North Carolina

Providers key in NC’s push to launch delayed Medicaid plans for complex populations

Published

6 months ago

February 11, 2024

Providers key in NC’s push to launch delayed Medicaid plans for complex populations

After multiple delays, the North Carolina Department of Health and Human Services says it’s “on track” to implement specialized Medicaid plans this summer that are designed for beneficiaries with complex needs.

Now scheduled to launch on July 1, the so-called “tailored plans” are expected to cover about 150,000 existing Medicaid participants who require more extensive care and support than typical enrollees. Many people with intellectual or developmental disabilities, traumatic brain injuries, complex psychiatric disorders and substance use disorders will be moved to the plans, according to DHHS.

Unlike standard Medicaid plans, the tailored plans will be administered by a network of four state-funded behavioral health organizations, or LME-MCOs. For the past decade, these regional managed care organizations have been providing access to behavioral health services for people with complex needs across the state, sometimes operating under a cloud of controversy.

Now, they have been tasked with connecting tailored plan participants to physical and mental health care providers.

The tailored plans were initially scheduled to go live in December 2022, but DHHS delayed the launch to give the LME-MCOs more time to prepare. Additional delays were announced last year, with the department citing a lack of buy-in among some providers.

Jay Ludlam, the state’s deputy secretary for Medicaid, gave lawmakers an update on the plans’ status as part of Tuesday’s meeting of the Joint Legislative Oversight Committee on Medicaid. The LME-MCOs, he said, have “made significant progress in closing any remaining gaps in their networks.”

Push for more providers

Ludlam told the committee that DHHS established an internal “disruption standard” after the most recent delay. The department’s goal was to ensure that at least 80 % of tailored plan participants would “not be disrupted in their current relationships” with providers.

“Our focus has been on those families that […] have worked with certain care teams for years, often since birth, to provide care to their loved ones,” Ludlam said. “We also saw pressures from others who wanted, as much as possible, to ensure that we as a department recognize that it’s not only just the provision of services, [but] also who’s providing those services … that is important to those families.”

He said that federal regulators were OK with the 80% goal last spring, but they want at least 90% of the state’s tailored plan participants to have the option of staying with their current provider in order for the plans to launch this July.

That rankled committee member Sen. Ralph Hise (R-Spruce Pine), even though he’s long been critical of the LME-MCOs.

Sen. Ralph Hise, left, and Sen. Joyce Krawiec during a meeting of the Joint Legislative Oversight Committee on Medicaid on Feb. 6, 2024.

Hise said he was concerned that the higher standard required by the Centers for Medicare and Medicaid Services would force the LME-MCOs to “sign contracts that might not be in the best interest of their system.” Some providers, he said, were already dissatisfied with the reimbursement rates that the LME-MCOs were offering for services.

“Then CMS kind of steps in and says, ‘First of all, you have to have 80 [%] and now you have to have 90 [%],’ and suddenly these contracts are getting signed,” Hise said. “I mean, somebody stuck their nose in a contract dispute, told them who they had to sign with and, in effect, what rates they had to sign for.”

Ludlam responded by pointing out that the issues with provider contracting “are sometimes not about money.”

“They’re about how many lives the tailored plans were managing, and that it wasn’t sufficient for the systems to basically bother to pick up the pen and sign those contracts,” he said. “By focusing on what the members need, and of course monitoring the potential impact on rates, I do believe that we will not only protect people through this process, but that we will be able to get to go live on July 1.”

One factor in creating a Medicaid plan is the quest for “network adequacy” — the ability for a patient to find the care they want and need close to home. This means the plans’ managers have to contract with hundreds, sometimes thousands of health care providers throughout a region.

Ludlam noted that two of the state’s LME-MCOs recently contracted with a “large system” to accept tailored plans. Ludlam declined to share the system’s name, but Charlotte-based Atrium Health had previously been identified as a significant holdout in the state’s push to enlist providers. A spokesperson for Atrium did not immediately respond to email from NC Health News on Wednesday.

Ludlam said DHHS has not “re-measured” the potential disruption of existing patient-provider relationships since the unnamed system came aboard.

“If I were to highlight any potential risk to go live, it is whether or not the tailored plans will be able to close out some of those other contracts that are going to be necessary to minimize the disruption for consumers and members,” Ludlam said.

He added that DHHS will make a “go or no-go decision” in April on the July 1 rollout date if the LME-MCOs have not contracted enough providers to satisfy CMS’ requirement by then.

