Medicaid Transformation

Medicaid Transformation

Clarity Offered on Crisis Services across Standard Plans

March 12, 2020

A memo was released by NC DHHS on March 6th that provides detail about needed capacity for Standard Plans in crisis services.  Within the current structure of Medicaid, individuals with behavioral health crises are referred directly to the LME/MCOs.  When the shift to have Medicaid beneficiaries with mild to moderate behavioral health needs in the…

Medicaid Transformation

RFA Pre-Release Spells Out Requirements for BH/IDD Tailored Plans

NC DHHS recently published a Request for Application (RFA) pre-release concept paper that outlines the proposed requirements for the BH/IDD Tailored Plans.  Legislation states that opportunities to be BH/IDD Tailored Plans are only available to the LME/MCOs for the first four years after the implementation of the Standard Plan.  Legislation also established that the BH/IDD…

Medicaid Transformation

Transition of Care Across Medicaid Plans Detailed in Concept Paper

March 1, 2020

Every day, people move from one insurance company to another and from one medical professional to another.  NC DHHS has published a draft concept paper that lays out more detail on how Medicaid beneficiaries can move from one payer or provider to another while their continuity of care is maintained during the initial implementation of…

Medicaid Transformation

Embedding State-Funded BH/IDD Services into Tailored Plans and More

February 4, 2020

The concept paper on State-funded BH/IDD services lays out a plan of action to create a more statewide, standardized approach to State funding. The paper indicates the State’s intent to move to a centralized decision-making process for eligibility, as reflected in the emphasis on the statewide structure described below. In addition to state funded services,…

Medicaid Transformation

Care Management: A Core Function in the BH/IDD Tailored Plan

NEWS UPDATE 2/11/20 Since the publication of the article below on the BH/IDD Tailored Plan Care Management application process NC DHHS has announced an extension before they begin the application process.  Originally they were to begin the first round of applications for Advanced Medical Home Plus practices and Care Management Agencies in February 2020.  That…

Medicaid Transformation

NC DHHS Expands on their Value-Based Payment (VBP) Strategy and Introduces the Medicaid Accountable Care Organization Model

The recently published concept paper, “North Carolina’s VBP Strategy for Standard Plans and Providers in Medicaid Managed Care” provides a lot of detail on strategies NC DHHS will employ to support the expanding use of value-based payment (VBP).  While their support strategies are optional, the paper also details the State’s contractual expectations for Prepaid Health…

Medicaid Transformation

NC Design for State Funded Services under the Tailored Plan

January 14, 2020

While the implementation of managed care has been suspended as legislative action is needed to move forward, the Department continues to work on the design of Tailored Plans to serve individuals with behavioral health and intellectual disabilities in lieu of Standard Plans. In addition to managing Medicaid services, Behavioral Health I/DD Tailored Plans also will be…

Medicaid Transformation

Policy on Medicaid Accountable Care Organizations for the Medicaid Standard Plan and Providers

This paper released on January 8th, provides details on an optional Medicaid ACO program, including ACO organizational requirements, payment parameters, total cost of care calculation and participation incentives for early adopters. PHPs and providers can form ACO arrangements as a way to promote value in Medicaid and meet the Department’s VBP targets. The Department welcomes…