Medicaid Transformation

Medicaid Transformation

RFP for Standard Plan Updates

September 19, 2018

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…

Medicaid Transformation

NC DHHS Puts More Meat on Medicaid Transformation Bones – Care Management/General

August 15, 2018

By all accounts, there is a lot going on in preparation for moving Medicaid physical healthcare to a managed care model. The General Assembly passed State Law 2018-48, which provided additional direction to NC DHHS on Medicaid Transformation and specifically allowed for the Standard Plan to include the mild-to-moderate behavioral health Medicaid population. NC DHHS…

Medicaid Transformation

Integrating Social Determinants of Health into Medicaid Transformation

April 23, 2018

Food insecurities, housing instability, unmet transportation needs and interpersonal violence all have an impact on a person’s health and well-being and ultimately will impact the cost and success of the health care they receive.  NC DHHS has outlined its plans to address social determinants of health (SDOH) within the new Medicaid program. The concept paper…

Medicaid Transformation

Vision for Long-Term Services and Supports – LTSS and Ombudsman Program

Long term services and supports will be part of Medicaid Transformation.  This is an area of concern for many individuals with intellectual and developmental disabilities, as these services and supports are many times required for a lifetime.   NC DHHS has published a concept paper entitled North Carolina’s Vision for Long-term Services and Supports under…