DHHS Submits Final Medicaid Reform Plan to CMS

Plans Builds on Triple Aim with Additional Provider Supports

The NC Department of Health and Human Services formally submitted North Carolina’s Medicaid Reform Waiver application earlier this week, completing the first step in a Medicaid transformation process that’s expected to span multiple years before fully implemented. Similar to what was previously reported in the NC Family Physician magazine, the final waiver builds on the Triple Aim by adding a variety of provider engagements and supports. At a high level, the waiver seeks to build on the state’s existing primary care case management and PCMH networks. It also will seek to address the administrative burdens by mandating uniform credentialing, prompt payment requirements and consistent quality metrics.

Additionally, the waiver will seek to reduce integrated care barriers of primary care practices, aggressively pursue value-based payment approaches, and promote a state workforce development strategy emphasizing community-based residency training.

The next step in the reform process will be for DHHS to develop formal Requests for Proposals to be considered by commercial managed care companies and provider-led entities. It’s expected that CMS’s approval process could take as long as 24-months. The Academy will continue to advocate for the interests of family physicians and their practices during all phases.