“If we really saw a high risk of potential member harm for individuals, we would do what is necessary to protect people,” Ludlam said of the possibility of another delay. “We would want to work very closely with CMS to make sure that if they’re declaring that we’re unable to go live, that they’re doing it based on the best available data and for all the right reasons.”

Rollout riding on LME-MCOs

Ludlam said the burden of contracting enough providers to maintain continuity of care for tailored plan patients will largely fall on the LME-MCOs. They know the “individuals who might be at risk” and “where they are,” he said.

“The work is going to be on them,” he said. “I think generally they are very close to getting contracts with these care teams, and we will continue to monitor it over the next couple of months.”

The implementation of tailored plans will follow a consolidation that left the state with four LME-MCOs instead of its previous six. Sec. Kody Kinsley, head of DHHS, ordered the consolidation in November to streamline the plans’ rollout.

Trillium Health Resources took control of Eastpointe Human Services under the consolidation, creating a single organization to serve 46 counties across eastern North Carolina. Another LME-MCO, the Sandhills Center, was dissolved in connection with the consolidation.

The remaining organizations include Vaya Health, which serves most of the western part of the state, and Alliance Health and Partners Health Management, which together cover a mosaic of counties in central North Carolina.

Ludlam said his “Day One goals” for tailored plans are to “make sure that members have cards in hand, that the health plans have sufficient networks, that providers can get paid and that members can have access to those health plans in order to understand their benefit, understand who they’ve been assigned to and make sure that they can get care.”

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

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North Carolina

NC State Has 16 Current Players From NC in the NFL

Published

1 hour ago

August 5, 2024

Press Room

NC State Has 16 Current Players From NC in the NFL

This past week kicked off NC State’s 2024 Fall Football Camp. Here’s a breakdown of some of the main highlights of what Wolfpack Head Coach Dave Doeren had to say. You can watch the full video of his time with the press ABOVE .

Highlights

On the first day of practice on Wednesday, without being prompted, Doeren went out of his way to give praise to two young new members of the Wolfpack.

“It was good to see Tamarcus Cooley make some plays today. Had some nice interceptions. Keenan Jackson had some nice catches. Those two guys stepped up today. I thought they looked good in practice.”

Cooley is a Redshirt Freshman Defensive Back, who transferred in from Maryland this offseason. In practice, he was running with the 2nd Team Defense as the Nickelback. Cooley was High School teammates with Wolfpack Receiver Noah Rogers, who transferred in from Ohio St. this offseason.

Jackson is a True Freshman, who flipped his commitment from UNC to NC State on National Signing Day back in December. He was a 4-Star prospect out of Weddington High School in Matthews, North Carolina.

Doeren also gave an update on Junior Sean Brown moving from Safety to Linebacker.

“Really well. He’s a smart football player. In-game last year we had to move in there when Payton (Wilson) was out in the Clemson game. He had eight tackles in the fourth quarter. He showed us that he can play there in a game. He’s built for it. He can run. He’s physical. He’s got really good instincts, vision. He understands coach [Tony] Gibson’s defense and what he wants. That position has to have a guy in it that can really run and erase things. Sean is built for that.”

Brown has big shoes to fill, moving into the void that was left at WILL Linebacker. Payton Wilson used to wear those shoes. Back in the Spring, Brown had put on 10 pounds of muscle, and from the looks of things this past week, he might have put on a few more pounds of muscle since then.

Dantonio Burnette, NC State’s Strength & Conditioning Coach, shared this tweet last week, sharing that Brown ran a 4.43 40-yard dash this offseason.

SEAN BROWN
New year, new position but Bigger, Stronger & Faster. As a former Linebacker I’m extremely excited to see him roam the field for the WOLFPACK this season.
PRO AGILITY – 4.02
40 – 4.43
VJ – 38.6”#HTT #1Pack1Goal #Sprinting #Agility #ProAgility #Speed #FeedTheWolf pic.twitter.com/odpzW2lNPp
— Dantonio Burnette (@CoachThunder_45) July 29, 2024

Check out our 2023 Highlight Reel of Brown.

Doeren said there are a few areas on the team where position battles are taking place.

“On the offensive line there’s some competition there. Looking forward to seeing that at the guard positions and the position of left guard in particular. There’s some really talented young receivers. Want to see how they come along and what they can do to help in some spots. On defense we brought in some older DBs. There’s a competition there.”

On Wednesday, former Walk-On, Redshirt Junior Matt McCabe was starting at Left Guard, and Redshirt Junior Anthony Carter Jr. was backing him up. Carter Jr. was the starter last season, and he has been recovering from offseason surgery. On the Right Side, Senior Timothy McKay was with the 1’s, and I expect him to remain there, serving as the starter last season.

