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Expanding our network of providers

Concern

In response to concerns that our provider network does not have capacity to provide ready access to services for eligible members, especially for high-need individuals such as foster youth, adult wards, and persons being discharged from emergency rooms.
 

What we are doing

  • Actively recruiting providers and seeking to add new services and sites that increase member choice and access to care.
  • Updating processes as part of a renewed effort to ensure that qualified, eligible, and billable services are available to our members in a way that is user-friendly for our providers.
  • Using federal block grant dollars with non-profit providers that serve indigent people, including undocumented individuals.
  • Expanding our Value-Based Contracting programs to work with high quality providers that create better health outcomes for members.

Supporting children & families

Concern

We recognize that making real improvements to support children in the care of DSS is a systemic issue across North Carolina, that major change will take time, and that we alone will not resolve all pain points overnight. That said, we are working to lead this change by introducing a new child welfare program.
 

What we are doing

  • Using funds received from DHHS to make an additional monthly payment to our county DSS partners for every Medicaid-eligible foster child in its care. Counties will be able to use these additional Medicaid funds to cover the cost of some preliminary or transitional care, or to address social determinants of health.
  • Assigning dedicated staff to each county DSS office to quickly identify high-needs cases, resolve emerging issues, and assist in identifying care and social needs earlier.
  • Partnering with preferred Therapeutic Foster Care providers to enhance service delivery.
  • Establishing a plan with provider partners to implement specialized foster care programs that can serve youth with more complex needs.

Intellectual and/or developmental disability services

What we are doing

  • Utilizing a grant from the Robert Wood Johnson Foundation and the Center to Advance Consumer Partnership, creating a member journey map informed by our members and guardians. We will use this process to begin shifting our culture to fully incorporate the member voice in all operational processes and decision making.
  • Implementing Electronic Visit Verification (EVV), a software tool to track the time and location of certain Innovations services provided in a member’s or family’s home. This technology will enable us to more readily identify gaps in the delivery of care, and then address the gaps with providers and members in more real time.
  • Improving understanding of the Innovations Waiver and the Registry of Unmet Needs (Innovations Waitlist) and implementing new strategies to connect people on the Registry of Unmet Needs with Medicaid services, including (b)(3) services, as well as non-Medicaid services.
  • Enhancing our focus on addressing Social Determinants of Health (SDOH) for our IDD members by utilization of the NCCare360 software platform. This statewide initiative will allow for healthcare screenings and identification of SDOH needs of our Innovations Waiver Members.

Emergency department utilization

Concern

People in a mental health crisis often resort to emergency settings that may not be best equipped to help them. We are committed to ensuring that vulnerable people get the right care at the right time in the right setting.
 

What we are doing

  • Developing a transition of care program, which will include both hospital inpatient and ED discharge planning program with the goal of reducing the length of stay and improving access to services post-discharge.
  • Expanding care initiatives and awareness activities to perform targeted interventions on a county-by-county basis.
  • Ensuring that regional and/or county-level crisis continuum stakeholder groups are operational and actively engaged on Local Area Crisis Plans.
  • Reporting monthly on goals related to the reduction of Emergency Department readmission rates.

Improving access to care and services

Concern

Ensuring that all members and community partners have access to both care and supports involves both a more deliberate effort to educate and inform, as well as removing barriers that delay care. 
 

What we are doing

  • Removing authorization requirements for a broad list of outpatient and community-based services. For services that still require a Treatment Authorization Request (TAR), we will issue a decision within 3 business days for our highest risk members.
  • Improving provider accountability through education and outreach based on the providers’ specific barriers to timely authorization submission.
  • Working to increase access to State-funded behavioral health services for people who are indigent and do not have Medicaid by conducting adult service continuum trainings and direct community outreach.
  • Developing updated member resources to improve ease of navigation and raise awareness of the service array offered by us.
  

County Action Plan

View or print the full County Action Plan.
View or print a summary of the County Action Plan.
 

Progress Reports

 

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