NC DHHS Takes Next Step in NC Medicaid Transformation

Mandy K. Cohen, MD, MPH – Secretary, NC DHHS

Last week the NC Department of Health and Human Services (NCDHHS) issued its much anticipated request for proposal (RFP) outlining the requirements for managed care organizations seeking a state contract to serve North Carolina’s Medicaid beneficiaries. Read the RFP.

This is the next step in a process that began in 2015 with passage of legislation moving the state’s Medicaid program to managed care. Many organizations, including Carolina Complete Health, a partnership between the North Carolina Medical Society (NCMS), the NC Community Health Center Association and Centene Corporation, are expected to submit proposals to the state by the Oct. 12, 2018 deadline. An evaluation committee made up of state employees with expertise in managed care will evaluate the proposals and award four statewide contracts for pre-paid health plans (PHP) in February 2019.  The new managed care system will be phased in regionally beginning in November 2019.

During a conference call with health care providers on Aug. 9, the day the RFP was issued, NC DHHS Secretary Mandy Cohen, MD, MPH, outlined several key points and answered questions, including that:

  • This RFP, the largest procurement in the department’s history, is the result of much input from the health care community, including more than 1,000 submitted comments on the transition to managed care. [The NCMS has worked closely with NCDHHS since 2015 to help protect members’ interests throughout the process.]
  • Each PHP will be subject to rigorous oversight including ensuring adequate networks and timely payments to providers.
  • The draft rate book, which may be reviewed here, is set by NC DHHS and ensures 100 percent of the current Medicaid fee-for-service rates.
  • Credentialing will be centralized by the state. It is expected that practices will contract with multiple PHPs and participate in multiple networks but physicians and PAs will not have to go through the credentialing process with each PHP they contract with.
  • There will be one pharmacy formulary for the state.

To learn more about the scope of services each PHP must offer as well as the credentialing process and the draft rate book for the capitated payments for patients visit the state’s Medicaid Transformation webpage.

As a physician or PA who would like to continue to see Medicaid patients, now is the time to familiarize yourself with what is being asked of the contract contenders in the RFP. The various managed care plans vying for one of the contracts currently are seeking physicians and PAs to join their networks, and Dr. Cohen encouraged practices to have ongoing discussions with each of these organizations.

For a helpful overview of the state’s move to managed care read NCMS’ Vice President of Legal & Regulatory Affairs and Associate General Counsel, Conor Brockett’s summary of the process thus far.

Throughout the fall, NC DHHS also is offering training to help you understand the state’s Advanced Medical Home model as the primary vehicle for delivering local care management at the transition to Medicaid managed care takes place. Learn more about the upcoming statewide webinars as well as the regional training forums and register.


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