All-Provider Meeting September 27, 2017 Medicaid Reform Overview - - PowerPoint PPT Presentation

Presentation to the

All-Provider Meeting

September 27, 2017

Medicaid Reform Overview

Capitation

• Full capitation

Infrastructure

• Division of Health Benefits
• LME/MCOs remain in current form for 4 years

after implementation on physical health side Health Plans

• Up to 12 Provider Led Entities (PLEs) in 6 regions
• 3 statewide Commercial Plans (CPs)

Timeline

• 1115 Waiver application
• Review, approval and implementation process

(approximately 3 years – through July 1, 2019)

• Move towards a fully integrated system
• We are exploring options for the future
• Key stakeholders support of a specialty

system for individuals with MH/SA/IDD

• Recently released NC Medicaid Program

Design provides a potential future option for

• ne or more LME/MCOs
• Our goal is to have the future of LME/MCO

written into the 1115 waiver

What We Know

• NC DHHS released proposal August 8
• Pending legislative authorization, DHHS

intends to permit statewide Commercial Plans and regional Provider-Led Entities (PLEs) to develop and offer two types of products:

• Standard Plans
• Tailored Plans

DHHS White Paper

• Standard Plans
• Will serve most Medicaid enrollees, including

adults and children

• Will provide integrated physical health, behavioral

health, and pharmacy services at the launch of Medicaid managed care program

• Tailored Plans
• Previously DHHS referred to these plans as

Special Needs Plans or Specialty Plans

• Will be specifically designed to serve special

populations with unique health care needs

Types of Managed Care Plans

Medicaid Transformation Timeline

Key Activity Estimated Date 1115 waiver application submitted June 1, 2016 Stakeholder feedback due August 8, 2017 CMS waiver approval (assumed) January 1, 2018 Medicaid Managed Care RFP issued March 2018 Medicaid Managed Care proposals due June 2018 Medicaid Managed Care awards complete Sept 2018 Medicaid Managed Care go-live July 1, 2019 LME/MCO structure ceases July 1, 2023

• DHHS to continue working with stakeholders

to refine program design proposal

• Late Fall 2017 – DHHS will release a PHP

Request for Information (RFI) to:

• Solicit additional information from potential PHPs
• Assess interest in participation and market readiness
• RFI will include additional details about the plan

for implementing Medicaid managed care

• Also this fall DHHS will submit an amended

1115 Waiver to CMS

Next Steps