NCOA is the voice of our specialty in North Carolina. Through education, communications, advocacy and professional relations, the NCOA promotes excellence in patient care and represents the interests of North Carolina's orthopaedic surgeons.
2020 NCOA Annual Meeting, Oct. 2-4
Save the date!
2020 NCOA Annual Meeting
Oct. 2-4 at the Omni Grove Park Inn, Asheville, NC
Questions: Contact Arielle Stout at 919-833-3836 or firstname.lastname@example.org.
Medicaid Transformation Update
The NC Department of Health and Human Services (DHHS) announced on August 9, 2018, that it has issued a Request for Proposal (RFP) for Medicaid Prepaid Health Plans (PHP) as part of the state's transition from Medicaid fee-for-service to managed care. In a call with stakeholders, DHHS Secretary Dr. Mandy Cohen noted that this is the largest procurement in DHHS history and she expressed her appreciation for the stakeholders' collaboration and feedback throughout the process. DHHS has published on its Medicaid Transformation webpage a helpful fact sheet summarizing the key content within the PHP RFP, including program goals and structure.
NC DHHS Medicaid Transformation Webpage
The RFP seeks proposals for standard plans by October 12, 2018. A PHP Evaluation Committee comprised of state employees will be tasked with the selection of four statewide plans and up to 12 regional plans. DHHS will announce the awardees in February 2019. Standard plans will launch in a phased-in approach with select regions going live on November 1, 2019. Full statewide implementation of standard plans is expected on February 1, 2020.
A separate procurement for tailored plans to provide services to beneficiaries with significant behavioral health and/or intellectual/development disability will be conducted at a later date.
This development follows the DHHS's August 3 announcement that the state has awarded a contract for Medicaid managed care enrollment broker services to MAXIMUS, a government services provider based in Reston, VA, to provide choice counseling, enrollment assistance and education to beneficiaries as they select from a variety of health plans.
Approval of the new program design is required from the Centers for Medicare and Medicaid Services (CMS) before the state's transition to managed care can be fully implemented. In September 2015, the NC General Assembly directed the transition of Medicaid from a fee-for-service structure to a managed care structure in North Carolina. The state submitted its managed care design plan to CMS in June 2016 in the form of an 1115 waiver. A revised 1115 waiver application was sent in November 2017 and is still under review by CMS. Dr. Cohen did not address the status of the 1115 waiver on the August 9 call with stakeholders.
Conor Brockett, the North Carolina Medical Society's Vice President of Legal & Regulatory Affairs and Associate General Counsel, offers this quick overview of Medicaid transformation in North Carolina as of July 2018.
The North Carolina Orthopaedic Association (NCOA) is a statewide membership organization dedicated to serving the profession, representing patients interests and advancing musculoskeletal health. Through advocacy, education and public relations, the NCOA is committed to representing the best interests of orthopaedic surgeons and their patients.
NCOA | PO Box 27167 | Raleigh, NC 27611 | Phn: 919-833-3836 | Fax: 919-833-2023 | email@example.com