North Carolina 2019-2020 Session Status: In Committee

SB 548 — Medicaid Changes for Transformation.

Last action — Passed 1st Reading

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  1. ✓
    Introduced
  2. 2
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2019-2020 Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

29 added · 30 removed

Plain-language change summary

The latest version of Senate Bill 548 adds a requirement for a contested case hearing form to be no longer than one side of one page. This is significant because it simplifies the process for individuals involved, making it easier for those without legal representation, such as Medicaid or NC Health Choice recipients, to understand and participate in hearings. By streamlining the paperwork, the bill aims to enhance accessibility and reduce confusion for those navigating the system.

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FILED SENATE GENERAL ASSEMBLY OF NORTH CAROLINA Apr 2, 2019 S.B.
GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2019 S 1 SENATE BILL 548* Short Title:
548 SESSION 2019 PRINCIPAL CLERK S D SENATE BILL DRS55053-MR-91C* Short Title:
A BILL TO BE ENTITLED AN ACT TO MODIFY THE LAWS PERTAINING TO MEDICAID AND NC HEALTH CHOICE AS NEEDED FOR THE IMPLEMENTATION OF MEDICAID TRANSFORMATION.
Rules and Operations of the Senate April 3, 2019 A BILL TO BE ENTITLED AN ACT TO MODIFY THE LAWS PERTAINING TO MEDICAID AND NC HEALTH CHOICE AS NEEDED FOR THE IMPLEMENTATION OF MEDICAID TRANSFORMATION.
– The network of providers that have contracted with a local management entity/managed care organization to furnish mental health, *DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 intellectual or developmental disabilities, and substance abuse services to enrollees.
– The network of providers that have contracted with a local management entity/managed care organization to furnish mental health, *S548-v-1* General Assembly Of North Carolina Session 2019 intellectual or developmental disabilities, and substance abuse services to enrollees.
Page 2 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 (14) Notice of managed care action.
Page 2 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 (14) Notice of managed care action.
DRS55053-MR-91C* Page 3 General Assembly Of North Carolina Session 2019 (b) Without Cause Enrollee Requests or Disenrollment.
Senate Bill 548*-First Edition Page 3 General Assembly Of North Carolina Session 2019 (b) Without Cause Enrollee Requests or Disenrollment.
Page 4 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 (a) In General.
Page 4 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 (a) In General.
DRS55053-MR-91C* Page 5 General Assembly Of North Carolina Session 2019 "Enrollee Grievances and Appeals.
Senate Bill 548*-First Edition Page 5 General Assembly Of North Carolina Session 2019 "Enrollee Grievances and Appeals.
Page 6 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 (a) Notice of Managed Care Action.
Page 6 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 (a) Notice of Managed Care Action.
– When the time limits for completing a standard appeal could seriously jeopardize the enrollee's life or health or ability to attain, maintain, or regain maximum function, an enrollee, or a network provider authorized in writing to act on behalf of an enrollee, the enrollee's authorized representative, has the right to file a request for DRS55053-MR-91C* Page 7 General Assembly Of North Carolina Session 2019 an expedited appeal of a managed care action an adverse benefit determination no later than 30 60days afterthemailingdateofthenoticeofmanagedcareaction.adversebenefitdetermination.
– When the time limits for completing a standard appeal could seriously jeopardize the enrollee's life or health or ability to attain, maintain, or regain maximum function, an enrollee, or a network provider authorized in writing to act on behalf of an enrollee, the enrollee's authorized representative, has the right to file a request for Senate Bill 548*-First Edition Page 7 General Assembly Of North Carolina Session 2019 an expedited appeal of a managed care action an adverse benefit determination no later than 30 60days afterthemailingdateofthenoticeofmanagedcareaction.adversebenefitdetermination.
Page 8 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 G.S.
Page 8 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 G.S.
Theform shall include at least all of the following:
Theformshall include at least all of the following:
DRS55053-MR-91C* Page 9 General Assembly Of North Carolina Session 2019 (h) Simple Procedures.
Senate Bill 548*-First Edition Page 9 General Assembly Of North Carolina Session 2019 (h) Simple Procedures.
OAH shall not conduct a hearing of any contested case involving a dispute of a managed care action an adverse benefit determination until it has Page 10 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 received notice from the mediator assigned that either (i) the mediation was unsuccessful, (ii) the petitioner has rejected the offer of mediation, or (iii) the petitioner has failed to appear at a scheduled mediation.
OAH shall not conduct a hearing of any contested case involving a dispute of a managed care action an adverse benefit determination until it has Page 10 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 received notice from the mediator assigned that either (i) the mediation was unsuccessful, (ii) the petitioner has rejected the offer of mediation, or (iii) the petitioner has failed to appear at a scheduled mediation.
DRS55053-MR-91C* Page 11 General Assembly Of North Carolina Session 2019 (a) Except as provided in G.S.
Senate Bill 548*-First Edition Page 11 General Assembly Of North Carolina Session 2019 (a) Except as provided in G.S.
(3e) "Fee-for-service program" means a payment model for the Medicaid and NC Health Choice programs operated by the Department of Health and Human Services pursuant to its authority under Part 6 and Part 8 of Article 2 of Chapter 108A of the General Statutes in which the Department pays enrolled providers for services provided to Medicaid and NC Health Choice recipients Page 12 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 rather than contracting for the coverage of services through a capitated payment arrangement.
