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North Carolina unveils plan for managed care system; public comment sought

By Erin Smith

The North Carolina Department of Health and Human Services has debuted a plan to begin moving towards a managed care system for Medicaid services. Bladen County Health and Human Services Director David Howard said here locally folks will notice few changes.

Howard said what the plan will do is give the delivery of services over to pre-paid plans and change the system from a fee for service scenario to a fixed fee. He said the General Assembly is trying to create some predictability when it comes to costs. Funding for the Medicaid program is made up of federal and state funds.

According to a release from the NC Department of Health and Human Services, the plan released by the state is designed to move the Medicaid and NC Health Choice programs “to managed care, as directed by the North Carolina General Assembly in 2015. DHHS is accepting comments on this proposal through Sept. 8, 2017.” You can read the entire plan here.

“Our proposed Medicaid managed care program design reflects the specific strengths and needs of North Carolina,” said Dave Richard, Deputy Secretary for Medical Assistance. “For example, the proposed design supports:

*Integrating services for physical health, behavioral health, intellectual and developmental disabilities, and substance use disorders;

*Addressing unmet social needs and their effect on overall health; and

*Building on and strengthening what is working well today, such as care management, while supporting providers and beneficiaries through any changes during the transition and beyond.”

The idea behind the plan is to better control expenses while giving clients more choices. Howard said,  “Basically, they are putting a fixed number on costs.”

The plan calls for the creation of provider lead entities and managed care organizations (MCOs). Howard said those entities will be allowed to bid on contracts to provide the services called for in the plan. He said the plan would allow large LMEs-MCOs such as Trillium or Cardinal Health to have the opportunity to bid on contracts to provide such services as physical health, behavioral health, substance abuse and other services.

Howard said the Bladen County Health Department performs some Medicaid reimbursed services for clients. The Health Department bills for the services it provides for the Medicaid clients through the state system. Under the new plan, the services (physical, behavioral, etc.) will be contracted out to an MCO and the MCO will create a pre-paid plan. Howard explained once the service is performed for the client, the provider will then bill the MCO for payment not the state.

“The process (of providing and billing for the services) will basically be the same, just a different payer,” said Howard. “With respect to our Medicaid paid services, we are in the same position as any other provider.”

Public comments regarding the plan may be emailed by September 8, 2017,  to

Medicaid.Transformation@dhhs.nc.gov; by U.S. mail to the Department of Health and Human Services, Division of Health Benefits, 1950 Mail Service Center, Raleigh NC 27699-1950; or deliver in person at the Department of Health and Human Services, Dorothea Dix Campus, Adams Building, 101 Blair Drive, Raleigh.

For additional information about transformation efforts, visit ncdhhs.gov/nc-medicaid-transformation.

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