New NC Senate Bill Proposes 4-6 MCOs!! And the Creation of ARPLOs!!

Senate Bill 568 was filed today!!! It is a bill that you should follow!

SB 568 reads: “It is the intent of the General Assembly to transform the State’s health care purchasing methods from a traditional fee-for-service system into a value-based system that provides budget predictability for the taxpayers of this State while ensuring quality care to those in need.”

It proposes, among other things, a consolidation of the 9 current managed care organizations (MCO) here in North Carolina to “not more than 6” and “no less than 4” MCOs.

It further establishes another acronym: ARPLOs.

“At-Risk Provider-Led Organizations (ARPLOs). ARPLOs are capitated health plans administered by North Carolina’s provider-led Accountable Care Organizations that will manage and coordinate the care for the Patient Population, outside of the PCMHs, pending waiver approval where appropriate for this transformation by the Center for Medicare & Medicaid Services.”

Remember, the House has pushed for ACOs and the Senate has pushed for MCOs.  See blog.

Is the Senate bending toward the House??????

More to come…

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on March 26, 2015, in "Single State Agency", Accountable Care Organizations, Administrative Costs, Agency, CMS, CMS Proposal, Division of Medical Assistance, Doctors, EastPointe, ECBH, General Assembly, Health Care Providers and Services, Legislation, MCO, Medicaid, Medicaid Advocate, Medicaid Appeals, Medicaid Attorney, Medicaid Providers, Medicaid Reform, Mental Health, NC, NC DHHS, North Carolina, Primary Care, Primary Care Physicians, Provider Medicaid Contracts and tagged , , , , , , , , , , , , , , , , , , , , , . Bookmark the permalink. 7 Comments.

  1. Rollo McCuller

    When it states in the first paragraph, “while ensuring quality care for those in need.” Does that mean the “registry of unmet needs” (previously known as waiting list) will be dispensed with and served? It is certainly the case that hundreds or perhaps thousands of persons with IDD are not being served but being placed on these lists, while many more are being ignored completely.

    • I don’t have numbers specific to IDD on the registry, but there are currently 9,000 individuals on the list awaiting Innovations services. So if IDD is just 25% of that it’s in the thousands.

      Personally, I think the existence of the waiting list is probably illegal. But that’s a whole nother story.

  2. Because it is my primary area, I always wonder if they consider I/DD individuals with these models, especially under MCO and ACO. Better coordination of care for these folks would be fantastic. Studies have shown that I/DD people in institutions have more access to physical health care (although not necessarily better or effective), but it’s easy to provide doctors to people who have no choice but to see a doctor. So we should definitely ensure that as I/DD people transitioning to home and community based services are not losing out on physical care.

    However, the medical model in general does not really work for the I/DD specific diagnoses. We can improve quality of life. We can improve and maintain basic skills. But a person with severe mental retardation is still going to have severe mental retardation. There is no medical outcome that ends with this person no longer has mental retardation, or this person no longer has cerebral palsy.

    It seems to me that the current thinking is budget stability for I/DD services means “not spending any additional funds for these services equals stability.”

    I have a difficult time seeing how any model, LME, MCO, or ACO accounts for this group.

  3. Geoffrey Zeger

    There has been word in the wind about the reduction of and merging of LME/MCO’s for a while. I don’t know if you read the Winston Salem Journal, but Richard Craver has been covering the ongoing merger talks between Center Point and Partners.

    One of the questions I have had (and I can’t seem to get an answer for it) is:

    – if the whole state goes towards an ACO design, will the LME/MCO’s be absorbed into the ACO’s or remain as separate ‘carve outs?’ The carve out model is used with some private insurance companies (like UHC carving out mental health to UBH, or BCBS carving out mental health to Magellan).

    If the state goes to the ACO design and the LME/MCO’s are absorbed, that may mean a WHOLE NEW ROUND of applications and site visits and learning computer authorization systems….etc. etc. I’ve been through paneling with EDS, Durham Center, Alliance, PBH, Cardinal (sheesh!!!)…will mental health providers have to re-do enrollment with some entity called ‘NC Central ACO?’

    Do you know, Knicole?

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