On Wednesday, Sophomore KC Concepcion, Redshirt Freshman Noah Rogers and Redshirt Junior Dacari Collins were the starting Wide Receivers. I expect them to be the starters in Week 1 against Western Carolina, but expect a lot of the young talent behind them to fight for playing time as the year progresses. In my opinion, I can’t foresee any player behind Concepcion or Rogers taking their starting roles, but it will be interesting to see if someone pushes Collins for his job.

Obviously Aydan White will be starting at one of the Cornerback spots, and it looks like Sophomore Brandon Cisse is poised start on the other side, but I’m sure Corey Coley and Devon Marshall, who both Transferred in this offseason, are going to fight tooth-and-nail for that spot.

He had some kind words to say about McCabe’s journey from Walk-On to Scholarship Player.

“I’m really proud of Matt. Matt’s worked really hard. He does everything we ask him to do. He plays really hard. He trains really hard. He handles himself well in the community, in the classroom. It’s a great story.”

McCabe was awarded a Scholarship prior to the 2023 season.

Finally, Doeren thinks that NC State and Quarterback Grayson McCall are a perfect match.

“We’re very, very grateful that he’s here, one. Excited for him. Impressed by him. He understands the game. He’s a quick learner. He’s a really good teammate. Goes hard, holds himself to a high standard. Has no problem holding guys accountable and he does it in a good way. He’s demanding but not demeaning with people. He’s got great touch on the football. His game management skills, his clock management, everything. He’s a vet. He’s a great fit in our program.”

This past week, the ACC Network stopped by NC State’s practice for their ACC Football Road Trip, and chatted with Doeren as well.

A couple of notes from that:

Kevin Concepcion will be a part of the return game in some way this year on Special Teams. He was working with the Punt Return team in practice last week.

He also alluded to the fact that opposing Defenses won’t be able to simply focus on KC this year, because if they do, it will open up things for Noah Rogers, Justin Joly, Dacari Collins, Wesley Grimes and the Running Backs.

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North Carolina

North Carolina Central student dies from injuries following car crash

Published

9 hours ago

August 5, 2024

Press Room

North Carolina Central student dies from injuries following car crash

DURHAM, N.C. (WTVD) — An NC Central student who was planning to play for the school’s football team has died following a car crash last month.

19-year-old Terrance Howard enrolled in summer classes, and was driving to Durham when he was involved in a car crash outside Salisbury. When he got out of his car to check on others, he was struck by another vehicle. After 10 days in a medically induced coma, Howard passed away in the hospital on July 30.

“It just seems incomprehensible,” said Rick LaFavers, Howard’s football coach at Ridge Point High in Missouri City, Texas.

In an interview with ABC 13 in Houston, LaFavers recalled his competitive spirit.

“I just remember his smile. He came in my office in May when he came back, and he came in the coach’s office and went and talked to the team,” said LaFavers.

That drive ultimately led him to walk on at the University of Alabama last season, where he spent a year with the SEC champions. Sunday afternoon, head coach Kalen DeBoer began his press conference by acknowledging Howard’s passing.

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“He’s got some guys that are here on this team who were close to him and also thinking about him. Just want to send prayers and thoughts up to his family,” said DeBoer.

Howard was also highly regarded for his skills as a track & field athlete. In a statement, Cheryl Thompson-Harris, his coach with Mainland Jaguars Track Club, wrote:

Terrance was a very special kid. He was a member of the Mainland Jaguars Track since the age of 11 years old. His dad coached with us a many years. He was a great teammate, athlete, and all-around great young man. Our hearts and prayers go out to his wonderful family. Terrance will be truly missed.

Howard announced his commitment to NC Central in May, sharing three pictures of him wearing Eagles jerseys as part of his post on X.

He was such a competitor and everybody loved him

Many have shared condolences on social media, including NC Central men’s basketball coach LeVelle Moton, who wrote: “May God provide comfort and healing to this family.”

ABC11 has reached out to NC Central and NC Central’s football program for comment but has not heard back at this time.

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North Carolina

Tropical Storm Debby: ‘Historic,’ ‘catastrophic’ flooding possible on South Carolina coast

Published

16 hours ago

August 4, 2024

Press Room

Tropical Storm Debby: ‘Historic,’ ‘catastrophic’ flooding possible on South Carolina coast

Tropical Storm Debby, in the Gulf of Mexico Sunday afternoon and headed toward the Big Bend area of Florida, is forecast to impact parts of South Carolina and North Carolina this week. Alerts have been issued for the storm that could bring potentially historic rainfall, rough surf and flooding to these regions.

