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The Pulse

  • Bill Modifying the Medicaid Transformation Legislation Passes NCGA

    On Friday, the House and Senate voted on the compromise version of HB 156: Medicaid PHP Licensure & Transformation Modifications, which had been in a conference committee since the end of the 2017 session. The bill is now on the Governor’s desk for final approval.


    The changes included in this legislation build off of the Medicaid reform law passed in 2015, HB 372: Medicaid Transformation and Reorganization, which laid out the framework for transforming the state’s Medicaid program from fee-for-serivce to capitated contracts. The state submitted the 1115 waiver application to transform to managed care in 2016, and submitted an amended waiver in 2017. The state is still awaiting approval from CMS to move forward with the transformation process.


    Beginning on page 16 of HB 156, the patient-provider insurance protections that Medicaid insurers and health benefits plans must comply with are listed out. Of the many protections that apply to private insurance plans, seventeen are specifically listed within HB 156, in addition to other state and federal requirements.


    NCAPA is excited to announce that among the seventeen protections within HB 156, G.S. 58-50-26 – Physician services provided by PAs, is included in this legislation. This ensures that the services PAs provide to Medicaid patients will be reimbursed by the capitated contracts, and not denied payment simply because the services were rendered by a PA acting within their scope of practice.


    A more detailed post on the other protections included in the bill, and the legislation as a whole, as well as HB 403: Medicaid and Behavioral Health Modifications, which also addresses changes to the 2015 law, will be posted in the near future. HB 403 was also voted on by both chambers last week after coming out of a 2017 conference committee.

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