Ensure Continuity of Care in Tailored Plans.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 466

Short Title: Ensure Continuity of Care in Tailored Plans. (Public)
Sponsors: Senators Burgin and Grafstein (Primary Sponsors).
Referred to: Rules and Operations of the Senate
March 25, 2025
*S466-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO ENSURE CON TINUITY OF CARE FOR BH IDD TAILORED PLAN 2
PARTICIPANTS AND TO PROMOTE COMPETITION AMONG THE BH IDD 3
TAILORED PLANS. 4
The General Assembly of North Carolina enacts: 5
SECTION 1. No later than July 1, 2025, the Department of Health and Human 6
Services, Division of Health Benefits, shall submit to the Centers for Medicare and Medicaid 7
Services (CMS) any amendment to the 1115 waiver for Medicaid Transformation necessary to 8
obtain approval to effectuate the following changes related to BH IDD Tailored Plans: 9
(1) Beneficiaries may opt to remain in the Medicaid fee -for-service program, 10
known as Medicaid Direct, for physical healthcare services when any of the 11
beneficiary's healthcare pr oviders are not contracted with the LME/MCO 12
Tailored Plan network, if staying in Medicaid Direct is necessary as a 13
reasonable accommodation of the beneficiary's need for continuity of care. 14
(2) Based on differing service arrays, available services, or prov ider networks, 15
beneficiaries may opt into a BH IDD tailored plan that is operating outside of 16
the region in which the beneficiary resides. 17
SECTION 2. No later than August 1, 2025, the Department of Health and Human 18
Services, Division of Health Benefits, shall report to the Joint Legislative Oversight Committee 19
on Medicaid with recommendations for promoting competition among local management 20
entities/managed care organizations in such a way that fosters innovation and leads to better care 21
for Medicaid beneficiaries. The report shall also contain a copy of all State Plan amendments or 22
other documents submitted to CMS in accordance with Section 1 of this act. The report shall also 23
contain all identified legislative changes needed to conform with the requiremen ts of Section 1 24
of this act and other recommendations made in the report. 25
SECTION 3. This act is effective when it becomes law. 26