NCMS Morning Rounds 5-10-19

The weekend is almost here!

But first, enjoy your NCMS Morning Rounds.

Problem Solver: Contracting for Medicaid Transformation

NCMS members increasingly have been reaching out to our Director for Health System Innovation Kristen Spaduzzi with questions about deadlines to finalize contracts with pre-paid health plans (PHP) to provide Medicaid services as the state transitions to managed care. Spaduzzi was able to get the following answers from Lynne Testa, the NC Department of Health and Human Services (NCDHHS) Senior Program Analyst for the Division of Health Benefits.

“There is no state requirement or deadline for provider contract signings. Please know that the state is in the process of approving all PHP provider contracts and handbooks. Some plans may have made a business decision to wait on contracting with providers until their contracts are completely approved by the state. This avoids having to go back to providers with amendments to previously executed contracts. That being said, providers may sign PHP contracts that have not been officially approved as long as they understand that the PHP may come back with contract amendments following state approval. Providers signing contracts prior to formal state approval should anticipate contract amendments will be sent to them with final approved language.

For additional details you may refer to the NC General Statutes for each item:
The definition of “amendment” (NCGS 58-50-270)
PHP’s obligations relating to these amendments. (NCGS 58-50-280)

“It is important to note that the “soft launch” for Phase I Medicaid managed care enrollment will begin in late June 2019 for those Medicaid beneficiaries who will be transitioning to managed care. This means that beneficiaries will be able to select their PHP as well as their primary care physicians (PCP) and Advanced Medical Home (AMH) beginning in late June 2019. This is for Medicaid Managed Care Regions 2 and 4. Review map of the regions.

“Provider directories will include only those providers who have successfully completed credentialing and signed their provider contracts. Directories will be updated regularly as providers complete the contracting/provider network participation process. Therefore, providers who have made business decisions to delay contract signing should anticipate that future provider directories will include them once they too have completed the process.

“PHPs are permitted to require a provider to give verbal or written acceptance of a written offer to contract within 30 calendar days of receipt of the offer, or consider the provider to be out-of-network and subject the provider to the out-of-network payment requirements. More specifically, the PHP Contract (Section V.D.2.c.vii.b.) provides that ‘if within 30 calendar days the potential network provider rejects the request or fails to respond either verbally or in writing, the PHP may consider the request for inclusion in the Medicaid Managed Care Provider Network rejected by the provider. If discussions are ongoing, or the contract is under legal review, the PHP shall not consider the request rejected.’ The 30-day turnaround is applicable only for a provider who is not currently contracted with a PHP. The 60-day period pertains to the time the PHP must give a contracted provider to object to a proposed amendment to an existing contract.

“NCDHHS interprets a “written offer” to only have been made when the offer includes a copy of the approved provider contract and all related addendums and appendices. Providers who fail to respond within 30 calendar days to the written offer may be considered an out-of-network provider by the PHP. However, should a provider decide to contract after the 30 calendar days are finished, the PHP will be required to issue a new offer, in writing, to the provider. The offer may have the same terms as the original, but the PHP must issue another offer. NCDHHS expects that providers and PHPs will act in good faith, and will not unreasonably withhold offers or acceptance of offers in order to avoid compliance with the PHP Contract and/or to avoid out-of-network status. The PHP will have the option to update the offer except in cases where the provider is subject to a rate floor, which must always be offered to such providers as the minimum rate the PHP offers.”

If you have questions regarding the transition to Medicaid managed care, you can access the resources on the NC DHHS’ provider support page, or feel free to reach out to Kristen Spaduzzi or call 919-833-3836, and she will try to get an answer.

Send Us Your Best Shot

The NCMS Photo Contest is collecting your amazing images to be considered for our 2020 NCMS Calendar, so send us your best shots. The deadline for submissions is June 28, 2019. Get all the details.

This is the 11th Annual NCMS photo contest and each year more NCMS members participate. The 13 winning photos will grace our much sought after calendar, which adorns the walls of exam rooms, offices and homes throughout North Carolina.
Enter your photo today!

Campbell School of Medicine Partners With SR AHEC To Train Students

NCMS member Campbell University School of Osteopathic Medicine formally has announced its partnership with the Southern Regional Area Health Education Center (SRAHEC) to bring medical students to the Center in Fayetteville for month-long training rotations.

The hope is that by bringing the students to Fayetteville they will create ties to the community and may later want to practice in the area.

Read the Fayetteville Observer’s coverage of the partnership announcement yesterday.

In the News

Want to Invest in Social Prescribing? It’s Not All About the Money, The Advisory Board Forum, 5-2-19

Learning Opportunity

The NC Chamber’s Workplace Diversity and Inclusion Conference will be held June 13 from 8:30 a.m. to 2:30 p.m. at the Sheraton Imperial Hotel & Convention Center in Durham. Early bird pricing ends next week. Learn more and register.


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