Today the North Carolina Department of Health and Human Services issued a Request For Proposal (RFP) for organizations wishing to participate in Medicaid managed care as Prepaid Health Plans (PHPs) when the program launches in 2019.
In 2015, the General Assembly directed the transition of Medicaid to a managed care structure. In managed care, DHHS will oversee all aspects of the Medicaid and NC Health Choice programs. However, PHPs will directly manage certain health services, assume financial risk and contract with providers to provide services for beneficiaries.
This RFP reflects three years of collaboration with and extensive feedback from beneficiaries, clinicians, hospitals, counties, health plans, elected officials, advocates and other stakeholders to design the managed care program. DHHS hosted listening sessions across the state, reviewed more than one thousand written public comments and released 15 policy papers on different aspects of the program.
This RFP is the largest procurement in DHHS history. It clearly communicates DHHS’ requirements and defines the standards that PHPs must adhere to in contracting with DHHS. All plans will be subject to rigorous oversight by DHHS to ensure strong provider networks, a full range of benefits, accountability for quality and outcomes, a positive beneficiary experience and timely payments to providers among aspects of a successful managed care program.
“DHHS is committed to improving the health and well-being of all North Carolinians through an innovative, whole-person centered, and well-coordinated system of care that addresses both medical and non-medical drivers of health,” said DHHS Secretary Mandy Cohen, M.D. “This Request for Proposal seeks Prepaid Health Plans that share this commitment as we work to implement North Carolina’s new Medicaid managed care program.”
Among the innovations in this RFP for the North Carolina Medicaid managed care program are:
- The integration of physical health, behavioral health and pharmacy services so all managed care beneficiaries will have one insurance card and one health plan managing their care.
- An Advanced Medical Home (AMH) program that will preserve broad access to primary care services for Medicaid enrollees while strengthening the role of primary care in local care management, care coordination and quality improvement.
- Encouraging smart investments in areas that impact health outside of health care services, known as Opportunities for Health, in the domains of housing, food, transportation, employment and interpersonal safety, to build on work already being done in communities.
This procurement is only for the Standard Plans in which most Medicaid managed care beneficiaries will be enrolled.
DHHS will accept proposals from potential PHPs until Oct. 12, 2018. Both DHHS and the federal Centers for Medicare & Medicaid Services will have to approve the contract awards, which are anticipated to be announced on Feb. 4, 2019.
This is an official procurement. Send all procurement inquiries to Kimberley Kilpatrick, 919-527-7015 or Medicaid.Procurement@dhhs.nc.gov. For more information about Medicaid managed care, visit the Medicaid Transformation website at https://www.ncdhhs.gov/medicaid-transformation.