10A NCAC 26C .0703       SECRETARY RESPONSE TO COUNTY REQUESTS TO DISENGAGE FROM A LOCAL MANAGEMENT ENTITY-MANAGED CARE ORGANIZATION

(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.

 

History Note:        Authority G.S. 122C-115;

Eff. February 1, 2017.