Medicaid Transformation

Medicaid Transformation

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

April 23, 2018

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…

Medicaid Transformation

Quality and Performance – Holding PHPs Accountable in Medicaid

A key question is answered by the draft NC DHHS Quality Strategy and concept paper – how will Prepaid Health Plans (PHPs) be held accountable in the Medicaid/Health Choice managed care structure for quality services?  Accountability will be related to performance measures that will also impact providers, and PHPs will have to work in partnership…

Medicaid Transformation

Beneficiaries and Care Management Focus of Recent DHHS Concept Papers

April 6, 2018

Two new concept papers published by NC DHHS provide a little more “meat on the bones” of the NC Medicaid Transformation Plan. All of the concept papers build upon each other and the concepts are proposals with feedback welcomed. These most recent papers are published with a March 31 turnaround time for feedback. Beneficiaries and…

Medicaid Transformation

NC DHHS Moving Quickly and Adding Detail to Medicaid Transformation Plan

March 14, 2018

NC DHHS has been publishing concept papers since last summer to provide information on specific areas of Medicaid Transformation. The Medicaid Transformation website now separates out concept papers, RFPs, the waiver amendment, application, etc. It is important to note that concept papers are point-in-time proposals by NC DHHS and include comment periods. The waiver amendment and…

Medicaid Transformation

Proposed MH/SA Access to Care Criteria Sets a Higher Standard

March 11, 2018

NC DHHS recently posted its latest Medicaid Transformation concept paper focused on the Standard Plan access to care and network adequacy standards. The paper does not outline standards for the Tailored Plan. The difference between the current access to care standards under the Medicaid (b)(c) waiver and the proposed requirements under the Standard Plan are…

Medicaid Transformation

NC’s Plan for Addressing Social Determinants of Health

March 10, 2018

NC’s State Health Director and Chief Medical Officer for the NC Department of Health and Human Services (DHHS) Dr. Betsy Tilson recently shared with the members of the Developmental Disabilities Consortium how DHHS is working to address social determinants of health (SDOH) for Medicaid recipients. The state is looking at a multi-layered approach to tackling…