Category Archives: HB 320

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….