Current through Register Vol. 39, No. 6, September 16, 2024
(a) Upon
written request by a county seeking to disengage from an LME-MCO, the Secretary
may waive the nine month requirement set forth in Rule .0702(a) of this Section
upon consideration of the following factors:
(1) the impact of delay upon consumers
currently served in the county seeking to disengage;
(2) the financial vulnerability of the
LME-MCO from which disengagement is sought; and
(3) any substantiated evidence of criminal
activity or malfeasance on the part of the LME-MCO from which disengagement is
sought.
(b) The
Secretary shall consider the following in deciding whether to approve a county
request to disengage from an LME-MCO and realign with a different LME-MCO
operating under a Medicaid waiver:
(1) the
impact to and public comments received from consumers, advocates,
self-advocates, and State and Local CFACs within the county in response to Rule
.0702(c) of this Section;
(2) the
county's plan for disengagement from one LME-MCO and realignment with a
different LME-MCO;
(3) the county's
plan to ensure continuity of services during the disengagement and realignment
phase;
(4) whether the county has
complied with the requirements of Rule .0702 of this Section;
(5) whether the county is contiguous to the
catchment area of the LME-MCO with which it is requesting to align;
(6) the timing of the request and whether the
disengagement will conflict with setting capitation rates;
(7) whether the disengagement will impact the
financial viability of the LME-MCO from which the county is seeking to
disengage;
(8) whether the
disengagement and realignment will ensure compliance with the population
requirements of
G.S.
122C-115(a);
(9) whether the disengagement and realignment
will impact the stability, as a whole, of the State's healthcare
system;
(10) how the disengagement
and realignment will affect the quality, variety, and amount of services for
the clients, as defined in
G.S.
122C-3, in the subject county; and
(11) the operational alignment of the county
within the context of the LME-MCO disengagement related to geography, service
delivery, and demonstrated provision of whole-person centered care.
(c) The Secretary shall issue a
written decision to approve or deny the request for disengagement and
realignment within 90 calendar days of receipt.
(d) The Secretary may approve the request as
submitted or set conditions upon its issuance based upon consideration of the
factors set forth in Paragraph (b) this Rule.
(e) The Secretary shall notify the following
of the decision to approve or deny a county request for disengagement and
realignment:
(1) The Board of County
Commissioners of the county seeking to disengage;
(2) The Boards of County Commissioners of the
counties of the LME-MCO with which realignment is requested;
(3) The LME-MCO from which disengagement is
sought;
(4) The LME-MCO with which
realignment is requested; and
(5)
The Co-Chairs of the Joint Legislative Oversight Committee on Health and Human
Services.
Authority
G.S.
122C-115;
Eff. February 1,
2017.
