must work with the county department of social services to develop a plan for the county department of social services to resume Medicaid eligibility administration and perform Medicaid eligibility determinations in a timely manner, and (7) the Department must inform the county board of commissioners, the county manager, the county director of social services, and the board of social services or the consolidated human services board created pursuant to GS 153A-77(b) 34 of key activities and any ongoing concerns during the temporary assumption of Medicaid eligibility administration.
Provides that, upon the Department's determination that Medicaid eligibility determinations can be performed in a timely manner by the county department of social services, the Department must notify the county department of social services, the county manager, and the board of social services or the consolidated human services board that temporary assumption of Medicaid eligibility administration will be terminated and the effective date of termination. Establishes that, upon termination, the county department of social services resumes its full authority to administer Medicaid eligibility determinations.
Amends GS 150B-23 (provisions for administrative hearings) by enacting a new subsection (a5) to establish that a county that appeals a decision of the Department of Health and Human Services to temporarily assume Medicaid eligibility administration in accordance with GS 108A-70.37 may commence a contested case under Article 3 of GS Chapter 150B (Administrative Hearings) in the same manner as any other petitioner, and that the case is to be conducted in the same manner as other contested cases Article 3.
Provides that the corrective action procedures described in new GS 180A-70.36 supersede the corrective actions procedures in 10A NCAC 23C .0204 and 10A NCAC 23C .0205 related to timeliness processing of Medicaid applications by county department of social services.
Authorizes the Department to adopt and amend rules to implement new Part 10 of Article 2 of GS Chapter 108A.
Effective January 1, 2017 and applies to monthly timely processing standards on that date.
Appropriates Funds to Implement the Act
Appropriates $143,215 to the Department’s Division of Central Management and Support for the 2016-17 fiscal year in recurring funds to be used to fund three new Business System Analyst positions within the Operational Support Team under the Assistant Secretary of Human Services. Provides that these funds are to provide a State match for an estimated $143,215 in recurring federal funds in the 2016-17 fiscal year, and appropriates those federal funds to be used for the same purpose.
Appropriates $156,785 to the Department’s Division of Social Services for the 2016-17 fiscal year in recurring funds to be used to fund four new Human Services Evaluator/Planner positions within the Performance Management Section of the Division of Social Services. Provides that these funds are to provide a State match for an estimated $156,785 in recurring federal funds in the 2016-17 fiscal year, and appropriates those federal funds to be used for the same purpose.
APPROP, GS 108A, GS 150B