March 12, 2020

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 Tailored Plan will go into effect no earlier than one year after the implementation of the Standard Plan. 

If the tentative start date for the BH/IDD Tailored Plans for July 2021 were to stand, the Standard Plans would have to be implemented no later than July 2020.  The ongoing budget impasse between the NC General Assembly and the NC Governor has left us with an indefinite suspension of the implementation of managed care in physical healthcare and that may require an adjustment of the go-live date for BH/IDD Tailored Plans.  Regardless of the actual start date for the BH/IDD Tailored Plan, NC DHHS is moving forward on the RFA process.  As the concept paper shows, there are a multitude of preparations and processes that must occur prior to the implementation of BH/IDD Tailored Plans.  Dave Richard, Deputy Secretary for Medicaid, noted to legislators recently that it will facilitate ongoing preparation to identify the BH/IDD Tailored Plans and allow for focused work with awardees.    

Basic premises of the RFA:

When a Contract isn’t Awarded in a Region: 

Alignment with Standard Plan Requirements:

BH/IDD Tailored Plan Solvency and Risk:

Value-Based Care and Withholds:


In-Reach, Transition and Diversion from Higher Levels of Care:


Current Proposed Timeline for Implementing of the BH/IDD Tailored Plan—what we know:

February 21, 2020:  Pre-Release of the BH/IDD Tailored Plan RFA concept paper comments due

Spring 2020:  BH/IDD Tailored Plan RFA is released.  LME/MCOs have 120 days to respond.

Late Summer 2020:  LME/MCO responses to RFA are due.  NC DHHS has certain turnaround time to award contracts? 

Readiness Reviews – Unknown

Late Fall 2020:  NC DHHS awards BH/IDD Tailored Plan contracts.

July 2021:  Tentative go-live of BH/IDD Tailored Plans. 

What is the Medical Loss Ratio? 

General Definition:  Medical Loss Ratio (MLR) is a measure of the percentage of premium dollars that a health plan spends on medical claims and quality improvements, versus administrative costs.

Because NC DHHS is proposing an 88% MLR for the BH/IDD Tailored Plans, each plan will not be able to spend more than 12% of their capitation payments on administrative expenses. 

OPEN MINDS article RFA Pre-Release Puts In Question Number Of North Carolina Tailored Behavioral Health Plans To Be Awarded for which i2i served as an Expert Resource.