GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 2017

H                                                                                                                                                    1

HOUSE BILL 156

 

 

Short Title:      Eyeglasses Exemption From Medicaid Capitation.

(Public)

Sponsors:

Representatives McNeill, Lambeth, Dobson, and Brisson (Primary Sponsors).

For a complete list of sponsors, refer to the North Carolina General Assembly web site.

Referred to:

Health

February 22, 2017

A BILL TO BE ENTITLED

AN ACT to exempt the fabrication of eyeglasses from capitated prepaid health plan contracts under medicaid transformation.

The General Assembly of North Carolina enacts:

SECTION 1.  Subsection (4) of Section 4 of S.L. 2015‑245, as amended by Section 2(b) of S.L. 2016‑121, reads as rewritten:

"(4)      Services covered by PHPs. – Capitated PHP contracts shall cover all Medicaid and NC Health Choice services, including physical health services, prescription drugs, long‑term services and supports, and behavioral health services for NC Health Choice recipients, except as otherwise provided in this subdivision. The capitated contracts required by this subdivision shall not cover:

a.         Behavioral health services for Medicaid recipients currently covered by the local management entities/managed care organizations (LME/MCOs) for four years after the date capitated contracts begin.

b.         Dental services.

c.         Services provided through the Program of All‑Inclusive Care for the Elderly (PACE).

d.         Audiology, speech therapy, occupational therapy, physical therapy, nursing, and psychological services prescribed in an Individualized Education Program (IEP) and performed by schools or individuals contracted with Local Education Agencies.

e.         Services provided directly by a Children's Developmental Services Agency (CDSA) or by a provider under contract with a CDSA if the service is authorized through the CDSA and is included on the child's Individualized Family Service Plan.

f.          Services for Medicaid program applicants during the period of time prior to eligibility determination.

g.         The fabrication of eyeglasses, including complete eyeglasses, eyeglass lenses, and ophthalmic frames."

SECTION 2.  This act is effective when it becomes law.