North Carolina SB 330: LME/MCO Transparency and Accountability.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 330

Short Title: LME/MCO Transparency and Accountability. (Public)
Sponsors: Senator Grafstein (Primary Sponsor).
Referred to: Rules and Operations of the Senate
March 19, 2025
*S330-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO REQUIRE QUARTERLY REPORTING BY LOCAL MANAGEMENT 2
ENTITIES/MANAGED CARE ORGANIZATIONS REGARDING ACCESS TO 3
HEALTHCARE PROVIDERS AND TO PROVIDE FOR SPECIFIC MINIMALLY 4
ADEQUATE SERVICES REQUIREMENTS TO BE MET BY LOCAL MANAGEMENT 5
ENTITIES/MANAGED CARE ORGANIZATIONS. 6
The General Assembly of North Carolina enacts: 7
8
PART I. QUARTERLY LME/MCO REPORTING 9
SECTION 1. On a quarterly basis beginning October 1, 2025, and for the period of 10
four years thereafter, every local management entity/managed care organization shall submit to 11
the Department of Health and Human Services (DHHS) the following information: 12
(1) The number of individuals served by the LME/MCO who had an emergency 13
department stay of more than 24 hours and the length of stay for each 14
individual. 15
(2) The number, and percentage of, individuals served by the LME/MCO who 16
were unable to access a healthcare provider both willing and able to initiate 17
services within 30 days of the approval of those services. 18
(3) The amount of funds retained by the LME/MCO as a result of services that 19
are approved for an individual served by the LME/MCO but that are not used 20
due to limited access to appropriate or available providers. 21
(4) For the initial report, the number of healthcare providers in the LME/MCO's 22
network, by provider type. For each subsequent report, any change, positive 23
or negative, in the number of providers in the LME/MCO's network, by 24
provider type. 25
(5) The number of individuals who are deemed eligible for mental, behavioral, or 26
substance use services pursuant to contract between DHHS and the 27
LME/MCO who are not receiving any or all of those services through the 28
LME/MCO, except when the needed service is made available by another 29
payor. 30
31
PART II. LME/MCO MINIMALLY ADEQUATE SERVICES REQUIREMENTS 32
SECTION 2.(a) The Secretary shall adopt rules incorporating the following 33
standards for minimally adequate services provided by local management entities/managed care 34
organizations (LME/MCOs) to be met no later than December 31, 2023, and each quarter 35
thereafter: 36

General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 330-First Edition
(1) LME/MCOs shall have fewer than two beneficiaries per county in the 1
LME/MCO's catchment area boarded in a hospital emergency department at 2
any one time. For the purposes of this subdivision, the term "boarded" means 3
a stay of more than 24 hours after an individual is medically cleared for 4
discharge or referral to a behavioral healthcare setting. 5
(2) Individuals served by the LME/MCO shall have access to a willing and 6
available healthcare provider and begin receiving all approved services within 7
45 days of the approval of the services at least eighty-five percent (85%) of 8
the time. This goal does not include specialized medical services for which 9
there are extended wait times for individuals who are not Medicaid 10
beneficiaries. 11
SECTION 2.(b) The Secretary may incorporate the criteria specified in subsection 12
(a) of this section in any future managed care contracts. In addition to the measures outlined in 13
this section, the Secretary may develop additional measures of LME/MCO compliance with 14
established requirements for timely access to services for individuals served by the LME/MCO. 15
SECTION 2.(c) The failure of an LME/MCO to meet the access to service 16
benchmarks specified in subsection (a) of this section, or as specified in rules adopted in 17
accordance with that subsection, for two consecutive quarters shall constitute a failure to provide 18
for minimally adequate services and the Secretary shall take corrective action. 19
20
PART III. EFFECTIVE DATE 21
SECTION 3. This act is effective when it becomes law. 22