The North Carolina Medical Society (NCMS) is meeting regularly with state officials charged with constructing the new capitated Medicaid framework mandated by the General Assembly as well as with other stakeholders and the managed care entities likely to be pursuing a contract with the state. We are monitoring and working to influence their objectives to make sure they are in keeping with our core values and principles.
Key principles guiding our work include ensuring that the new system:

  • Puts the patient at the center, making certain that the whole person is cared for, factoring in community services as necessary to sustain the person’s health.
  • Is led by physicians with the clinical knowledge to understand what constitutes excellent patient care.
  • Uses meaningful quality performance measures that are consistent across all entities, are clinically relevant and not an additional burden to physicians.
  • Is transparent in reporting data, quality measures, costs and savings.
  • Strives for administrative simplicity during this transition period leading to sensible and streamlined procedures once the system is in place.
  • Establishes network adequacy standards to ensure access to care based on federal law or regulations.

The NCMS was an integral part of the process as the state’s Medicaid reform legislation was being developed, and we successfully advocated to incorporate patient and physician protections into the final law.
“This is a lengthy and complex process with myriad details to attend to before the new system is operational and patients are being seen within it,” said NCMS CEO Robert W. Seligson. “We are knee deep in those details and will continue to report progress to our members. And we encourage our members to let us know their concerns as we continue our work at the highest levels.”
The most immediate signpost on this pioneering trek is Secretary of the North Carolina Department of Health and Human Services, (DHHS) Rick Brajer’s report to the General Assembly in March 2016 outlining his progress toward implementing the Medicaid reform legislation. Other markers on the timeline include DHHS’ application to the Centers for Medicare and Medicaid Services for approval of the state’s Medicaid reform plans. It is unknown how long the federal approval process will take, but once approved the General Assembly has allowed 18 months to select the managed care organizations or provider led entities to serve patients and begin enrollment. Many observers expect enrollment to begin as early as January 2018.
Watch for updates in the Bulletin as well as our Director of Legislative Relations Chip Baggett’s video blog (aka Bowtie Briefing) on Fridays. Please comment on this blog or contact us directly at [email protected] or 800-722-1350.