Medicaid Transformation

Medicaid Transformation

Medicaid Transformation Gets 1115 Waiver Approval

October 31, 2018

NC DHHS announced on October 24th that the 1115 Medicaid waiver application has been approved by the Centers for Medicare and Medicaid services (CMS). This approval was a major hurdle to overcome and now almost guarantees the timeline that NC DHHS had set for implementation going forward. The approved waiver includes the BH/IDD Tailored Plans…

Medicaid Transformation

Responses Received on RFP for Standard Plan

October 22, 2018

DHHS has posted on their website the names of the organizations that responded to the Standard Plan RFP to be either a statewide plan or a provider-led entity.  They are as follows: Aetna AmeriHealth Caritas North Carolina Healthy Blue – a partnership of Blue Cross and Blue Shield of North Carolina and Amerigroup Partnership Plan…

Medicaid Transformation

Organization Changes within NC DHHS

September 19, 2018

Kody Kinsley has begun a new position as the Deputy Secretary for Behavioral Health and Intellectual and Developmental Disabilities. Mr. Kinsley started with NC DHHS as the Deputy Director of the Division of MH/IDD/SUD Services and served as the Interim Senior Director of the Division. Now, he oversees the Division of MH/IDD/SUD Services, the Division…

Medicaid Transformation

RFP for Standard Plan Updates

The Request for Proposal (RFP) for the Standard Plan now includes: Answers to questions submitted by responding organizations; Revisions to the RFP, most notably: PHPs must achieve NCQA LTSS Distinction by the end of Contract Year 3; The Scope of Services medical benefits is inclusive of LTSS services, including Nursing Facility Services, Home Health Services,…

Medicaid Transformation

Building the Ombudsman Program

The Ombudsman Program is a key component of Medicaid Transformation. NC DHHS released a Request for Information (RFI) for organizations interested in providing the Ombudsman function. Feedback was due on June 27, 2018 and it was a required response for any organization that intends to apply for the contract. Download PDF: Building the Ombudsman Program

Medicaid Transformation

Advanced Medical Home Resources Available

NC DHHS has provided multiple resources on their Medicaid Transformation website that give more detail to the Advanced Medical Home (AMH). The Advanced Medical Home role is primary to achieving an integrated care approach under Medicaid Transformation because the AMH will conduct care management functions. Download PDF: Advanced Medical Home Resources Available

Medicaid Transformation

Provider Credentialing RFP Released

NC DHHS has published a Request for Proposal (RFP) for organizations interested in being the Provider Data Contractor for the State as it relates to credentialing of providers. Any organization that responds to the RFP should be certified as a Credentialing Verification Organization (CVO) through the national accreditation program that NC DHHS has chosen for…

Medicaid Transformation

New RFI for Medicaid Managed Information System

Shifting from a MMIS to a MIMS will Upgrade State’s Managed Care Capacity In 2013 NC DHHS went live with NC TRACKS. NC TRACKS is a multi-payer Medicaid Management Information System (MMIS) that merged separate information systems for Medicaid, Health Choice, and other programs such as State MH/IDD/SUD funding (known as IPRS, Integrated Payment and…