(3e) "Fee-for-service program" means a payment model for the Medicaid and NC Health Choice programs operated by the Department of Health and Human Services pursuant to its authority under Part 6 and Part 8 of Article 2 of Chapter 108A of the General Statutes in which the Department pays enrolled providers for services provided to Medicaid and NC Health Choice recipients Page 12 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 rather than contracting for the coverage of services through a capitated payment arrangement.
…." DRS55053-MR-91C* Page 13 General Assembly Of North Carolina Session 2019 SECTION 6.
…." Senate Bill 548*-First Edition Page 13 General Assembly Of North Carolina Session 2019 SECTION 6.
An administrative law judge assigned to a contested Medicaid case shall make reasonable efforts in a case involving a Medicaid orNC HealthChoicerecipient whois not representedbyanattorney to assure a fair hearing and to maintain a complete record of the hearing.
An administrative law judge assigned to a contested Medicaid case shall make reasonable efforts in a case involving a Medicaid orNC HealthChoicerecipient whois not representedbyan attorney to assure a fair hearing and to maintain a complete record of the hearing.
108A-70.9A(e) or other clear request for a hearing by a Medicaid or NC Health Choice recipient, OAH shall immediately notify the Mediation Network of North Carolina, which shall Page 14 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 contact the recipient within five days to offer mediation in an attempt to resolve the dispute.
108A-70.9A(e) or other clear request for a hearing by a Medicaid or NC Health Choice recipient, OAH shall immediately notify the Mediation Network of North Carolina, which shall Page 14 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 contact the recipient within five days to offer mediation in an attempt to resolve the dispute.
DRS55053-MR-91C* Page 15 General Assembly Of North Carolina Session 2019 (2b) "Behavioral Health and Individuals with Developmental Disabilities Tailored Plan or BH IDD Tailored Plan" has the same meaning as in G.S.
Senate Bill 548*-First Edition Page 15 General Assembly Of North Carolina Session 2019 (2b) "Behavioral Health and Individuals with Developmental Disabilities Tailored Plan or BH IDD Tailored Plan" has the same meaning as in G.S.
…." Page 16 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 SECTION 11.
…." Page 16 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 SECTION 11.
inpatient behavioral health services, outpatient behavioral health emergency room services, outpatient behavioral health services provided by direct-enrolled providers, mobile crisis management services, facility-based crisis services for children and adolescents, professional treatment services in a facility-based crisis program, outpatient opioid treatment services, ambulatory detoxification services, nonhospitalmedical detoxification services, partial hospitalization, medically supervised or alcohol and drug abuse treatment center detoxification crisis stabilization, research-based intensive behavioral health treatment, diagnostic assessment services, and Early and Periodic Screening, Diagnosis, and Treatment services.
inpatient behavioral health services, outpatient behavioral health emergency room services, outpatient behavioral health services provided by direct-enrolled providers, mobile crisis management services, facility-based crisis services for children and adolescents, professional treatment services in a facility-based crisis program, outpatient opioid treatment services, ambulatory detoxification services, nonhospital medical detoxification services, partial hospitalization, medically supervised or alcohol and drug abuse treatment center detoxification crisis stabilization, research-based intensive behavioral health treatment, diagnostic assessment services, and Early and Periodic Screening, Diagnosis, and Treatment services.
DRS55053-MR-91C* Page 17 General Assembly Of North Carolina Session 2019 2.
Senate Bill 548*-First Edition Page 17 General Assembly Of North Carolina Session 2019 2.
Page 18 DRS55053-MR-91C* General Assembly Of North Carolina Session 2019 (2) Subdivision (4) of Section 4 of S.L.
Page 18 Senate Bill 548*-First Edition General Assembly Of North Carolina Session 2019 (2) Subdivision (4) of Section 4 of S.L.
SECTION 14.(a) The Revisor of Statutes is authorized to replace references to the Division of Medical Assistance, and any derivatives thereof, in the General Statutes with DRS55053-MR-91C* Page 19 General Assembly Of North Carolina Session 2019 references to the Division of Health Benefits, except that references to the Division of Medical Assistance shall not be changed in G.S.
SECTION 14.(a) The Revisor of Statutes is authorized to replace references to the Division of Medical Assistance, and any derivatives thereof, in the General Statutes with Senate Bill 548*-First Edition Page 19 General Assembly Of North Carolina Session 2019 references to the Division of Health Benefits, except that references to the Division of Medical Assistance shall not be changed in G.S.
Page 20 DRS55053-MR-91C*
Page 20 Senate Bill 548*-First Edition
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Action History

  1. Passed 1st Reading

  2. Ref To Com On Rules and Operations of the Senate

  3. Filed

Sponsors

  • Krawiec · Primary
  • Bishop · Cosponsor

Sponsorship breakdown

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1 sponsors · 1 co-sponsors · 177 not signed on

Sponsors (1)

  • Krawiec

Co-sponsors (1)

  • Bishop

Not signed on (177)

177 members have not signed on to this bill.

Show all 177 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

Who sponsors SB 548?
SB 548 is sponsored by Krawiec and Bishop.
What is the current status of SB 548?
This bill died with 2019-2020 Session. It reached “In Committee” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 548?
Track SB 548 free on One Click Politics — get push/email alerts when it moves.

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