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Autism Society of North Carolina Public Policy updates:

• NCGA Short Session Wraps Up
• Tailored Plans Begin

 

NCGA Wraps Up Regular Short Session

NC Legislature wrapped up its up regular short session at the end of June and passed a resolution to reconvene monthly until December 13, 2024, to address any remaining legislative issues including veto overrides and, possibly, additional budget adjustments. The NCGA did not pass an omnibus budget adjustments act in their April-June session, though they did pass legislation providing additional funding for childcare centers who were facing the loss of federal funds.

During the regular short session, the NCGA did vote on any additional bills, including an appropriations adjustment act, that would have addressed any additional ASNC public policy priorities that were not addressed in 2023, the previous long session year. The NCGA does have the option of looking at additional legislation and appropriations bills as they reconvene between now and December.

House and Senate of the North Carolina General Assembly will reconvene on the following dates:

• Wednesday, July 10, 2024, at 12 p.m.
• Monday, July 29, 2024, at 12 p.m.
• Monday, September 9, 2024, at 12 p.m.
• Wednesday, October 9, 2024, at 12 p.m.
• Tuesday, November 19, 2024, at 12 p.m.
• Wednesday, December 11, 2024, at 12 p.m.

The 2023 Regular Session of the General Assembly will adjourn sine die on Friday, December 13, 2024.

Tailored Plans Launch for Medicaid beneficiaries with I/DD

North Carolina has entered the next phase of Medicaid Transformation with the launch of Medicaid Tailored Plans for people with intellectual and/or developmental disabilities (I/DD), as well as those with significant mental health and substance use issues. ASNC has written previously about Tailored Plans and Transformation here https://www.autismsociety-nc.org/medicaidtransformation/

Having problems with your new Medicaid Tailored Plan coverage? Here are some resources:

Do you think you have been incorrectly assigned to a Tailored Plan or Standard Plan?  If so, you can connect with the Enrollment Broker to ask questions about Medicaid health care coverage and see what your options are. A reminder that Tailored Plans have specialized I/DD services like 1915i services, state funded services, in lieu of services, and Tailored Care Management that are *not* offered in the Standard Plans.

Is a provider you use not in your Tailored Plan network? Tailored Plans have been continually working to add additional specialized and primary care providers. Not every provider has opted to go through the process of joining Tailored Plan provider networks and some providers have not been accepted. If your current providers are not in the Tailored Plan care network, you have a few options:

• Talk with your provider about joining the Tailored Plan network, if they have not already tried to do so.
• Request that the Tailored Plan/LME MCO include a specific provider in their network.
• Choose a different provider of that service that *is* in the Tailored Plan network.
• Ask your provider if they can serve you “out of network.” Out of network providers can continue to serve you without prior authorization until September 30, 2024. Between July 1, 2024, and Jan. 31, 2025, Tailored Plans will permit uncontracted, out-of-network providers enrolled in NC Medicaid to follow in-network provider prior authorization rules. Starting on Feb. 1, 2025, out-of-network providers must seek authorizations for all services. The provider can bill Medicaid while they are in the process of contracting with Tailored Plan OR while you find a new provider. Out of network providers are paid at 90% of the Medicaid rate. You may be responsible for the remainder of the cost.

Are you getting b3 services like respite through the LME and have not yet been able to transition to 1915i Medicaid services?

• The first step in getting access to 1915i services is to get assessed by your Tailored Care Manager (TCM). If you are not aware of who your TCM is, or if you have not signed up for TCM, you can contact your Tailored Plan at https://www.ncdhhs.gov/providers/lme-mco-directory to get care management.
• Once the assessment is done, and you are authorized to get 1915i services, your care manager and Tailored Plan will coordinate to get you connected with 1915i services providers. Providers will help write an individual services plan and set goals for your services.
• ASNC has written about 1915i Services in Medicaid including more details and resources. Click here for that information.
• If your services have not transferred from b3 to 1915i by August 31, b3 services will end. You may reapply for 1915i at that time. Please confirm with your Care Manager and or your Tailored Plan if you are not sure.

Are you having these or other problems with the changeover to Tailored Plans that just aren’t getting sorted out?  You can reach out to the Medicaid Ombudsman at https://ncmedicaidombudsman.org/ or by calling 877-201-3750 from 8 a.m. to 5 p.m., Monday through Friday, except State holidays.

ASNC has resources that may help as well:
Autism Resource Specialists can provide information, support, and connections to community organizations: Fill out a Talk with a Specialist Form or call our 800-442-2762 for more information.

ASNC provides direct services including 1915i, waiver services, employment supports and other services, as well as social recreation programs, support groups, and workshops. Please see our services map for more info about what is available in your area.

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