At 2 p.m. Sunday, the National Hurricane Center issued an advisory for Tropical Storm Debby, noting that it is expected to strengthen into a hurricane before making landfall Monday morning. Debby is expected to move slowly across northern Florida and into southern Georgia before moving into the Atlantic Ocean and up the coast.

The cone that shows the storm’s probable path includes much of S.C. However, many variables remain, including the strength of the still-developing storm and its exact eventual path.

Track Tropical Storm Debby

Track Debby: South Carolina Storm Tracker and Model Mixer

What can we expect in South Carolina?

The Hurricane Center’s forecast shows the center of the storm reaching South Carolina by about 8 p.m. Tuesday. But effects like heavy rain could start as early as Monday night.

Rainfall along the coast is expected to be the main concern. The S.C. coast from the southern part of the state past the Charleston area could see 16-20 inches of rain, with local amounts of up to 30 inches. That will likely result in “considerable” flash and urban flooding, and some river flooding is possible, the Hurricane Center said.

“Heavy rainfall will likely result in considerable flooding impacts from the Florida Big Bend region through southeast Georgia and the Coastal Plain of the Carolinas through Friday,” the Hurricane Center said. “Potentially historic heavy rainfall across southeast Georgia and South Carolina through Friday morning may result in areas of catastrophic flooding. Significant river flooding is also expected.”

The likelihood of storm surges creates a life-threatening situation, the Hurricane Center said. Persons located within these areas should take all necessary actions to protect life and property from rising water and the potential for other dangerous conditions. Promptly follow evacuation and other instructions from local officials.

Rain of about 1-4 inches is forecast for parts of the Upstate.

What watches and warnings are in effect in South Carolina?

A flood watch is in effect from 2 a.m. Monday through Friday morning for southeast South Carolina, including Allendale, Beaufort, Charleston, Coastal Colleton, Coastal Jasper, Dorchester, Hampton, Inland Berkeley, Inland Colleton, Inland Jasper and Tidal Berkeley.

A tropical storm watch is in effect for Charleston, McClellanville and Edisto Island. The forecast calls for winds of 20-30 mph with gusts to 40 mph.

A storm surge watch is in effect beginning Monday afternoon for Charleston, McClellanville and Edisto Island, with a potential of 2-4 feet above ground.

What other watches and warnings are in effect?

As of Sunday afternoon the depression was about 125 miles west-southwest of Tampa, Florida.

A hurricane warning is in effect for Florida coast from the Suwannee River to the Ochlockonee River.
A hurricane watch is in effect for the Florida coast west of the Ochlockonee River to Indian Pass * Florida coast south of the Suwannee River to Yankeetown.
A tropical storm warning is in effect for the Dry Tortugas, the Florida coast south of the Suwannee River to East Cape Sable and the Florida coast west of the Ochlockonee River to Indian Pass.
A tropical storm watch is in effect for the Florida coast west of Indian Pass to Mexico Beach, and the Georgia and South Carolina coast from the Mouth of the St. Mary’s River to South Santee River South Carolina.
A storm surge warning is in effect for the Florida coast from the middle of Longboat Key northward to Indian Pass including Tampa Bay.
A storm surge watch is in effect for the Florida coast from Bonita Beach northward to the middle of Longboat Key, including Charlotte Harbor, and thr Georgia and South Carolina coast from the Mouth of the St. Mary’s River to South Santee River South Carolina.

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More: Heat wave continues, cooling stations open in Spartanburg County. What about Greenville?

Where is Tropical Storm Debby?

Track it: South Carolina Storm Tracker and Model Mixer

Conditions at 2 p.m. Aug. 4:

Location: 125 miles west-southwest of Tampa, Florida.
Maximum sustained winds: 65 mph.
Movement: North-northwest at 13 mph.

More: Heat advisory in effect for Greenville, Spartanburg and Anderson, precautions to stay cool

Are you prepared for a hurricane?

Hurricane season runs from June 1 to Nov. 30. Even if this system won’t pose a threat to the Upstate, it’s never too early to be prepared.

Iris Seaton, Carolinas Connect, and Cheryl McCloud, USA TODAY NETWORK – Florida, contributed.

Todd Runkle is the Carolinas Connect editor and also a content coach for the Asheville Citizen Times, part of the USA TODAY Network. Reach him at trunkle@gannett.com.

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