Mandatory Use of NC CSRS in Effect July 7

A STOP Act requirement to check the NC Controlled Substances Reporting System (NC CSRS) before prescribing certain controlled substances will be in effect as of July 7, NCMB has been advised by the NC Department of Health and Human Services (NC DHHS).

To view the complete announcement on the NCMS website, follow this link.

MGMA to HHS: Disburse remaining Provider Relief Funds

MGMA is urging the Department of Health & Human Services (HHS) to expeditiously provide financial relief to group practices by disbursing the remaining Provider Relief Funds. Congress appropriated $175 billion to HHS to deliver financial relief to healthcare providers in order to cover expenses and lost revenue attributable to COVID-19. HHS is making disbursements through a $50 billion General Distribution, however some providers that submitted applications for additional funding have yet to receive payments, despite applying over a month ago. MGMA is encouraging HHS to quickly deliver funds pursuant to those applications.

After accounting for disbursements to date, HHS still has approximately $95 billion in unallocated Provider Relief Funds. Since eligibility for payments under the $50 billion General Distribution was contingent upon Medicare enrollment, MGMA is urging HHS to support group practices underrepresented in this distribution, such as providers that do not accept Medicare.

DHHS Support Due to Hurricane Dorian

The Department of Health and Human Services is committed to ensuring beneficiaries and health care professionals can continue receiving and providing services during Hurricane Dorian. On Sept. 4, 2019, the Department received federal authority to make temporary changes to some Medicaid services and processes that will make it easier for beneficiaries to get the services they need.

Below are highlights of the temporary flexibilities and other special procedures in place now due to Hurricane Dorian. IMPORTANT: Please read the Sept. 5, 2019, Medicaid Special Bulletin for details about effective dates, re-evaluation timing, provisions and processes.

  • Reimbursement for medically necessary services. NC Medicaid will reimburse providers for medically necessary drugs and services, and equipment and supplies, provided during the Hurricane Dorian emergency without prior approval from Sept. 4-11, 2019.
  • NC Health Choice flexibilities. NC Health Choice flexibilities are temporarily added to several key policies and procedures through Nov. 3, 2019.
  • Innovations waiver flexibilities. Approved Innovations waiver flexibilities includes temporarily exceeding certain time and benefit limits; postponement or relaxation of timing for annual reassessments, service plan approvals and face-to-face meetings; and no prior approval for services provided out-of-state. Please note: Innovations waiver flexibilities have specific uses and circumstances, and are time limited. Please refer to the Medicaid Special Bulletin for details.
  • Behavioral health services are available. Anyone in need of or receiving behavioral health care who are uninsured or are a Medicaid beneficiary can access care by calling their regional behavioral health Local Management Entity/Managed Care Organization (LME/MCO). They can also call the Disaster Distress Helpline at 1-800-985-5990. It is available year-round, 24 hours a day, seven days a week to provide immediate crisis counseling for people who are experiencing emotional distress related to natural or human-caused disasters.
  • CAP/C and CAP/DA emergency and disaster plan activation. Preparation steps, coordination and reporting for case management entities to serve CAP/C and CAP/DA beneficiaries.
  • Medication prior approval and prescription refills. Pharmacy providers are approved to override prior approval requirements and to early fill medications effective Sept. 3, during the Governor’s state of emergency order.
  • Medications for HIV shipped early. Walgreens shipped medications for HIV early to patients living in coastal communities. They are also authorized to fill emergency prescriptions.
  • Medication assisted treatment is available. Individuals receiving medication assisted treatment from an opioid treatment program may take home additional doses for treatment or receive guest-dosing at another licensed opioid treatment program. Other locations can be found in the Central Registry.
  • Shelters have naloxone. Naloxone for opioid-related overdose was sent to shelters today.
  • Shelter for medically fragile patients is open. A 50-bed State Medical Support Shelter (SMSS) for medically fragile patients is now open in Clayton. Individuals who need active monitoring, management or intervention from a medical professional to maintain their health must contact their county emergency management office to request placement in the SMSS.
  • Shelters are accessible and supportive of those with behavioral illnesses or intellectual and developmental disabilities. DHHS is working with its partners so that shelters have, for example, calming rooms to support individuals with autism or other disabilities, when a congregant setting may not be conducive for their wellbeing.
  • Food benefits will be available early for WIC participants. In addition, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants in storm-affected counties who were scheduled to receive their benefits should have had those benefits automatically added to their eWIC card by their local WIC agency. WIC participants can confirm that benefits have been added by calling the eWIC customer service line at 844-230-0813 or by accessing their account at This automatic renewal will continue through the weekend in storm-affected counties.
  • Critical access hospital bed limits. The limit of 25 beds is lifted Sept. 4-11, 2019.
  • Nursing home admissions. Temporary PASSR procedures are not required for new admissions for 30 days, and transfers between nursing facilities due to Hurricane Dorian will not require a PASSR. Also, from Sept. 4-11, 2019, the 3-day qualifying hospital stay requirement is waived for beneficiaries how requires a short-term stay in a nursing facility due to Hurricane Dorian.
  • Health care professionals not enrolled as an NC Medicaid provider. Providers not enrolled in NC Medicaid can apply to temporarily provide service to Medicaid beneficiaries through an expedited process.
  • Personal care services. Assessments scheduled Sept. 4-6 in certain counties have been cancelled. A list of counties is available in the Medicaid Special Bulletin. An expedited assessment process may be available for evacuees placed in an Adult Care Home by DSS due to shelter needs.
  • Durable medical equipment replacement. Documentation that will be accepted for equipment loss or damage due to Hurricane Dorian.

