HB 320: The Good News and the Bad News for NC Medicaid Providers

If you have been following my blog, then you know that I have been vehemently opposing House Bill 320. Well, the bad news is that HB 320 passed its 2nd reading today. The good news is that HB 320 has morphed from a  MCO-sovereign Bill into a more reasonable Bill.

Prior to the strike outs, HB 320 allowed

  • 108D-10: The MCOs to conduct closed networks (i.e., disallowing providers into the networks);
  • 108D-11: The MCOs to select the providers allowed in the network;
  • 108D-13: The MCOs to conduct unannounced on-site visits, post-payment reviews and any other allowable function of Program Integrity;
  • 108D-15: The MCOs to suspend payments to providers (under certain circumstances);
  • 108D-16: The MCOs to require a provider to undergo prepayment review (i.e., suspension of Medicaid reimbursements for a period of time without an appealable right);
  • 108D-18: The jurisdiction for grievances against an MCO to be superior court, not OAH.

After the strike out, everything listed above is deleted.  Click here for the legislative history of HB 320.

Now, remember, this HB 320 is not law.  It is a proposal.  But the current revision with all the above-referenced deletions could mean a big win for health care providers.

In this case, I think the good news outweighs the bad.  But we shall see if the current revision remains….

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on May 14, 2013, in Behavioral health, Division of Medical Assistance, Health Care Providers and Services, Legislation, MCO, Medicaid, Mental Health, Mental Illness and tagged , , , , , , , , , , , , . Bookmark the permalink. 4 Comments.

  1. Thank you for the informative updates you so generously share.

  2. I echo Linda’s comment. Thank you so much for your blog! I have to wonder what this means. It almost looks as if under this bill the MCO’s aren’t MCO’s anymore. I mean if they can’t operate a closed network, pick and choose who can participate, put people on pre-payment and post-payment reviews like they’ve been doing, they’ll really loose much of the power that they currently exercise as MCO’s…which is a good thing!

  1. Pingback: General Assembly in Full Swing: What Medicaid Bills Are On the Agenda?? | medicaidlaw-nc

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