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2022 Announcements

 Please note these important public announcements provided by the State of North Carolina regarding multiple changes to the Medicaid State Plan:

Proposed NC Medicaid Changes

 

PUBLIC NOTICE

Revised (SPA 22-0033)

PHARMACY COVERED OUTPATIENT DRUGS (COD) PROFESSIONAL DISPENSING FEE (PDF)

AND

PHYSICIAN ADMINISTERED DRUG PROGRAM (PADP) LONG- ACTING REMOVABLE CONTRACEPTIVE (LARC)

 

The Department of Health and Human Services, Division of Health Benefits hereby provides notice of its intent to amend the Medicaid State Plan Attachment 4.19-B, Section 12. This amendment revises the pharmacy reimbursement methodology for professional dispensing fees (PDF) to be set at a flat fee determined by the Cost of Dispensing Study conducted on behalf of the North Carolina Department of Health and Human Services, Division of Health Benefit every five (5) years and removes the rule allowing for only one PDF per drug, per member, per pharmacy, per month. This amendment also changes the reimbursement for long acting reversable contraceptives (LARCs) in the Physician Administered Drug Program (PADP) acquired and dispensed under the 340B program, to be reimbursed at the lesser of 340B ceiling price plus six percent (6%) or billed amount. These new reimbursements will be applicable to all active NC Medicaid providers.

 

The amendments will become effective December 1, 2022. The annual estimated state fiscal impacts of these changes are:

  1. SFY 2023($94,623)
  2. SFY 2024($200,342)

A copy of the proposed public notice may be viewed at the County Department of Social Services. Questions, comments, and requests for copies of the proposed State Plan amendment should be directed to the Division of Health Benefit at the address listed below:

 

Dave Richard Deputy Secretary

Division of Medical Assistance 2501 Mail Service Center

 

Posted on the Division of Health Benefits Website: October 28, 2022 https://medicaid.ncdhhs.gov/get-involved/nc-health-choice-state-plan 

 

NOTICE

 

TO PERSONS WHO HAVE HAD OR MAY IN THE FUTURE HAVE THEIR MEDICAID BENEFITS TERMINATED OR REDUCED IN NORTH CAROLINA:

 

PROPOSED SETTLEMENT OF FRANKLIN et al. v. KINSLEY.

United States District Court – Eastern District of North Carolina Case No.: 5:17-CV-581

 

Franklin et al. v. Kinsley, formerly known as Hawkins et al. v. Cohen, is a federal lawsuit filed in 2017. This case was certified by the Court as a class action lawsuit on behalf of

N.C. Medicaid beneficiaries.

 

In this lawsuit, the Plaintiffs allege that the N.C. Medicaid agency, along with county Departments of Social Services (DSS), was terminating and reducing Medicaid benefits without considering eligibility under all Medicaid categories and without first providing timely and adequate written notice, in violation of federal Medicaid statute and the U.S. Constitution. The Defendant denied those allegations.

 

The named Plaintiffs and the Defendant have reached a Settlement Agreement to resolve the lawsuit. In reaching the Settlement Agreement, the Defendant has not admitted any wrongdoing, but has agreed to modify the procedures, forms, and notices for redetermining Medicaid eligibility. The Court plans to approve the Settlement Agreement unless a good reason is given not to do so. The Settlement Agreement includes detailed descriptions of the steps that have been or will be taken to:

 

  • Assure that Medicaid does not stop without notice because the county DSS has not timely redetermined Medicaid eligibility;
  • Assure that all categories of Medicaid eligibility are considered before termination or reduction of Medicaid;
  • Assure that persons receiving Medicaid in other categories are given an opportunity to have their eligibility as a disabled person considered prior to termination or reduction of their Medicaid benefits;
  • Assure compliance with all federal regulations governing the Medicaid eligibility process;
  • Assure that the written notice provided before Medicaid is reduced or terminated clearly and specifically states what action will be taken and the reason for that action;
  • Assure that all county DSSs comply with the provisions of the agreement.

 

The members of the class who would be bound by the settlement include all current or future North Carolina Medicaid recipients for whom Defendant or county DSSs reduced or terminated Medicaid benefits without following the procedures set out above.


RIGHT TO OBJECT: Any class member has the right to object to this proposed Settlement Agreement; however, a class member does not have the ability to exclude himself or herself from being bound by the settlement if it is approved.

 

You may review the proposed Settlement Agreement by visiting the Civil Clerk's office at 413 Middle Street, New Bern, NC 28560. The Settlement Agreement is also available at the following websites:

 

www.healthlaw.org/Franklinsettlement; www.charlottelegaladvocacy.org/Franklinsettlement.

 

You may file written objections to the dismissal by mailing your reasons for objection to the Clerk of Court at the above address no later than December 31, 2022. If you wish to file evidence to support your objections, you must file the evidence in writing by that date.

 

You also have the right to object to the Settlement Agreement in person at a hearing that will be held at 11:00 a.m. on January 13, 2023. The hearing will take place at the United States District Court, 413 Middle Street, New Bern, NC 28560.

 

To ask questions of Plaintiffs' attorneys about the case or the procedure for objecting to the dismissal, call toll free at 1-800-936-4971. You can also email Plaintiffs’ attorneys at hawkinsinfo@charlottelegaladvocacy.org.

