Medicaid Transformation Ramping Back Up

The new law, SL 2020-88, now gives a date certain, July 1, 2021, by which the Standard Plans will begin.  There is a tremendous amount of detail that goes into meeting that implementation date.  Of course, NC DHHS is not starting from scratch, but some of the infrastructure built to meet the previous February 2020 implementation date was deconstructed while the budget impasse continued between the Governor and the NC General Assembly.  Now that the funding has been authorized and other structural authorities have been provided, NC DHHS will have the additional challenge of balancing the business of addressing a pandemic along with the start-up of Medicaid transformation. 

Since the law was just signed, NC DHHS has not yet provided a detailed implementation plan. There is indication, however, that beneficiary engagement will be an immediate area for consideration with priority topics including open enrollment, enrollment broker, plan selection and the member engagement committee.  In June, Deputy Secretary for Medicaid Dave Richard gave the Medical Care Advisory Committee (MCAC) some general information regarding steps he anticipates NC DHHS will take.  These include:

• Update all stakeholder materials, websites, smart phone apps and technical systems across multiple platforms (Enrollment Broker, health plans, NCTRACKS)
• Formulate capitation rates and submit to CMS for approval
• Re-review and resubmit to CMS for approval several health plans’ contractual policies and procedures deliverables (annual compliance plans, call scripts, member marketing, value added service materials, and clinical coverage policies)
• Upgrade the Consolidated Provider Directory (NC DHHS, Enrollment Broker, health plans)
• Test Primary Care Provider Auto Assignment between NCFAST, NCTRACKS, health plans and providers
• Complete key testing activities to finalize data, analytics, reporting functionality including Transition of Care (NC FAST, Enrollment Broker, NC TRACKS, health plans, LME-MCOs, UM Vendors & CCNC) and Data Warehouse
• Re-review and re-validate Enrollment Broker readiness including call center staff and scripting once rehired
• Re-evaluate internal Division of Health Benefit staff readiness
• Complete provider contracting (health plans and providers)
• Analyze health plan network adequacy to ensure adequate provider networks and processes

NC DHHS is expected to provide more detailed implementation plans in the coming weeks.  It is important to note that SL 2020-88 did not change in any way the implementation of the Tailored Plans.  The previous statutory language in SL 2018-48 that sets the BH/IDD Tailored Plan implementation date at one year after the start of the Standard Plans remains in place.  The same statute also states that LME/MCOs will be the only entities that may operate a BH/IDD Tailored Plan for the first four years after the start of the Standard Plans.

SL 2020-88 does amend the statewide and regional standard benefit plan prepaid health plan (PHP) capitated contracts awarded as of June 1, 2020, so that the contract covers four contract year terms, instead of three, with the option to extend the contract for up to one successive contract year or a shorter period as required by DHHS.  PHPs have the option to decline this contract amendment.