DHHS NC Medicaid Transformation Seven-Year Forecast

The Department of Health and Human Services has delivered its North Carolina Medicaid Transformation Seven-Year Forecast legislative report, required by Session Law 2018-5 Section 11H.9, to the General Assembly and its Fiscal Research Division. This report provides a detailed forecast for the transition to Medicaid managed care for state fiscal years 2019 to 2025. For a brief summary of the report, an Executive Summary is included.

NC Medicaid Tailored Plan Eligibility & Enrollment Webinar

On March 26 from 1:30 – 2:30 p.m., DHHS will hold a stakeholder webinar to provide the specifics of Tailored Plan eligibility criteria, enrollment processes, and transitions between Standard Plans and Tailored Plans. On March 18, 2019, DHHS released a final policy guidance paper on these key concepts. The full paper can be found at https://files.nc.gov/ncdhhs/BH-IDD-TP-FinalPolicyGuidance-Final-20190318.pdf.


To Register: https://manatt.webex.com/manatt/onstage/g.php?MTID=ee52b3a507e3ebcded6e7cc6019bf92cd

  • Registration is required to access the webinar
  • Audio for this webinar uses computer or cell phone speakers with landline availability

Additional information may be found on the NC Medicaid transformation website at www.ncdhhs.gov/nc-medicaid-transformation.

NC Medicaid
Division of Health Benefits
NC Department of Health and Human Services

North Carolina’s Move to Medicaid Managed Care


This interview is part of a new collaborative series made possible by Business of Healthcare (BOH) and the North Carolina Medical Group Management Association (NCMGMA). These interviews further our mission to provide high-level continuing education content for our members while highlighting key players and issues in North Carolina’s healthcare industry.

In this interview:

cohen300aMandy K. Cohen, MD, MPH
Secretary, Department of Health and Human Services
State of North Carolina

Mandy Cohen, MD, MPH, Secretary of the Department of Health and Human Services for North Carolina, spoke with Business of Healthcare about the state’s transition to Medicaid managed care as well as efforts to impact social determinants of health and curb opioid abuse. The interview was recorded live with 200 physician practice leaders at the North Carolina Medical Group Management Association Fall Conference. Dr. Cohen will also be one of our Advocacy Days speakers on March 13, 2019 in Raleigh, NC.

Follow this link to view the interview video

Continuing Education Credit

By reading, watching or listening to the full interview, you may self-report to earn 0.5 hours Continuing Education Credits for Certified Medical Practice Executive (CMPE) or Fellow of the American College of Medical Practice Executives (FACMPE) credentials.

NCMGMA and BOH thank Mako Medical Laboratories
for helping to make this interview series possible.

About the Business of Healthcare

BOH was founded as a forum and information exchange for the 40,000 decision makers leading hospitals and health systems, physician practices, pharma, device, and senior living as well as government and commercial payers. These leaders, and innovators serving them, join Business of Healthcare interviews to solve the complex issues they face together.

Hosted by Matthew Hanis, each interview balances Margin & Mission: making good healthcare accessible to all. New subscribers come to BOH through your referrals. Please share our content with your colleagues and invite them to join our expert community.

Upcoming Interviews

Upcoming interviews in the series feature Jeff James, Chief Executive Officer of Wilmington Health; and Chad Price, Founder and Chief Executive Officer of Mako Medical Laboratories.

Interested in Participating?
If you are interested in being interviewed or have a tip on someone who would be a great interview candidate, please contact Melissa Klingberg in the NCMGMA offices at melissa@ncmgm.org.

Hurricane Florence Preparedness

Dear Colleagues,

Hurricane Florence will make landfall later this week, bringing potential flooding and power outages across the region. Our top priority is the health and safety of you and your patients. We have information and resources available for patients before, during, and after the storm. We are asking for your assistance in spreading this information. In addition, we are continuing to work with CMS and other partners on other flexibilities that will help during the storm and after. More information and updates will be forthcoming.

Tips for patients and providers:

  • Follow mandatory evacuation orders and evacuation routes. This will be a dangerous storm. Do not ride it out.
  • Never drive through standing water – turn around, don’t drown!
  • Don’t use gas-powered generators/burners inside your house.
  • Stock up and have ready emergency kits, take care of pets, check in with neighbors.
  • Make sure you have your medicines and fill your prescriptions before the storm hits. Many insurers are allowing early refills to make it easier.
  • People that rely on electricity-dependent medical devices should notify their local Department of Social Services as soon as possible. This will help authorities prioritize services during a power outage. Local DSS contact information can be found here: https://bit.ly/2N6zWon.

Important information for people in the Medicaid program:

  • Medicaid will cover a physician/clinician visit for beneficiaries who are evacuated, including those evacuated out-of-state.
  • Medicaid will cover early prescription refills by a Medicaid pharmacist. Beneficiaries are encouraged to refill their prescriptions before the storm

Important information for people in the Food and Nutrition Service program:

  • Electronic Benefits Transfer (EBT) cards can be used at any authorized retailer, even if they are in a different state.
  • Current Food and Nutrition Services households (people receiving SNAP benefits) that have a food loss may request replacement benefits through their county DSS.
  • Lost/Damaged EBT cards can be replaced by calling the EBT Call Center at 1-888-622-7328.

Other Resources:

  • Call 211 for non-emergency needs.
  • Download the ReadyNC app to a smartphone – provides details on how to prepare an emergency kit, where shelters are open, and other essential information. ReadyNC also may be accessed at https://readync.org/EN/Index.html.
  • Look out for NC Emergency Management’s latest updates at https://www.ncdps.gov/florence.

