SB 600 — Improve Health and Human Services.

GENERAL ASSEMBLY OF NORTH CAROLINA SESSION 2025 S 21 SENATE BILL 600 Health Care Committee Substitute Adopted 4/16/25 Short Title:

Senators Burgin, Galey, and Sawrey (Primary Sponsors).

Rules and Operations of the Senate March 26, 2025 A BILL TO BE ENTITLED AN ACT MAKING TECHNICAL, CONFORMING, AND OTHER MODIFICATIONS TO LAWS PERTAINING TO THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, DIVISION OF HEALTH BENEFITS.

Upon the recipient's release from incarceration, the exception under this subdivision shall continue to apply for *S600-v-2**S600-v-1* General Assembly Of North Carolina Session 2025 a period that is the shorter of the following:until the first day of the month following the twelfth month after the recipient's release.

(a)… (c) Limited Categorical Risk Provider Screening.Types.

– The Departmentfollowing shall conduct provider screeningtypes ofare Medicaidhereby providersdesignated inas accordance"limited" withcategorical applicablerisk: State or federal law or regulation.

(b) Enrollment Screening.

– The Department must screen all initial provider applications for enrollment in Medicaid, including applications for a new practice location, and all revalidation requests based on Department the Department's assessment of risk and assignment of the provider to a categorical risk level of "limited," "moderate," or "high." limited, moderate, orhigh.

Ifaprovidercouldfitwithinmorethanoneriskleveldescribedinthissection,thehighest level of screening is applicable.

(c) Limited Categorical Risk Provider Types.

– The All of the following provider types are hereby designated as "limited" limited categorical risk:

… (4) Health programs operated by an Indian Health Program (as Program, as defined in section 4(12) of the Indian Health Care Improvement Act) Act, or an urban Indian organization (as organization, as defined in section 4(29) of the Indian Health Care Improvement Act) Act, that receives funding from the Indian Health Service pursuant to Title V of the Indian Health Care Improvement Act.

(10a)… Skilled(e) nursingModerateCategoricalRiskProviderTypes.–Thefollowingprovidertypesarehereby facilitiesdesignated thatas are"moderate" limited categorical riskrisk: under subsection (k) of this section.

… (12)(15) PhysicianRevalidating orskilled nonphysiciannursing practitionersfacilities, (includingunless practitioners,they includingmeet nursethe practitioners,description CRNAs,in physiciansubdivision assistants,(g)(13) physicianof extenders,this occupationalsection. therapists, speech/language pathologists, chiropractors, and audiologists),optometrists, audiologists;optometrists;

dentists… and(g) orthodontists,High orthodontists;Categorical Risk Provider Types.

and– medicalThe groupsfollowing orprovider clinics.types are hereby designated as "high" categorical risk:

… (d)(13) LimitedProspective Categorical(newly Riskenrolling) Screenings.skilled nursing facilities and those undergoing a change in ownership.

–…." WhenSECTION the3.(b) DepartmentG.S. designates a provider as a "limited" limited categorical level of risk, the Department shall conduct such the applicable screening functions as required by federal law.

(e) Moderate Categorical Risk Provider Types.

– The All of the following provider types are hereby designated as "moderate" moderate categorical risk:

… (8) Pharmacy Services.

services.

… Page 2 Senate Bill 600-Second Edition General Assembly Of North Carolina Session 2025 (11) Revalidating agencies providing durable medical equipment, including, but not limited to, including orthotics and prosthetics.

… (15) Skilled nursing facilities that are moderate categorical risk under subsection (k) of this section.

(f) Moderate Categorical Risk Screenings.

– When the Department designates a provider as a "moderate"' moderate categorical level of risk, the Department shall conduct such the applicable screening functions as required by federal law and regulation.

(g) High Categorical Risk Provider Types.

– The All of the following provider types are hereby designated as "high" high categorical risk:

(1) Prospective (newly enrolling) Prospective, or newly enrolling, adult care homes delivering Medicaid-reimbursed services.

… (4) Prospective (newly enrolling) Prospective, or newly enrolling, agencies providing durable medical equipment, including, but not limited to, orthotics and prosthetics.

… (6) Prospective (newly enrolling) Prospective, or newly enrolling, agencies providing nonbehavioral health home- or community-based services pursuant to waivers authorized by the federal Centers for Medicare and Medicaid Services under 42 U.S.C.

§ 1396n(c).

(7) Prospective (newly enrolling) Prospective, or newly enrolling, agencies providing personal care services or in-home care services.

(8) Prospective (newly enrolling) Prospective, or newly enrolling, agencies providing private duty nursing, home health, or home infusion.

(9) Providers against whom which the Department has imposed a payment suspension based upon a credible allegation of fraud in accordance with 42 C.F.R.

§ 455.23 within the previous 12-month period.

The Department shall return the provider to its original risk category not later than 12 months after the cessation of the payment suspension.

… (11) Providers who that have incurred a Medicaid final overpayment, assessment, or fine to the Department in excess of twenty percent (20%) of the provider's payments received from Medicaid in the previous 12-month period.

The Department shall return the provider to its original risk category not later than 12 months after the completion of the provider's repayment of the final overpayment, assessment, or fine.

… (13) Skilled nursing facilities that are high categorical risk under subsection (k) of this section.