NCDHHS Releases Statement on Medicaid Expansion
RALEIGH — This is a momentous agreement that will directly improve the health and well-being of 600,000 North Carolinians. We applaud the efforts by the General Assembly to move this forward. Medicaid expansion will be transformative for access to health care in rural areas, for better mental health and for veterans, working adults and their families. For these people, today’s agreement is life changing.
NCDHHS will review the proposed legislation. We look forward to working with the General Assembly to get the timing right to maximize the federal funds coming to North Carolina to support hospitals and access to care across the state.
Expansion and HASP* will bring $8 billion annually to North Carolina with no additional cost to the state, along with $1.8 billion which can support behavioral health, public safety support, rural health care, and other needs. North Carolina can receive an additional $1.8 billion in HASP payments if we are able to implement both these programs this fiscal year.
NEWS BLAST: March Edition of North Carolina in the Movement
As we educate, advocate, and collaborate, state government, nonprofits, and community members are making an incredible impact in the anti-human trafficking movement in North Carolina. If you have any news you would like to share about human trafficking in North Carolina, please email Melinda Sampson at melinda@ncstophumantrafficking.org. Let us know what you are doing and get featured in our newsletter or on our website!
The North Carolina Department of Health and Human Services has awarded a contract to Optum to implement a new Provider Data Management/Credentialing Verification Organization (PDM/CVO) solution, scheduled to launch in 2024. Optum was selected after careful evaluation of the National Association of State Procurement Officials (NASPO) ValuePoint Contractors that responded to the state’s request for proposal.
The new PDM/CVO solution will coordinate enrollment, credentialing, and ongoing provider data maintenance as a multipayer system and applies to providers in all NCDHHS programs: Division of Health Benefits (NC Medicaid), Division of Mental Health (DMH), Division of Public Health (DPH) and Office of Rural Health (ORH). NCDHHS is committed to ensuring providers can continue to operate their business with minimal interruption during the transition to the new PDM/CVO.
As the PDM/CVO vendor, Optum will work closely with NCDHHS to ensure that the PDM/CVO solution will:
Align North Carolina’s provider enrollment and credentialing standards with the National Committee for Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS) Standards and Conditions
Improve multipayer services and the provider experience under a centralized credentialing process.
Offers enhanced security protocols, an interactive enrollment process collecting data using common accreditation standards and allows delegation within the organization for multiple users to complete an application.
Improves the provider notification process to streamline collaboration and effectively maintain provider data.
NCDHHS will support providers in the transition from the current enrollment process with education and outreach through webinars, stakeholder meetings, training workshops and communication bulletins, offering ongoing opportunities for providers to share feedback as the solution develops.
For additional information, please visit the NC Medicaid Provider Data Management / Credentialing Verification Organization webpage.
The North Carolina Council on Developmental Disabilities (NCCDD) intends to fund a three-year initiative to champion and increase employment and leadership of individuals with intellectual and other developmental disabilities (I/DD) within the systems that impact the developmental disability community, including care coordination, advocacy, schools, Local Management Entities/Managed Care Organizations (LME/MCOs), the North Carolina Division of Mental Health, Developmental Disabilities and Substance Use Services (NC DMH/DD/SUS), and providers.
A Request for Applications (RFA) is the way the North Carolina Council on Developmental Disabilities (NCCDD) asks for proposals for initiatives that will help the Council achieve the goals outlined in its Five-Year State Plan.
All applications (included in this RFA announcement) must be received by 5:00 pm EDT on April 19, 2023. Please apply on DD Suite: https://ddsuite.org/?nofa_id=2031
The Collaborative Model is profiled in NC Psychiatry March journal—services are reimbursed at 120% of Medicaid rate
https://www.linkedin.com/posts/activity-7037039623197364224-9JJ6?utm_source=share&utm_medium=member_ios
NC Medicaid Tailored Plan Rollout
To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) is delaying the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plans (Tailored Plans) until October 1, 2023.
Tailored Plans, previously scheduled to launch April 1, will provide the same services as Standard Plans and will also provide additional specialized services for individuals with complex behavioral health conditions, Intellectual/Developmental Disabilities (I/DDs), and traumatic brain injury (TBI).
Our highest priority is making sure that the transition to Tailored Plans is as seamless as possible for the beneficiaries they will serve. The individuals who will be served by Tailored Plans often have complex behavioral and physical health needs, and as a result their care is often more complex too. This increases the importance of a smooth transition with minimal disruption.
The most important aspects of a “smooth transition” are straightforward: on Day 1, people can get the care they need, people can get their prescriptions filled, and their providers can get paid.
While the LME/MCOs have made progress towards this goal, and our NCDHHS team has been working hard to ensure readiness, we aren’t consistently where we need to be statewide. Our latest data projects that, if we launched now, 20,000 to 30,000 of the people who will be in Tailored Plans would likely not have their current primary care provider in network on April 1.
The delayed start of Tailored Plans allows Local Management Entity/Managed Care Organizations (LME/MCOs), which will operate the Tailored Plans, more time to contract with additional providers to support member choice and to validate that data systems are working appropriately.
Beneficiaries set to receive care through the Tailored Plans will continue to receive behavioral health services and I/DD and TBI supports through their LME/MCO and physical health and pharmacy services through NC Medicaid Direct, just as they do today. Tailored Care Management, which launched on December 1, 2022, will continue to be implemented in the interim.
We understand that uncertainty is challenging for beneficiaries, especially those with complex medical needs. We will continue to work closely with LME/MCOs to launch Tailored Plans on the fastest possible timeline that can guarantee a smooth transition.
For more information about Tailored Plans please visit NC Medicaid’s Tailored Plan website.
