ncacc update at the 2016 ncccma winter seminar

NCCMA 2016 Winter Conference February 5, 2016

NCACC Update

NCACC ReportTopics from Managers:• School Construction Funding• County Eligibility for State Health Plan • PSAP Backup Requirements• Medicaid / Public Health Cost Settlement• Prayer Case• Sales Tax Redistribution efforts During the

2016 Short Session• What else?

County Resource & Outreach Services

• Retreat Facilitation and Board Leadership Development

• Resource/Consultation Teams• Enhanced Field Liaison Services• Recruitment Assistance

HHS Issues Dr. Linda Struyk

MillsapsPaige Worsham, Esq.

HHS Issue #1: Public Health

Reimbursements:

Services provided to Medicaid

eligible clients

These reimbursements are governed by a

Medicaid State Plan Amendment (SPA)

HHS Issue #1: Public Health

Background and Timeline:• Unrelated SPA submitted by NC in 2010.

– That change was approved in March 2011.• CMS used this as an opportunity to review the NC state plan, including cost reporting methodology for clinical services.• CMS indicates new cost reporting methodology required, April 2014.

– Effective date of March 2011.

Result: • Public Health Officials indicate new methodology would have significant, negative

financial implications. Many counties potentially have to “pay back” reimbursements already received.

• Public Health Directors consider legal action, communicatewith DHHS Secretary.

• Legislation passed directing DHHS to find a way to maximize Medicaid reimbursements to counties.

Methodology Used to Determine Medicaid Reimbursement for Covered Services

Pre-2013 Cost Reports 2013 & After

Total Medicaid Encounters Total Medicaid Paid Charges Total Encounters Total Charges

• Charges are “Billed” services paid by Medicaid.• Encounters are visits, including many provided services.• Impact varies significantly by county.

HHS Issue #1: Public Health

Members of the N.C. Association of Local Health Directors met for several months with representatives from the DHHS Division of Medical Assistance (along with NCACC staff)

Resulting Agreement:• Minimize impact of new methodology (although still a

potential loss).• Submit a Medicaid SPA to expand Medicaid reimbursement

to laboratory services provided by Health Departments.• Request (from CMS) an extension from 5 to 8 months to

provide health departments additional time to complete cost reports.

• Submit request to reimburse Health Departments for services provided to Health Choice patients.

• Facilitate training for local health departments to improve billing processes.

• More positive relationships.

HHS Issue #1: Public Health

Background:• October 2014 – USDA “increasingly

concerned about persistently low SNAP application processing”– Nationally fallen from 91% in 2004 to 88% in

2013.– Some states consistently process less than

90% timely.

• Standard: 95%– Corrective Action required if below

85%**.

HHS Issue #2: Benefits Processing

HHS Issue #2: Benefits Processing

HHS Issue #2: Benefits Processing

Background (FNS):• May 2015 DHHS received notice from USDA of

timeliness and quality control issues.

• Implemented a series of targets that must be met to retain funding.

85% timely processed July- December 201595% timely processed January – June 2016Also quality control standards

Timely:– Seven days for expedited (really 5)*– 30 days for non-expedited (really 25)*Failure to meet these deadlines statewide could

result in the loss of $80 million of federal funds (Mostly county, all administration)

HHS Issue #2: Benefits Processing

HHS Issue #2: Benefits Processing

HHS Issue #2: Benefits Processing

ACA/TurboTax Medicaid

ApplicationsLoss of Federal Funds

Alexander type lawsuit

NC Fast/IT Issues

State take over of individual county

processing $$ and People

Negative Press

Thank you!

NC Center for County ResearchDr. Linda Struyk MillsapsLinda.Millsaps@ncacc.org

Paige Worsham, Esq.Paige.Worsham@ncacc.org

Short Session Goals • PE-4: Seek legislation to repeal the statutory authority

under NCGS 115C-431(c) that allows local school boards to file suit against a county board of commissioners over county appropriations for education.

• TF-4: Seek legislation to authorize local option revenue sources already given to any other jurisdiction.

• GG-2: Support legislation, regulations and funding that would preserve local option and authority where needed to deploy community broadband systems and ensure community access to critical broadband services.

Thank you!