The Department is in the process of:

  • Recruiting volunteer teams of Environmental Health Specialists (EHSs) to come into storm-impacted counties to conduct inspections of restaurants, other food establishments, private septic systems and private drinking wells so that they can quickly return to normal operations.
  • Securing assistive technology devices and equipment to help individuals who are displaced due to the storm or who have devices or equipment that is destroyed or lost.Updates will be shared as they become available. In addition to messages like this one, information will be delivered through Medicaid Hurricane Dorian webpage posts, future Medicaid Special Bulletins on the Medicaid website, NCTracks Provider Portal posts and NCTracks Alert emails.


Medicaid Transformation Update – Open Enrollment Extension

The Department of Health and Human Services (DHHS) announced today that it will extend open enrollment for Medicaid beneficiaries and move to a statewide transition to managed care on February 1, 2020.

Managed care in North Carolina was scheduled to roll out in two phases, with Medicaid beneficiaries in part of the state beginning managed care services on November 1, 2019, and most of the state beginning on February 1, 2020. With today’s announcement, managed care will now go-live in one phase for the whole state beginning on February 1, 2020.

The timeline has been adjusted because DHHS cannot implement critical actions to go-live with managed care under the current continuing resolution budget. The updated timeline only impacts counties that were in Phase 1; it does not impact counties that were scheduled for Phase 2. The date of February 1, 2020 for statewide implementation remains unchanged.

Why does DHHS need to revise the timeline for Managed Care?

The transition to managed care is the most significant change ever undertaken by NC Medicaid. For the past four years, the Department has achieved significant milestones to keep the state on track for launch of the program.

The next set of activities that must be implemented depend upon budget action, including finalizing the rates to pay health plans and providers, ensuring health plans have enough providers in their networks to meet the needs of beneficiaries, deploying a complex algorithm to assign beneficiaries who do not self-select plans and doctors, and obtaining federal approval to launch. Since July, DHHS has advised its partners and the General Assembly that the timing of the budget would impact the state’s schedule for moving to managed care.

Furthermore, ongoing budget uncertainty has been an impediment to health plans finalizing contracts with doctors and health providers. An essential component of a well running managed care system is the strength of the health care network available to beneficiaries.

What will happen next for those beneficiaries and clinical providers who had been planning to launch in November?

The Department remains committed to transitioning Medicaid and NC Health Choice from fee-for-service to managed care as directed by the NC General Assembly (Session Law 2015-245). DHHS will continue to move forward with activities that are not tied to budget action, including supporting open enrollment.

Managed care will now launch in one phase. Open enrollment will be extended for the 27 counties in Regions 2 and 4 until December 13, 2019. Nothing changes for the remaining 73 counties. As planned, open enrollment will begin for those 73 counties on October 14, 2019 and run through December 13, 2019.

All stakeholders should continue to work towards the February 1, 2020 implementation date. It is critical that the managed care companies (PHPs) and doctors and health systems continue to work together on contracting.

The 27 counties where open enrollment will be extended include: Alamance, Alleghany, Ashe, Caswell, Chatham, Durham, Davidson, Davie, Forsyth, Franklin, Granville, Guilford, Johnston, Nash, Orange, Person, Randolph, Rockingham, Stokes, Surry, Vance, Wake, Warren, Watauga, Wilkes, Wilson and Yadkin counties.

