NCMGMA News is an official news resource of the North Carolina Medical Group Management Association (NCMGMA).
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2024 Alliance sponsor feature article courtesy of Aetna, a CVS Health Company
Aetna will be the new third-party administrator for the North Carolina State Health Plan beginning January 1, 2025. Open enrollment begins September 30, 2024, and ends October 25, 2024, which is when members will select a primary care provider (PCP).
What You Can Do Now to Get Ready
Step 1: Join the Aetna Network Not currently in the Aetna network? We’re excited to have you join us. We’ll walk you through the steps to request participation with us. Visit Go.Aetna.com/joinournetwork to get started today.
Step 2: Join the Clear Pricing Project (CPP) Already part of the Aetna network? You can join the Clear Pricing Project (CPP) now until May 31, 2024. Or, if you’re a current CPP provider, you’ll need to re-enroll in the CPP with Aetna to continue as a CPP provider. You only need to join the CPP once for your tax ID number (TIN). All providers practicing under that TIN will be part of the CPP.
Stay informed Visit Go.Aetna.com/ncshp to see additional ways you can get ready for the North Carolina State Health Plan transition to Aetna.
Need help? Send an email to the Aetna Network Management staff at NorthCarolinaNetwork@aetna.com or call 1-800-353 1232 (TTY: 711) during normal business hours.
New from the NCMGMA Advocacy Committee, we are featuring a weekly digest, “Did You Know?” spotlighting important healthcare advocacy news and events. Keep checking back and subscribe to NCMGMA News to stay current on all the latest updates!
Aetna® Update on Change Healthcare Service Interruption
On February 21, Change Healthcare took several of their services offline in response to a cyber security incident they experienced. This is impacting certain Aetna business operations, as well as the operations of other companies nationally. There is no indication that Aetna’s systems have been compromised. We’re committed to ensuring access to care as we navigate through this network disruption. We have business continuity plans in place to minimize disruption of service and apologize for any inconvenience our network providers and members may experience. We will continue to utilize our business continuity plans to minimize disruption until the Change Healthcare services are restored.
Originally published in the March 11th NC Medical Society’s Capitol Chronicle Reprinted with permission from the NCMS
Last week, Congress took significant action by enacting a spending package to fund the federal government. There was, however, a significant omission in the $460B spending bill– a reversal of the 3.37% Medicare physician payment cut for 2024. Rather than eliminating the cut, as the NC Medical Society and our partner medical societies had lobbied for, Congress instead reduced the pay reduction by 1.68%. This adjusted rate will apply to Medicare claims going forward and will not be retroactive to the first of the year.
New from the NCMGMA Advocacy Committee, we are featuring a weekly digest, “Did You Know?” spotlighting important healthcare advocacy news and events. Keep checking back and subscribe to NCMGMA News to stay current on all the latest updates!
NCDHHS Consolidates Local Management Entity/Managed Care Organizations Ahead of Tailored Plan Launch
On February 1st, the North Carolina Department of Health and Human Services consolidated the state’s Local Management Entity/Managed Care Organizations to improve access to health care services in preparation for the launch of the Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans July 1, 2024.
Tailored Plans are integrated health plans designed specifically to serve individuals with significant mental illnesses, substance use disorders, or long-term care needs including I/DD and traumatic brain injury.
Eastpointe and Trillium Health Resources have consolidated into one entity, and Sandhills Center has dissolved, at the direction of the North Carolina General Assembly and NCDHHS Secretary Kody H. Kinsley. To help ensure continuity of care and a smooth transition, NCDHHS and the LME/MCOs have developed a transition plan to best support beneficiaries and recipients, providers and counties during consolidation.
Trillium will now support the counties Eastpointe, Sandhills and Trillium previously served, with the exception of three counties: Partners Health Management will serve Davidson County, Alliance Health will serve Harnett County and Vaya Health will serve Rockingham County.
