Legislative roundup

NC Senate Medicaid overhaul moves forward

lbonner@newsobserver.com cjarvis@newsobserver.comJuly 17, 2014 

A proposal to overhaul Medicaid is on its way to a vote of the full Senate, carried out of committee Thursday on a wave of praise by the managed care industry and questions about its impact on existing programs.

The Senate proposes to have all Medicaid beneficiaries, now 1.7 million people, enrolled in managed care plans, anticipating a mix of provider-led and commercial plans competing for Medicaid patients.

Jeff M. Myers, president and CEO of Medicaid Health Plans of America, said that Medicaid beneficiaries in Medicaid managed care plans receive better care at lower costs.

Provider-networks and insurance companies will be paid a set amount for each patient, rather than for each medical service performed.

A comparison of health measures shows that Community Care of North Carolina patients do better in areas such as asthma and diabetes control than patients enrolled in Medicaid HMOs in other states. But Myers said it’s important to look at health outcomes as a whole rather than individual measures.

Doctors and hospitals have raised strong objections to the bill. Myers said providers are very concerned as managed care is introduced, but “over time, as they integrate into the system, they become more and more comfortable with it.”

Those assurances failed to quell the controversy.

The N.C. Hospital Association’s board of trustees on Thursday passed a motion opposing “turning any part of Medicaid over to corporate HMOs.”

Questions remain about what will happen to the regional government mental health offices. Sen. Ralph Hise, a Spruce Pine Republican who works on Medicaid issues, said the mental health offices can become full-service provider networks, or more likely, become contractors to bigger networks that manage the full health care array.

Rep. Nelson Dollar, a Cary Republican interested in preserving the mental health offices, asked how contracting with heath care providers would make sense, because the mental health offices don’t provide care.

“Why would you have multiple layers of care management?” Dollar asked.

The proposal would set up a Medicaid office separate from the state Department of Health and Human Services. The new department would be run by a board of directors.

The bill establishes a speedy timetable, with the new department created by Aug. 1 and board of directors appointments made by the end of September.

In order to keep DHHS employees from fleeing, the bill has “essential” employees in the Medicaid office and those within DHHS paid with federal Medicaid funds receiving bonuses until the new office takes starts running Medicaid in July 2016.

The essential employees must be identified by Sept. 1, under the bill.

Budget still stuck

Have you heard this one before?

Negotiations over a revised state budget have again slowed to a crawl.

House and Senate negotiators are trying to figure out how much to pay teachers, how much to cut Medicaid and how many teacher assistants the state should pay for.

The Senate made the last big move on the $21 billion plan, lowering its average raises for teachers from 11 percent to 8 percent, and agreeing not to cut thousands of elderly people off Medicaid, though it would still remove about 5,000 elderly from the rolls.

The Senate had wanted to cut funding teacher assistants in second and third grades, but its latest offer would pay for second grade assistants with non-recurring money.

The House has not yet made another public offer, but members are talking more about setting a base average teacher increase and letting the districts decide whether they should use the rest of the money to give teachers bigger raises or employ teacher assistants.

Chief Senate negotiator Harry Brown said if the House wants to give districts that flexibility, they should get it down on paper.

Senators are ready to meet House negotiators at any time, Brown said. “We can’t negotiate with ourselves.”

Catch-all crime bill passes Senate

A bill that a week ago was composed of a handful of relatively minor changes in criminal justice law blossomed into a catch-all vehicle for a variety of issues snatched from other pending bills.

The Senate tentatively approved it Thursday. Here are the highlights of House Bill 369:

• Exempts seven counties from the list of 17 North Carolina counties where BB guns, air rifles and air pistols are considered dangerous weapons and can’t be used by anyone younger than 12 without adult supervision. Those counties are Harnett, Anson, Cleveland, Stanly, Surry, Chowan and Caswell counties.

• Toughens penalties for state prison inmates caught with cell phones, and for those providing the phones to them.

• Creates a new offense for retaliating against an officer of the court. This provision and the previous one stemmed from the kidnapping of a Wake County assistant district attorney’s father.

• Permits remote video testimony by forensic experts in criminal proceedings.

• Makes it a felony for a second offense of carrying a concealed weapon without a permit.

• Expands the responsibilities of the state Human Trafficking Commission established last year to include studying ways to include child sex abuse awareness in schools.

Sales tax vote delayed

A late-session surprise bill that would require counties to choose between education and public transportation if they want to use sales taxes to pay for them was delayed in the Senate on Thursday.

A vote on the bill, which first surfaced in a Senate committee Wednesday, was scheduled in the full chamber Thursday. But after a 45-minute closed-door meeting of Republican senators, the vote was postponed until Monday.

Representatives of the state’s cities and counties said they were caught off guard by the proposal, and urged senators to study its implications rather than try to enact such a far-reaching law in the final days of the session.

Sen. Bob Rucho, a Republican from Matthews, said after the caucus meeting that one or two amendments were being considered, but he said he didn’t think there were any serious roadblocks ahead.

The Wake County Board of Commissioners is expected to decide next month whether to put a referendum on the November ballot asking voters’ permission to raise sales taxes by one-quarter cent to help pay for education. Wake’s current sales tax is 2 percent.

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