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NC Department of Health and Human Services Better With Time: Managed Medicaid Update With your Hosts: Hugh Tilson and Shannon Dowler And Special PHP CMO Guests: Michelle Bucknor RCC (Relay Conference Captioning) William Lawrence

  1. NC Department of Health and Human Services Better With Time: Managed Medicaid Update With your Hosts: Hugh Tilson and Shannon Dowler And Special PHP CMO Guests: Michelle Bucknor RCC (Relay Conference Captioning) William Lawrence Participants can access real-time captioning for this webinar here: Genie Komives https://www.captionedtext.com George Cheely /client/event.aspx?EventID=460 1554&CustomerID=324 Michael Ogden 1 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  2. Video Settings 2 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  3. How We Will Spend Our Time Together 1. Introduction to the Series 2. Better With Time: Transformation 3. Get to Know Your CMOs 4. What to do NOW for LATER 5. Medicaid Hot Topics 6. Open Questions and Answers with PHP & Medicaid CMOs 3 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  4. North Carolina’s Vision for Medicaid Transformation “To o improve the he he health of h of Nor orth h Carol olinians t thr hrou ough a h an n inn nnovative, w whol hole-person on centered, a and nd w well-coord ordinated sy syst stem of of care t tha hat addresse ses s both h the he medical a and nd non non- medical d dri rivers of of he health. h.” 4 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  5. Moving to Managed Care • 1.6 - 1.8 million Med edicaid benef neficiaries wi will enr enroll in n Sta tand ndard Pl Plans. • Benef Beneficiaries wi will be e able e to o choos hoose e from om 5 Prep Prepaid Hea ealth Pl Plans (PHPs) − Ameri eriHealth Ca Cari ritas, Hea ealth thy Bl Blue, e, Uni nited ed Hea ealthCare re, WellCa Care, e, Car arol olina a Compl plete He Heal alth (Reg egion ons 3, , 4, , 5) • All hea health plans ns, all reg region ons wi will go o live e on on Ju July 1, 2021. • Som ome e benef eneficiaries wi will sta stay in n fee ee-for-service e bec ecause se it t provi vides es ser services tha that t mee eet t sp spec ecific need needs, or or the they ha have limited ed benef enefits. Thi his wi will be e called ed NC C Med edic icaid Direc rect. t. 5 5 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  6. NC Medicaid Managed Care Regions REGION 2 REGION 4 REGION 6 ALLEGHANY NORTHAMPTON ASHE SURRY GATES WARREN STOKES GRANVILLE ROCKINGHAM CASWELL PERSON VANCE HERTFORD HALIFAX WATAUGA WILKES YADKIN ALAMANCE REGION 1 FORSYTH ORANGE DURHAM GUILFORD AVERY FRANKLIN BERTIE NASH CALDWELL DAVIE ALEXANDER EDGECOMBE YANCEY MADISON DAVIDSON MARTIN WASHINGTON IREDELL WAKE TYRRELL DARE BURKE CHATHAM WILSON RANDOLPH CATAWBA MCDOWELL ROWAN BUNCOMBE PITT BEAUFORT HAYWOOD JOHNSTON HYDE SWAIN LINCOLN GREENE LEE RUTHERFORD CABARRUS HENDERSON HARNETT WAYNE GRAHAM STANLY JACKSON MOORE GASTON POLK CLEVELAND LENOIR CRAVEN MONTGOMERY MECKLENBURG TRANSYLVANIA MACON CHEROKEE CLAY PAMLICO CUMBERLAND JONES SAMPSON RICHMOND HOKE REGION 3 UNION ANSON DUPLIN ONSLOW CARTERET SCOTLAND ROBESON BLADEN PENDER REGION 5 COLUMBUS BRUNSWICK 6 6 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  7. Challenges • CO COVID ID-19 19 − Uncertainty inty about provid ider’ r’s prioritiz itizing ing contracting ting − Compl plexi xity in pr project ct pl plan anning – rapi apid d evolvi ving co condi dition ons • Other ther Pr Prog ogra ram Cha Changes − Tai ailored d Plan an Request est for Appl pplicat cation on (RFA) an and d ope perat ation onal transition in preparation for July 2022 2022 launch − DHHS is s wor orki king wi with th the the Ea East ster ern Ba Band nd of of Che Cherokee ee Ind Indians to o develop elop a PC PCCM “Tri ribal Opti tion” on” to o go o live e in n Reg egion on 1 7 7 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  8. Medicaid Transformation Timeline DRAFT TRIBAL END OF OPTION & CHOICE BEGIN OPEN AUTO MANAGED ENROLLMENT ENROLLMENT PERIOD CARE LAUNCH OPEN 3/15/21 5/14/21 5/15/21 7/1/21 9/29/21 ENROLLMENT Begin State-wide Conclude State-wide Open Enrollment Open Enrollment The fun starts way before March! 