The department and the LME/MCOs have sent educational materials and resources to beneficiaries who will experience a change of LME/MCO to help them navigate services, including information on their new LME/MCO. Beneficiaries and recipients do not need to take any action. They will continue to receive the services they receive today and will be able to see the same providers.
Additional information for beneficiaries and recipients, as well as an overview of the consolidation for providers, are available to address frequently asked questions and provide contact details for LME/MCOs throughout the consolidation process.
New from the NCMGMA Advocacy Committee, we are featuring a weekly digest, “Did You Know?” spotlighting important healthcare advocacy news and events. Keep checking back and subscribe to NCMGMA News to stay current on all the latest updates!
Judge Rules BCBS North Carolina Can Continue State Health Plan Challenge
Visit Becker’s Payer Issues to learn more about the judge ruling, allowing BCBS North Carolina to continue the challenge of the State Health Plan being awarded to Aetna.
The Cigna Group to Sell Medicare Businesses and CareAllies to Health Care Service Corporation (HCSC)
Global health company The Cigna Group (NYSE: CI) today announced that it has entered into a definitive agreement whereby Health Care Service Corporation (HCSC) will acquire The Cigna Group’s Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D and CareAllies businesses, for a total transaction value of approximately $3.7 billion. As part of the transaction, The Cigna Group and HCSC have agreed to enter into a four-year services agreement under which Evernorth Health Services, a subsidiary of The Cigna Group, will continue to provide pharmacy benefit services to the Medicare businesses, effective on closing of the transaction.
The North Carolina Department of Health and Human Services (NCDHHS) is releasing updated information about the assumptions underlying the care management component of capitation payments to NC Medicaid Managed Care Standard Plan Prepaid Health Plans (Standard Plans), including consideration for Medicaid expansion effective Dec. 1, 2023.
As of Dec. 1, 2023, people ages 19 through 64 years with higher incomes are eligible for Medicaid coverage in North Carolina. For this expansion population, on average, $13.65 per member per month (PMPM) is the assumed cost of delivering care management in accordance with NCDHHS’s requirements, compared to $10.17 for non-expansion populations for State Fiscal Year 2024 (July 1, 2023-June 30, 2024).
This information is based on a set of assumptions about care manager staffing ratios by care management need level and qualifications, which should be understood as averages rather than policies about how each care team must be constructed. In reality, care teams will vary in how they are staffed according to the needs of individual members and assigned panels. NCDHHS has not established minimum care management fees and maintains the expectation that Standard Plans and practices will arrive at mutually agreeable rates that are commensurate with the intensity and breadth of the care management being provided.
By providing additional information on the assumptions NCDHHS used to develop components of the care management component of capitation payments, Standard Plans and AMH Tier 3 practices will be better positioned to enter into care management contracts that enable all parties to meet NCDHHS’ expectations in the execution of care management responsibilities and achievement of improved health outcomes.
Tuesday, November 14, 2023 12:00 PM – 1:00 PM EST | Zoom
Join us on November 14th for NCMGMA and NCMS’s November Lunch & Learn with Aetna representatives who will be covering general Aetna Network information with a focus on the State Health Plan and a run through of the Clear Pricing Project (CPP).
Webinar Speakers
Jason Keibler Executive Director and Network Head Aetna Jason is responsible for overall provider network strategy, composition, contracting, performance and provider relations in the Carolinas.
Gina Furlow Lead Director, Network Management Aetna Gina is responsible for contracting and servicing providers including health systems, ancillaries and physician groups in North Carolina.
Linda Cecarelli Executive Director, State Health Plan Network Lead Aetna Linda is the Network lead for the State Health Plan, responsible for provider-facing aspects of the implementation plan, including the Clear Pricing Project.
Registration
This webinar is free but you must be registered to attend. Space is limited so register early! After you register, you will receive an emailed confirmation with webinar and phone-in instructions. Please check your spam/junk folder if you do not see the confirmation email after you register.
Continuing education credit may be granted through your professional organization (MGMA, PAHCOM, AHIMA, etc.). Please self-submit for these organizations.
North Carolina Medical Group Management Association Blog 