North Carolina s Transformation to Managed Care Jay Ludlam, Assistant Secretary Department of Health and Human Services December 2017
My background Only 10+ years of experience in Medicaid Assistant Attorney General, Missouri Attorney General s Office MFCU Director of Operations local Medicaid Managed Care health plan Acting Medicaid Director and Deputy Division Director for Missouri 2
North Carolina s Vision for Medicaid Managed Care By implementing managed care, and advancing integrated and high-value care, North Carolina Medicaid will improve population health, engage and support providers, and establish a sustainable program with more predictable costs. 3
North Carolina s Health Care System Priorities 1 2 3 Improve the health and well-being of North Carolinians Focus on health of the whole person Support providers in delivering high-quality care at good value 4
North Carolina s Goals for Medicaid Managed Care 1 2 3 Measurably improve health Maximize value to ensure program sustainability Increase access to care 5
Prepaid health plans overview State delegates management of Medicaid health services State sets actuarially sound capitated rates Health plans are at risk : Responsible for cost overruns 6
Waiver overview Behavioral health integration/ care management Access to care Provider supports Social determinants of health Benefit package per population 7
WAIVER OVERVIEW Standard Plan and BH I/DD Tailored Plan Behavioral Health, I/DD & Traumatic Brain Injury Services STANDARD & BH I/DD TAILORED PLANS BH I/DD TAILORED PLANS STATE PLAN SERVICES Inpatient behavioral health services Outpatient behavioral health ED services Outpatient behavioral health services provided by directenrolled providers Partial hospitalization Mobile crisis management Substance abuse intensive outpatient program (SAIOP) Facility-based crisis services for children and adolescents Professional treatment services in facility-based crisis program Psychosocial rehabilitation Outpatient opioid treatment Ambulatory detoxification Non-hospital medical detoxification Medically supervised or ADATC detoxification crisis stabilization Substance abuse comprehensive outpatient treatment program Research-based intensive behavioral health treatment Diagnostic assessment Early and Periodic Screening Diagnostic Treatment (EPSDT) STATE PLAN SERVICES Residential treatment facility services Child and adolescent day treatment services Intensive in-home services Multi-systemic therapy services Psychiatric residential treatment facilities (PRTFs) Assertive community treatment (ACT) Community support team (CST) Substance abuse non-medical community residential treatment Substance abuse medically monitored residential treatment Intermediate care facilities for individuals with intellectual disabilities (ICF/IID) WAIVER SERVICES TBI waiver services Innovations waiver services 1915(b)(3) services ALL STATE-FUNDED BH & I/DD SERVICES STATE-FUNDED TBI SERVICES A full list of State-funded BH and I/DD benefits can be found on the DHHS DMH/DD/SAS website 8
WAIVER OVERVIEW Access to care Maintain access to essential safety-net providers Increase access to inpatient and residential substance use disorder and behavioral health treatment through IMDs Address health disparities of tribal members by supporting model Tribal Health System 9
WAIVER OVERVIEW Access to care Create Telemedicine Alliance Establish Telemedicine Innovation Fund Pilot new approaches to telemedicine and support providers in using telemedicine 10
WAIVER OVERVIEW Provider supports Support transition and address administrative burden Strengthen provider workforce through new initiatives specially designed to address the needs of Medicaid population Establish Innovation Workforce Fund 11
WAIVER OVERVIEW Social determinants of health Address unmet needs that impact health and health care costs Public-private regional partnership pilots to identify, test, strengthen and sustain evidence-based interventions Comprised of entities that provide or authorize health and social services 12
Transformation milestones Nov. 2017 Early 2018 2018 Feb. 2018 Spring 2018* July 2019* Released 2 Requests for Information Released proposed PHP capitation rate setting methodology Released 2 concept papers: Behavioral Health I/DD Tailored Plans & Supplement Payments Submitted amended 1115 waiver application to CMS Publish additional concept papers Procure centralized credentialing & enrollment broker vendors Anticipated CMS approval: Expenditure authority to pay for substance use disorder services in an IMD Amended waiver application Release Request for Proposal Managed care Phase 1 goes live; waiver effective for 5 years * Assuming timely CMS approval and other activities 13
To share comments, email: Medicaid.Transformation@dhhs.nc.gov For NC Medicaid managed care information and documents: www.ncdhhs.gov/nc-medicaid-transformation 14