Stay safe,


Elizabeth Cuervo Tilson, MD, MPH
State Health Director
Chief Medical Officer
Office of the Secretary
NC Department of Health and Human Services

Office: 919-855-4800
Fax: 919-715-4645

Takeaways from the August 9th DHHS Stakeholder Call with Mandy Cohen, M.D.

By Leah, Paraschiv, NCMGMA Board Member

On Thursday, August 9th, the NC Department of Health and Human Services (DHHS) held a stakeholder call led by DHHS Secretary Mandy Cohen, M.D. The call addressed DHHS’s upcoming issuance of the Request for Proposal for Prepaid Health Plans (PHP) in Medicaid Managed Care.

In short, DHHS has issued an official RFP for managed care carriers. They will accept proposals until October and announce their final selections in February. Managed care will officially begin in the fall of 2019.

Here are the most important takeaways from the call:

  • PHPs cannot refuse to contract with you.
  • Physicians and physician extenders are guaranteed payment at current rates.
  • DHHS has worked to mitigate administrative burden for clinicians.
  • PHPs will have real accountability and rigorous oversight.
  • You will receive education and support during and after the transition to managed care.

Anticipated Timeline:

  • Now and ongoing — PHPs may start to reach out to initiate contract discussions with clinicians.
  • February 2019 — DHHS will announce which health plans will be PHPs in managed care.
  • Summer 2019 — PHPs must have contracted with enough care providers to meet DHHS network standards.
  • July 2019 — PHPs must have all call centers operational and all relevant staff located in North Carolina.
  • July – September 2019 — Managed care will start in two phases. For regions of the state in Phase 1, this will be the window in which beneficiaries select a PHP.
  • November 2019 — Medicaid Managed Care program will launch in regions in Phase 1.
  • October – December 2019 — For regions of the state in Phase 2, this will be the window in which beneficiaries select a PHP.
  • February 2020 — Medicaid Managed Care will launch in regions in Phase 2.

For additional information on Prepaid Health Plans in Medicaid Managed Care, there is a two page fact sheet available on the NC DHHS website which contains more details specific to the provider community, with even more information for all stakeholders on the full website.

Partnering for the People of North Carolina

2018 Alliance sponsor feature article provided courtesy of UnitedHealthcare

From technology and patient needs to payment models and innovative partnerships, trends are converging in a rapid and exciting fashion. We’re all in it together: patients, physicians and care providers, and payers. UnitedHealthcare Community Plan shares your commitment to delivering a superior patient experience and improving health outcomes.

We believe that the best solutions come when we work together with care providers. We share the power to chart a new path, creating a stronger health care system that works better for everyone. And we’re ready to support you with tools and data resources designed to help you serve your patients and allow your practice to thrive.

Our Promise to the people of North Carolina:

Health care is constantly changing in North Carolina and throughout the country, and all stakeholders – individuals, care providers, community partners and federal and state governments – feel the impact. In the face of this changing landscape, the business and social mission of UnitedHealthcare will always remain the same: To help people live healthier lives and to help make the health system work better for everyone.

We have a long history in the great state of North Carolina and are proud of our record improving the health of more than 1.4 million people we are privileged to serve through the delivery of quality, cost-effective health care. We are committed to continuing to serve North Carolinians and working together to move the new Medicaid program forward today and for the future.

UnitedHealthcare has update its After-hours reimbursement policy for commercial plans in North Carolina

Beginning July 1, 2018, UnitedHealthcare will reimburse Primary Providers for CPT Code 99051 “Services provided in the office on evenings, weekends or holidays when Office is normally schedule to be open” when billed with a non-preventative office visit.

  • 99051: Eligible expenses for after-hours health services will be reimbursed at a value determined using the alternate of (‘gap-fill’) Fee Source as CMS does not publish an RVU value for the code.

This policy update will be effective for claims with dates of service July 1, 2018 and after. A national policy update will be implemented later in 2018.

If you have any questions about this policy update please contact Provider Relations at Carolinaprteam@uhc.com and include your practice name, tax ID number and National Provider Identifier to assist us in identifying your assigned Advocate. The reimbursement rate for CPT code 99051 will be available via the fee schedule lookup tool in Link beginning 07/01/2018.

10th Annual Advocacy Days a Success


10th Annual Advocacy Days a Success

The NCMGMA Advocacy Days event had a very positive response from the members who were able to attend. Some of the feedback describing the experience:

“Pertinent and timely issues impacting the practice due to legislation passed, Medicaid, and State Health Plan.”

“Excellent. Speakers were great and relative to all that is happening in NC right now. Well worth the time and money. Dinner was delicious!”

“I wanted to learn more about Medicaid and was extremely pleased. I wish I had planned to stay for the Legislative day, next year – I will!”

Attendees learned about the future of many different healthcare issues that will affect our state both now and in the future, including Medicaid Managed care, new legislation impacting our provider networks, and updates on hot healthcare topics currently being debated in Raleigh. In addition to the education sessions, attendees enjoyed the opportunity to engage with peers from other practices; they were able to proactively share challenges and solutions.

Finally, several attendees of the legislative visits also learned a great deal about what actually happens at the legislative level when concerns are raised by the public (when visiting the legislature, that’s US!). Attendees were able to witness and talk to the people who establish the criteria for what is heard by our lawmakers and also HOW it is being heard from different constituencies. They saw the true impact of what it means to make sure your voice is represented.

The Advocacy committee and NCMGMA Board would like to thank all the attendees for participating. Though our positions are sometimes varied, we do many times speak with a singular voice on many of the issues facing our practices. Your active participation in both education and advocating for our practices is invaluable; we thank you for making our organization a success!