N.C. Gen. Stat. § 108A-54.1A

(2) , (c) Repealed by Session Laws 2015-245, s. 18, effective September 23, 2015.

(4) Repealed by Session Laws 2015-245, s. 18, effective September 23, 2015.

(5) Any public notice required under 42 C.F.R. 447.205 shall, in addition to any other posting requirements under federal law, be posted on the Department's Web site. Upon posting such a public notice, the Department shall notify the members of the Joint Legislative Oversight Committee on Medicaid and NC Health Choice and the Fiscal Research Division that the public notice has been posted. Public notices shall remain posted on the Department's Web site.

History

(2013-360, s. 12H.2(a); 2014-100, s. 12H.21(a); 2015-245, s. 18.)

Primary Care Case Management for Dual Eligibles. - Session Laws 2014-100, s. 12H.20(a), provides: "The Department of Health and Human Services, Division of Medical Assistance, shall draft one or more waivers that would expand primary care case management and that are designed to accomplish the following:

"(1) Medicare and Medicaid dual eligibles shall be required to enroll in primary care case management to the maximum extent allowed by the Centers for Medicare and Medicaid Services (CMS).

"(2) Primary care case management shall be provided for enrolled dual eligibles.

"(3) Primary care case management for dual eligibles with a primary diagnosis of mental illness or intellectual or developmental disability may be administered by the LME/MCOs.

"The Department may submit drafts of the waivers to the Centers for Medicare and Medicaid Services (CMS) to solicit feedback but shall not submit the waivers for CMS approval until authorized by the General Assembly."

Session Laws 2014-100, s. 12H.20(b), provides: "No later than March 1, 2015, the Department shall submit to the House Appropriations Subcommittee on Health and Human Services and the Senate Appropriations Committee on Health and Human Services a copy of the draft waivers and a report, which shall include the following:

"(1) The anticipated increase in number of dual eligibles that will enroll in primary care case management.

"(2) The costs associated with serving the increased number of enrolled dual eligibles.

"(3) The anticipated savings to the Medicaid program."

Drug Ingredient Pricing Methodology. - Session Laws 2014-100, s. 12H.8(a)-(c), provides: "(a) The Department of Health and Human Services, Division of Medical Assistance, shall adopt an average acquisition cost methodology for brand and generic drug ingredient pricing to be effective beginning on January 1, 2015. The drug ingredient pricing methodology shall be consistent with new federal requirements or, if the new federal requirements have not yet been finalized by October 1, 2014, consistent with the draft federal requirements. In adopting a new drug ingredient pricing methodology, the Department shall also do all of the following:

"(1) Raise dispensing fees so that the average acquisition cost ingredient pricing plus the dispensing fees, net of any drug rebates, generates nine hundred seventy-five thousand dollars ($975,000) in savings in General Fund appropriations.

"(2) Maintain a distinction between the dispensing fees for preferred and brand drugs.

"(3) Ensure that ingredient prices are updated at least monthly.

"(b) The Department of Health and Human Services, Division of Medical Assistance, shall issue a request for proposals (RFP) for a contractor to perform a statewide drug dispensing fee study to begin on March 1, 2015. The Department shall use the one hundred thousand dollars ($100,000) appropriated in this budget for this study as the State share to draw down additional federal Medicaid funds for this study.

"(c) The Department of Health and Human Services, Division of Medical Assistance, shall follow the procedures in G.S. 108A-54.1 A in submitting the State plan amendment required to implement this section."

Session Laws 2015-241, s. 12H.19(a), (b), provides: "(a) The Department of Health and Human Services, Division of Medical Assistance, (Department) shall adopt an average acquisition cost methodology for brand and generic drug ingredient pricing to be effective beginning on January 1, 2016. The drug ingredient pricing methodology shall be consistent with new federal requirements or, if the new federal requirements have not yet been finalized by July 1, 2015, consistent with the most recent draft federal requirements. In adopting a new drug ingredient pricing methodology, the Department shall also do all of the following:

"(1) Raise the average dispensing fee to a weighted average amount that does not exceed twelve dollars and forty cents ($12.40).

"(2) Set actual dispensing fees that maintain a higher dispensing fee for preferred and generic drugs and a lower dispensing fee for brand and nonpreferred drugs.

"(3) Ensure that ingredient prices are updated at least monthly.

"(b) In order to implement this section, the Department shall either amend the State plan amendment request submitted to the Centers for Medicare and Medicaid Services (CMS) pursuant to Section 12H.8 of S.L. 2014-100 so that it conforms with the requirements of this section or shall withdraw that State plan amendment and submit a new State plan amendment request to CMS that conforms with the requirements of this section. Any State plan amendments required to implement this section shall not be subject to the 90-day prior submission requirement of G.S. 108A-54.1 A(e) [repealed] but shall be submitted by January 1, 2016."

Graduate Medical Education. - Session Laws 2015-241, s. 12H.23(a)-(d), as amended by Session Laws 2015-264, s. 88, provides: "(a) The Department of Health and Human Services shall submit a State Plan amendment to modify Section 4.19-A of the Medicaid State Plan, such that, effective January 1, 2016, no Medicaid provider may receive reimbursement for Graduate Medical Education (GME) in addition to their DRG Unit Value (Base) rate under the methodology as defined in the current Medicaid State Plan.

"(b) The modification to the Medicaid State Plan required by subsection (a) of this section shall be implemented upon approval by the Centers for Medicare & Medicaid Services (CMS).

"(c) The Department of Health and Human Services, Division of Medical Assistance, shall be exempt from the 90-day prior submission requirement in G.S. 108A-54.1 A(e) [repealed] in order to submit to CMS the State Plan amendment required to implement this section but shall submit the State Plan amendment by January 1, 2016.

"(d) The Department of Health and Human Services, Division of Medical Assistance, shall submit a report to the Joint Legislative Oversight Committee on Health and Human Services and the Fiscal Research Division by March 1, 2016, identifying options for alternative funding streams to replace the GME reimbursement eliminated by this section."

Session Laws 2020-88, s. 9, repealed Session Laws 2015-241, s. 12H.23(a)-(d), as amended by Session Laws 2015-264, s. 88, effective July 2, 2020.