S.L. 2013-85: Effective Operation of 1915(b)/(c) Medicaid Waiver

• Secretary of Health and Human Services must certify LME/MCO compliance every six months beginning August 1, 2013, based on independent external review assessing financial stability, timely provider payments (90% within 30 days), and HIPAA-compliant data exchange.

• Non-compliant LME/MCOs on critical measures (insolvency, payment delays, data standards) face immediate contract assignment to a compliant LME/MCO within 10 days; other contract violations receive 30-day cure period before potential reassignment or required merger.

• Secretary oversees orderly transfer of operations from failing LME/MCOs to compliant ones, including reimbursement for unpaid claims, assumption of management responsibilities, and transfer of assets and risk reserves.

• Counties may disengage from LME/MCOs and realign with other area authorities with Secretary approval, subject to service continuity, population requirements, and adequate notice requirements.

• Area boards must include county commissioner advisory boards and may expand catchment areas upon majority board resolution and Secretary approval; repeals provisions allowing pro-rata distribution of dissolved authority funds to member counties.