Medicaid Reform: Resources
- Medicaid-Reform Resources, from the North Carolina Department of Social Services (NC DHHS) NC Medicaid Division of Health Benefits (NC DHB).
Medicaid Reform: Updates
As our Practice Support Team learns of new information on the rollout of managed care that could directly impact your own practice, and your patients, it will be posted here, just as soon as we have verified it.
The latest updates will always appear first, along with the date of posting.
Do not hesitate to contact Marla Smith, QI Specialist, with any questions on any of this information, or with any other practice needs related to the rollout of Managed Care. Reach Marla at (252) 902-9221, or email@example.com.
The Latest …
Managed-Care Go-Live Date Extended for Phase 1 Counties
The go-live date for the statewide transition to managed care, along with open enrollment for Medicaid beneficiaries, has officially been extended until Feb. 1, 2020, for ALL North Carolina counties. This change really only affects counties that were in the original Phase 1 of the rollout, including Wilson and Nash counties; the go-live date for counties in Phase 2 was Feb. 1, 2020, to begin with.
Managed care had been scheduled to roll out in two phases, with counties in Phase 1 to have begun managed care services Nov. 1, 2019, and most of the state beginning Feb. 1, 2020. With the Sept. 3 announcement from NC DHHS, managed care is now scheduled to go live in one phase for the whole state, beginning Feb. 1, 2020.
NC DHHS adjusted the timeline due to complications with the state’s current continuing- resolution budget (see the official NC DHHS announcement at https://bit.ly/2lYQNNd).
CCNC Contract Ending; Interim Contract to Cover Until Go-Live
Primary-care practices may receive a letter from Community Care of North Carolina (CCNC) to announce the Oct. 31, 2019, end of CCNC’s state contract to provide primary-care case-management (CM) services to Medicaid patients.The announcement of the contract ending is no cause for concern; this was scheduled to happen. A new contract between CCNC and the state extends CCNC’s CM services through Phase 1 and Phase 2 practices’ go-live dates (Nov. 1, 2019, for Phase 1; February 2020, for Phase 2), to prevent a lapse in CM coverage during the transition to managed care through the Prepaid Health Plans (PHPs).Access East will continue to provide its Phase 1 and Phase 2 primary-care practices with CM for their Medicaid patients, and practice support, up through the practices’ go-live date for managed care.
Fraudulent Email Being Sent to Providers
NC Medicaid’s Office of Compliance and Program Integrity has issued a warning concerning a fraudulent third-party email being sent to North Carolina healthcare providers in an effort to “defraud you and the NC Medicaid program.” Providers are urged not to respond to the email, displayed here. The warning also includes additional cautions for providers, as well as further details about this specific scam effort, which falsely asserts there is a set deadline for credentialing for Medicaid Managed Care and/or a specific health plan.
Sign Up for NCDHHS Webcast: Medicaid/Managed Care Update
NCDHHS will hold a webcast at 2:30 p.m. Monday, July 15, with updates on NC Medicaid managed-care implementation, including details on Phase 1 open-enrollment activities, plus an opportunity to ask questions. NCDHHS Secretary Mandy Cohen, MD, will be among the presenters. Note that REGISTRATION is required to access the webcast.
Phase 1 Medicaid Launch on Track for Nov. 1
A subscriber email from NC Tracks today, on behalf of Dave Richard, Deputy Secretary for NC Medicaid, says the Nov. 1 target date for Phase 1 beneficiaries to begin using their health plans is on track, despite earlier reports of a possible delay. The message also notes that enrollment packets have begun being mailed out this week to beneficiaries in Phase 1 counties, including Nash and Wilson, and open enrollment for Phase 1 is scheduled to begin next week, on Monday, July 15.
Possible Delay to Medicaid Launch
It was announced last week that a delay in approval of the North Carolina budget, coupled with concerns voiced by doctors and other providers who have yet to sign contracts with Prepaid Health Plans (PHPS), may lead state legislators to postpone the scheduled November launch date. Due to this possible delay, the mail-out of enrollment materials for patients who live in Phase 1 counties, which was originally planned to begin June 28, has not yet happened. (The enrollment broker’s website and toll-free phone number, however, are operational.) Therefore, practices that serve Phase 1 patients may want to postpone outreach to these patients until there is official word on whether the enrollment timeline will be delayed.This NC Health News story goes into more detail; scroll down to the “Delay for managed care switch?” section.
Judge Denies Appeals from Health Plans
A North Carolina administrative judge last week denied appeals from three health plans — Aetna, My Health, and Optima — that were unsuccessful in their bids to be chosen as one of the Medicaid managed-care groups. These three health plans may continue to pursue their appeals within the state court system, but the judge’s order denying the injunctions suggests that the groups are unlikely to overturn the state’s current contract decisions.Check out this NC Health News story for more detail.
Billing Issue for Phase 2 Practices
We have had a confirmation regarding Phase 2 practices that serve patients living in Phase 1 counties: Phase 2 practices will continue to bill via NC Tracks for all patients, including those patients living in Phase 1 counties, until those practices’ Phase 2 launch date in February 2020.