October 31, 2018

Medicaid Transformation Gets 1115 Waiver Approval

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 and behavioral health homes for Medicaid beneficiaries with high BH/IDD needs. Behavioral health homes are aligned with the Advanced Medical Home care coordination model. Further, there is a Healthy Opportunities pilot included in the waiver and authority for NC DHHS to implement new flexibilities that allow for treatment of substance use disorder in institutions of mental disease (IMDs) as another mechanism to fight the opioid epidemic. The overarching vision is to create whole person care that focuses on physical and behavioral health and I/DD needs as well as on Social Determinants of Health.

BH/IDD Tailored Plan
NC DHHS has developed an internal work team to further develop the BH/IDD Tailored Plans. The work team is led by Deputy Secretary for Medicaid, Dave Richard, and will take a project organizational approach. They have divided into six “clusters” that are teams with a specific focus.

They are as follows:
Topic Area NC DHHS Lead Staff Person Division
Foster Care and Special Populations Deb Goda NC Medicaid
Network Adequacy Kelsi Knick NC Medicaid
BH/IDD Tailored Plans Planning and Operations Julia Lerche NC Medicaid
BH/IDD Tailored Plans Formation Keith McKoy NC DMH/DD/SAS
1115 Waiver Support Kathy Nichols NC DMH/DD/SAS
Special Initiatives Janie Shivar NC DMH/DD/SAS

The work team will present design work to the DHHS Secretary/leadership staff, act as a public face for the work and present it to stakeholders, make recommendations on the work, and update/foster communication within DHHS team.

Response to RFP on Standard Plan: DHHS has posted on its website the names of the organizations that responded to the Standard Plan RFP. They are as follow:

AmeriHealth Caritas North Carolina
Healthy Blue – a partnership of Blue Cross and Blue Shield of North Carolina and Amerigroup Partnership Plan
Carolina Complete Health – a partnership of Centene, NC Medical Society, NC Community Health Centers Association
My Health by Health Providers – a partnership of twelve NC healthcare systems and Presbyterian Healthcare Services
Optima Health
United Health Care
WellCare Health Plans

Community Engagement
DHHS will continue to implement its stakeholder engagement plan that will include information dissemination, targeted education, and outreach. The fact sheet which accompanied the PHP RFP release serves as an example of the type of communication DHHS will have with Medicaid beneficiaries.

Additional materials to be distributed include formal legal notices regarding enrollment, welcome packets from the Enrollment Broker. Entities with responsibilities for beneficiary supports including the Enrollment Broker will support the Department’s work in reaching beneficiaries and helping them understand and navigate manage care.

 Beginning in the Winter 2018: DHHS will continue introducing brief managed care topics to increase awareness and understanding of managed care
 Early 2019 – Spring 2019: Distribute information with increasing level of detail (i.e. managed care- populations impacted, timeline, regions/phases)
 Spring 2019: Begin in person and webinar engagement
 Summer 2019 formal notices

The subcommittees that were established to provide NC DHHS recommendations on specific topics within Medicaid Transformation continue their work through the Medical Care Advisory Committee.

Legislative Action
The General Assembly has already conducted two special sessions related to recovery funding from Hurricane Florence. They have always planned to come back on November 27th for a special session. This will be the most likely time, if at all, when the General Assembly will take up any legislative action needed on Medicaid Transformation with the current legislators. The Long Session begins in January 2019, and the election will bring some new legislators to the General Assembly who have not been involved in Medicaid Transformation. Any statutory changes may trigger changes in the rules as well (e.g.,Chapter 122C related to community-based and State facility MH/IDD/SUD services).

NC DHHS is offering some upcoming webinars through the fall on the Advanced Medical Home certification process, role and responsibility for interested agencies. You can find more information on these trainings at https://medicaid.ncdhhs.gov/amh-training.