NC DHHS submits amended Medicaid reform application to CMS

2017-12-12 | December 12, 2017

On November 20, 2017, the North Carolina Department of Health and Human Services (DHHS) submitted an amended 1115 demonstration waiver application to the federal government. The 1115 waiver is the application that the state uses in order to reform the state's Medicaid program from fee-for-service to managed care. The original application was submitted to the federal government on June 1, 2016. 

Key components of the amended waiver (sourced directly from DHHS fact sheet):

Opioid Strategy - To support North Carolina’s opioid strategy, the Department is seeking authority to increase access to inpatient and residential substance use disorder and behavioral health treatment through reimbursement for services in institutions of mental disease.
Behavioral Health Integration - North Carolina does not need a waiver to integrate behavioral health and physical health services, but the Department is seeking authority from CMS to use Medicaid funds to build capacity to support a robust health home care management model for behavioral health and I/DD populations.
Tailored Plans - The Department is seeking authority to provide certain behavioral health benefits through only Tailored Plans, not Standard Plans. For more information on Tailored Plans, see “Behavioral Health and I/DD Tailored Plan,” a concept paper recently published by Department, at
Public-Private Regional Pilots - To improve health, it is crucial to think beyond what happens inside a doctor’s office. The Department is seeking authority from CMS to use Medicaid funding to create publicprivate regional pilots to address unmet resource needs. The Department also seeks support to establish standardized tools to screen and refer individuals.
Workforce - The Department is seeking authority from CMS to use Medicaid funding to expand existing loan repayment programs for providers in underserved areas, and to support the development of other workforce/job functions needed to develop a transformed system.
Telemedicine - The Department is seeking authority from CMS to use Medicaid funding to pilot new approaches to telemedicine, and supporting providers in optimizing the use of telemedicine in their practices.
Payments to Safety-Net Providers - The Department is seeking authority to continue cost settlements with certain essential safety-net providers outside of reimbursement arrangements with the new prepaid health plans. In addition, the Department is requesting authority to establish an uncompensated care pool to strengthen federally recognized tribal providers. 
As the Medicaid reform process continues to move forward in North Carolina, NCAPA is monitoring the proposed policies and submitting public comments to DHHS, as appropriate.