MM Curator summary
The winners were announced last week, and will be live Sept 1.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
The North Carolina Department of Health and Human Services announced the selection of seven organizations to serve as Behavioral Health and Intellectual/Developmental Disability Tailored Plans (Behavioral Health I/DD Tailored Plans). Individuals who need certain services to address a serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual/developmental disability or traumatic brain injury may be eligible to enroll in a Behavioral Health I/DD Tailored Plan.
Following a competitive selection process, the following organizations were awarded a contract to serve as regional Behavioral Health I/DD Tailored Plans:
• Alliance Health
• Partners Health Management
• Sandhills Center
• Trillium Health Resources
• Vaya Health
• Cardinal Innovations Healthcare*
*While Cardinal Innovation Healthcare was awarded a contract, it is anticipated they will not operate a Behavioral Health I/DD Tailored Plan at launch due to the consolidation with Vaya Health.
Behavioral Health I/DD Tailored Plans will provide integrated physical health, behavioral health, long-term care, pharmacy services and will address unmet health-related resource needs for qualifying North Carolinians under one plan. These plans will provide the same services as NC Medicaid Standard Plans with additional specialized services to serve individuals with significant behavioral health conditions, including those utilizing 1915(c) Home and Community-Based Services waivers and those utilizing State Funded Services.
“NCDHHS looks forward to working with the awardees to make this innovative design a reality for the thousands of North Carolinians who will benefit from a whole person centered, well-coordinated system of care,” said NCDHHS Secretary Mandy K. Cohen, M.D. “Today moves us closer to that goal as we begin to implement this important program design.”
At launch, Behavioral Health I/DD Tailored Plans will operate regionally, offering robust care management to approximately 200,000 individuals estimated to enroll. An additional unique feature of Behavioral Health I/DD Tailored Plans is the combination of Medicaid and state funding to support enrolled populations.
The contract award covers counties in each catchment area as of July 26, 2021, as well as realignments approved by Secretary Cohen effective Sept. 1, 2021. Given additional county requests for disengagement, NCDHHS anticipates county alignments for Behavioral Health I/DD Tailored Plans will be significantly different at launch. County realignment and disengagement requests must go through the process identified in law and rule which ultimately require DHHS Secretary’s approval. The list below indicates the anticipated county alignments at go-live.
“We will work closely with LME/MCO’s to assure a smooth transition to Behavioral Health I/DD Tailored Plans while they continue to oversee the crucial services currently provided through the LME/MCO’s” said Deputy Secretary of NC Medicaid, Dave Richard.
Only entities operating as LME/MCOs were eligible to apply to become Behavioral Health I/DD Tailored Plans. The first Behavioral Health I/DD Tailored Plans contract term will last four years. The Department has the authority to award no more than seven and no fewer than five regional Behavioral Health I/DD Tailored Plan contracts and may not award any statewide contracts.
Under Medicaid Managed Care, Standard Plans and the Eastern Band of Cherokee Indians (EBCI) Tribal Option launched on July 1, 2021, followed by Tailored Plans on July 1, 2022.
For information specific to Behavioral Health and I/DD Tailored Plans, please visit the Behavioral Health I/DD Tailored Plans page.
More information about the transition to NC Medicaid Managed Care can be found on the Medicaid website at medicaid.ncdhhs.gov/transformation.
Projected County Alignments at Tailored Plan Launch for July 1, 2022
This list reflects projected county assignments based on disengagements requested or approved. County realignment and disengagement requests must go through the process identified in law and rule which ultimately require approval by the NCDHHS Secretary.
Alliance Health: Cumberland, Durham, Johnston, Orange, Mecklenburg and Wake.
Eastpointe: Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Wayne and Wilson.
Partners Health Management: Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union and Yadkin.
Sandhills Center: Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond and Rockingham.
Trillium Health Resources: Bladen, Brunswick, Carteret, Columbus, Nash, New Hanover, Onslow, Pender, Beaufort, Bertie, Camden, Chowan, Craven, Currituck, Dare, Gates, Hertford, Hyde, Jones, Martin, Northampton, Pamlico, Pasquotank, Perquimans, Pitt, Tyrrell and Washington.
Vaya Health: Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Swain, Transylvania, Vance, Watauga, Wilkes and Yancey.
Pending: Chatham, Halifax, Stokes and Warren.