8 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  9. Restarting Managed Care Implementation – Highlight of Activities • Update a all s stakehol older materials, websites, smart phone apps and technical systems across multiple platforms (Enrollment Broker, health plans, NCTracks) • Formulate capitation on r rates s beginning in November ’20 and submit to CMS for approval • Re-review and resu submit t to o CMS f for or approval several health plans’ contractual policies and procedures deliverables (annual compliance plans, call scripts, member marketing, value added service materials, and clinical coverage policies) Update the Consolidated P Provider Directory (NC DHHS, Enrollment Broker, health plans) • • Test Prima mary Care P Provider A Aut uto A Assi sign gnment • Comp mplete k key test sting activities s to finalize data, analytics, reporting functionality including Transition of Care (NC FAST, Enrollment Broker, NCTracks, health plans, LME-MCOs, UM Vendors & CCNC) and Data Warehouse Re-validate Enrol ollment B Broker r readiness ss including call center staff and scripting once rehired • • Re-evaluate internal Divisi sion on o of Health B Benefit s staff r readiness ss • For netw twork a k adeq equacy – monitor progress of provider c contracting g (health plans and providers) • Moving forward with managed care related procurements including Member Ombudsman, EQRO, Health Opportunities Pilots 9 9 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  10. Medicaid Transformation Provider Outreach and Education Timeline DRAFT 10 10 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  11. Advanced Medical Home MCL Timeline • October: r: La Launch A h AMH MH T Technical Advisory G Group oup an and D d Data ata S Sub-Com ommi mittee; A AMH MH Mod Modifications re released • No Novem embe ber: Laun unch A AHEC EC A AMH MH T Tier 3 r 3 C Coaching ng Progr ogram • June une 2 2021: AM AMHs Hs r rece eceiv ive f fir irst data: ata: histori orical claims s inf nformation a and nd b bene neficiary f files on s on assi ssigned p patients • July 2 2021: AMH T Tier 3s l s laun unch 11 11 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  12. Get to Know Your CMO’s 12 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  13. Three Things To Do NOW To Be Ready LATER 13 13 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  14. 1. Update the Provider Directory • A new, redesigned, Provider Directory will be available January 1 1, 2021. • In advance, you s shoul ould r review NCTracks with attention to the following sections: − Basic Information − Health Benefit Plan Selection (i.e. Medicaid and NC Health Choice) − Addresses and the associated Taxonomy Classification − Accreditation − Hours of Operation − Services (i.e. Accepting New Patients, Siblings, and Physically Handicapped indicator, Languages Supported, Ages Served) − Affiliation Provider Information • Confirm that individual providers are correctly affiliated to organizations billing on their behalf and to each appropriate location within that organization. When a beneficiary searches for an individual doctor at a specific organization’s location, the affiliated • information from NCTracks is used in the search. Therefore, all individual providers should check their affiliations not only to the group NPI, but also to the specific location(s) where services are rendered. • Bot oth Individual and Orga ganization on records s s shoul ould b be reviewed. • The NCTracks Manage Change Request (MCR) process is used to view and update record information: − NCTracks User Guide & Fact Sheets webpage or call the CSRA Call Center at 800-688-6696. SOURCE: 14 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  15. 2. FINALIZE YOUR CONTRACTS Don’t Delay! − Amendments may occur; if so, you will have the opportunity to review any changes. − Once you are contracted, there is a process that follows before your information is populated to DHB and to the provider directory. − Getting it right NOW will minimize disruption to your patients and practice later. 15 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  16. • Don’t put off making changes to perform as an 3. Ready, AMH Tier 3 practice! Set, • Look for updates coming soon to the AMH program AMH! that provides a “glidepath” for Tier 3 practices. 16 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

  17. Medicaid Hot Topics 17 17 NCDHHS, Division Health Benefits | Fireside Chat: Better With Time| October 20202

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