 

AVISO

A PERSONAS QUE HAN TENIDO O PUEDEN EN EL FUTURO TENER SUS BENEFICIOS DE MEDICAID TERMINADOS O REDUCIDOS EN CAROLINA DEL NORTE:

 

PROPUESTA DE ACUERDO DE FRANKLIN et al. v. KINSLEY.

Tribunal de Distrito de los Estados Unidos – Distrito Este de Carolina del Norte Caso Núm.: 5:17-CV-581

 

Franklin et al. c. Kinsley, anteriormente conocido como Hawkins et al. v. Cohen, es una demanda federal presentada en 2017. Este caso fue certificado por la Corte como una demanda colectiva en nombre de los beneficiarios de Medicaid de Carolina del Norte.

 

En esta demanda, los Demandantes alegan que la agencia de Medicaid de Carolina del Norte, junto con los Departamentos de Servicios Sociales (DSS) de los condados, estaba terminando y reduciendo los beneficios de Medicaid sin considerar la elegibilidad bajo todas las categorías de Medicaid y sin proporcionar primero un aviso por escrito oportuno y adecuado, en violación del estatuto federal de Medicaid y la Constitución de los Estados Unidos. El Demandado negó esas acusaciones.

 

Los Demandantes nombrados y el Demandado han llegado a un Acuerdo de Conciliación para resolver la demanda. Al llegar al Acuerdo de Conciliación, el Demandado no ha admitido ninguna ofensa, pero ha acordado modificar los procedimientos, formularios y avisos para redeterminar la elegibilidad de Medicaid. El Tribunal planea aprobar el Acuerdo de Conciliación a menos que se dé una buena razón para no hacerlo. El Acuerdo de Conciliación incluye descripciones detalladas de los pasos que se han tomado o se tomarán para:

 

  • Asegurar que Medicaid no se detenga sin previo aviso porque el DSS del condado no ha redeterminado oportunamente la elegibilidad de Medicaid;
  • Asegurar que todas las categorías de elegibilidad de Medicaid se consideren antes de la terminación o reducción de Medicaid;
  • Asegurar que personas que reciben Medicaid en otras categorías tengan la oportunidad de que se considere su elegibilidad como persona discapacitada antes de la terminación o reducción de sus beneficios de Medicaid;
  • Asegurar el cumplimiento de todas las regulaciones federales que gobiernan el proceso de elegibilidad de Medicaid;
  • Asegurar que el aviso por escrito proporcionado antes de que Medicaid se reduzca o termine establece clara y específicamente qué acción se tomará y la razón de esa acción;
  • Asegurar de que todos los DSS del condado cumplan con las disposiciones del acuerdo.

 

Los miembros de la demanda colectiva que estarían obligados por el acuerdo incluyen a


todos los beneficiarios actuales o futuros de Medicaid de Carolina del Norte para quienes el Demandado o los DSS de los condados redujeron o terminaron los beneficios de Medicaid sin seguir los procedimientos establecidos anteriormente.

 

DERECHO A OBJETAR: Cualquier miembro de la clase tiene el derecho de objetar este Acuerdo de Conciliación propuesto; sin embargo, un miembro de la demanda no tiene la capacidad de excluirse de estar obligado por el acuerdo si se aprueba.

 

Puede revisar el Acuerdo de Conciliación propuesto visitando la oficina del Secretario Civil, Tribunal de los Estados Unidos - Civil Clerk’s Office, 413 Middle Street, New Bern, NC 28560. El Acuerdo de Conciliación también está disponible en los siguientes sitios web:

 

www.healthlaw.org/Franklinsettlement; www.charlottelegaladvocacy.org/Franklinsettlement.

 

Puede presentar objeciones por escrito al despido enviando por correo sus razones de objeción al Secretario del Tribunal – Clerk of Court – a la dirección anterior a más tardar el 31 de diciembre de 2022. Si desea presentar pruebas para respaldar sus objeciones, debe presentarlas por escrito antes de esa fecha.

 

También tiene derecho a objetar el Acuerdo de Conciliación en persona en una audiencia que se llevará a cabo a las 11 a.m. el 13 de enero de 2023. La audiencia se llevará a cabo en Tribunal de Distrito de los Estados Unidos, 413 Middle Street, New Bern, NC 28560.

 

Para hacer preguntas a los abogados de los Demandantes sobre el caso o el procedimiento para objetar el despido, llame gratis al 1-800-936-4971. También puede enviar un correo electrónico a los abogados de los Demandantes a hawkinsinfo@charlottelegaladvocacy.org.

 

 

HEALTH HOMES (STATE PLAN OPTION): Below is a public notice representing a proposed change to amend the Medicaid State Plan notice this amendment will authorize North Carolina’s Health Home benefit, called Tailored Care Management. The Health Home benefit will be available to NC Medicaid beneficiaries with a significant behavioral health condition (including both mental health and severe substance use disorders), intellectual/developmental disability (I/DD), or traumatic brain injury (TBI), as defined in this State Plan Amendment. The goal for the Health Home program is to advance the delivery of high-quality, integrated, whole-person care through better coordination and collaboration across all of an enrollee’s needs. This amendment will become effective December 1, 2022.