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MINUTES-Draft <br />ORANGE COUNTY BOARD OF HEALTH <br />September 26, 2018 <br />S:\Managers Working Files\BOH\Agenda & Abstracts\2018 Agenda & Abstracts/ September Page 3 <br />• Medicaid will transition from a predominantly fee-for-service structure to managed care <br />where DHHS will remain responsible for all aspects of the Medicaid and NC Health <br />Choice programs. <br />• Regarding Prepaid Health Plans (PHPs), there will be 4 statewide MCOs and up to 12 <br />Provider-Led Entities (PLEs) in 6 regions. <br />• Regional Rollout <br /> Phase 1 involves the rollout of 2 regions in November 2019; while in phase 2, the <br />remaining 4 regions will do so in February 2020. <br />• Standard health plans will rollout first. They will cover physical health and mild to <br />moderate behavior health. <br />• Tailored health plans will rollout in 2020. They will cover physical health, complex <br />behavior health needs, serious mental illness, substance abuse, etc. <br />• NC goals for Medicaid managed care are to 1)measurably improve health, 2)maximize <br />value to ensure program sustainability and 3)increase access to care. <br />• For the most part, OCHD services will remain the same. As a primary care provider, the <br />OCHD will concurrently launch the Advanced Medical Home (AMH) model with the <br />Managed Care Model. There will be one standardized contract across the state in which <br />DHHS will be responsible for developing and requiring PHPs to use. The PHPs will be <br />responsible for frontline oversight and have the right to terminate with the LHDs. <br />• There are 4 tiers in the AMH model. OCHD is currently a level 2 Carolina Access <br />program meaning we will be grandfathered into tier 2 but are able to attest to tier 3. <br />Before doing so, the OCHD must make sure that it’s a good fit for us. The biggest <br />difference between the two tiers is the reimbursement rates. <br />• DHHS will require PHPs to monitor the performance of AMHs in all tiers and calculate <br />performance-based measures based on a set of quality measures. <br />• AMH implications for LHDs include the LHDs having options to choose which tier they <br />want to participate in depending on eligibility and readiness. <br />• The safety net and current access to care for Medicaid patients should not decrease, but <br />be enhanced. <br />• There will be no changes to our Managed Care payments for the first 2 years. Cost <br />Settlement will continue for Medicaid services provided that are not in the Medicaid <br />Transformation plan. OCHD will bill and receive payment from the PHPs for services <br />provided to their patients. <br />• Some of the participating PHPs include Aetna, United Healthcare and UNC. <br /> <br />The BOH had questions that were addressed by Ms. Stewart. <br /> <br /> <br />VI. Action Items (Non-Consent) <br /> <br />A. BOH Policy <br /> <br />Quintana Stewart, Health Director, led the Board in a discussion of the proposed revisions to the <br />Standard Operating Procedures. The proposed revisions went sent to the Board for their review <br />prior to the BOH meeting. Proposed revisions included: <br /> <br />III. Composition <br /> <br />A. The composition of the Board of Health is governed by NCGS 130A-35(b)-(d) which states <br />the composition of the board shall reasonably reflect the population and makeup of the county.