Provider Playbook Announcement from NC Medicaid Deputy Secretary

At DHHS, we know that well-informed Medicaid providers like you are essential to the success of managed care. We are committed to ensuring you have the tools and resources to transition your business models, and to help your Medicaid patients navigate enrolling in a health plan for the first time and learning how to make managed care work best to get the care they need. I would like to share several steps that DHHS is taking to give you the support you want and need:

  • New Provider Playbook. DHHS has launched an online “Provider Playbook” to ensure you have at your fingertips the latest information on managed care, including communications and materials provided to your patients. The Provider Playbook combines new resources, such as a beneficiary enrollment experience paper and managed care fact sheets with the existing training, forums and virtual office hours already in place to support providers.
  • New Provider Issues and Resolutions Overview. Raising issues as they are encountered allows for prompt research and implementation of improvements that have an immediate effect on the provider and beneficiary experience. It is also important to share the situations and their resolution broadly for other providers to anticipate potential needs in their own practices. Attached is the first Provider Issues and Resolutions Overview that describes the issue, its resolution and next steps. Naturally, there will be times when mitigating circumstances may affect the outcome. In those cases, the Overview includes a “Know” section that provides you with background information and additional considerations.
  • New Provider Calls Start August 13. The complex transition to managed care requires regularly scheduled and ongoing interaction between providers, stakeholders and DHHS to quickly identify, discuss and solve issues and concerns. For example, there are times when it is more effective to ask questions and get answers from Medicaid leadership and experts on specific topics rather than receive a written update. Starting Tuesday, August 13, Medicaid will hold calls with provider associations where association leadership will hear an update on the progress to launch Medicaid Managed Care, an overview of provider-related issues and how they are being addressed, and other information specific to the provider community. This will be an interactive call with time reserved for questions and answers. Calls will initially occur with provider associations. We will add open calls for all providers and other stakeholders in the weeks that follow. Look for details to arrive shortly.

This is an exciting time for NC Medicaid and the health care professionals who take care of about 1.6 million people who will be moving to Medicaid Managed Care. Thank you for your dedication to their health and well-being, and for your valuable partnership. We encourage you to explore the Provider Playbook, review the Medicaid Issues and Resolutions Overview, and join us for the first call on August 13.

— Dave

Dave Richard
Deputy Secretary
NC Medicaid
Division of Health Benefits
NC Department of Health and Human Services

Office: 919-855-4101
Mobile: 919-500-1596

1985 Umstead Drive, Kirby Building
2501 Mail Service Center
Raleigh, NC 27699-2501

Medicaid Managed Care Update

A Message from NC Medicaid Deputy Secretary Dave Richard

Thank you for everything you and your teams have been doing to prepare for the launch of Medicaid managed care. We appreciate your effort and engagement over the past several months to ensure that you are ready for this transition, and we have benefited from your thoughtful input.

The call center and website for Medicaid managed care are now live, meaning that Medicaid beneficiaries can now call and go online to select and enroll in a health plan. As a reminder, while all beneficiaries can access these tools, only those in Regions 2 and 4 can enroll during Phase 1. (See the NC Medicaid County Playbook for more details.)

While the call center and website are live, we are delaying sending enrollment packets to beneficiaries which were scheduled to begin on July 1. New legislation has been proposed which could delay the start of Medicaid transformation. So as not to confuse beneficiaries, we are temporarily holding off in direct outreach about managed care until we have a better sense of if there will be new legislative action.

Everything else is moving forward as scheduled. All training and site visits will happen as planned. We continue to work and plan towards a November 1 go-live date for managed care in Phase 1 counties.

We will keep you closely informed about the timing of sending enrollment packets in your county. Please do not hesitate to reach out if you have any questions or concerns.


Dave Richard
Deputy Secretary
NC Medicaid
Division of Health Benefits
NC Department of Health and Human Services

Office: 919-855-4101
Mobile: 919-500-1596

1985 Umstead Drive, Kirby Building
2501 Mail Service Center
Raleigh, NC 27699-2501

Provider Transition to Managed Care Reminders

The following opportunity remains this week for Medicaid providers transitioning to NC Medicaid Managed Care. Additional opportunities will be added soon. The latest information and resources for providers transitioning to NC Medicaid Managed Care are available at:

Virtual Office Hours
Friday, April 26, 2019 | 12:30 p.m. – 2:00 p.m.
Virtual office hours provide an interactive format for providers to have their questions answered. This session will focus on Medicaid provider enrollment and credentialing. A panel of NC Medicaid subject matter experts on this topic will be available to answer questions. For more information and to register, visit:

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.

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.

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

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.