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Agenda - 09-02-2021; 12-7 - Information Item - Memorandum - LME-MCO Realignment Status
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Agenda - 09-02-2021; 12-7 - Information Item - Memorandum - LME-MCO Realignment Status
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9/2/2021
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Agenda
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12-7
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Agenda for September 2, 2021 Board Meeting
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2 <br /> STATE <br /> NC DEPARTMENT OF ROY COOPER • Governor <br /> HEALTH AND <br /> - HUMAN SERVICES MANDY COHEN, MD, MPH • Secretary <br /> Division of Health Benefits DAVE RICHARD • Deputy Secretary, NC Medicaid <br /> August 6, 2021 <br /> Dear County Managers: <br /> On July 29, 2021, Secretary Cohen approved the Transition, Consolidation, and Dissolution Agreement to <br /> effectuate the consolidation of Cardinal Innovations ("Cardinal") and Vaya Health ("Vaya"). The <br /> Dissolution Agreement contemplates that the consolidation will be completed no later than April 1, <br /> 2022; however,the day-to-day operations of Cardinal will be assumed by Vaya prior to that date as <br /> described in the Dissolution Agreement. Adding significant complexity to the consolidation, several <br /> counties have either been approved to disengage from Cardinal Innovations, indicated an intent to <br /> remain with Cardinal Innovations and ultimately align with Vaya Health, or indicated an intent to realign <br /> with a different LME/MCO. <br /> As the consolidation proceeds it is critically important that the individuals served by all LME/MCOs <br /> continue to receive services with as little disruption as possible. It is also vital both for the individuals <br /> served,for the providers serving those individuals, and for the operations of the LME/MCOs that a clear <br /> timeline be in place to ensure that Cardinal and Vaya are best positioned to hand off outgoing counties <br /> to the receiving LME/MCOs,which also must be best positioned to serve the individuals residing in <br /> realigning counties. <br /> The purpose of this communication is to share the Department's overall timeline for ensuring a <br /> transition that is most suitable for the individuals served and the continued stability of the LME/MCOs. <br /> The Department has reviewed the requests of Forsyth, Davie, Davidson, Rockingham, Orange, and <br /> Mecklenburg counties, and approves those counties' requests to leave Cardinal LME/MCO and align <br /> with other LME/MCOs, as set out below. <br /> To effectuate a transition that meets the goals of ensuring minimal disruption for the individuals served <br /> by the dissolving LME/MCO (Cardinal),the LME/MCOs taking on new counties, and their provider <br /> networks, as well as to promote the stability of the LME/MCO system,the Department approves the <br /> following overall timeline for transition. <br /> Cabarrus, Stanly, and Union Counties have already been approved for transition to Partners effective <br /> September 1, 2021. Between October 1, 2021 and December 15, 2021, Forsyth and Davie Counties will <br /> transition to Partners; Rockingham and Davidson Counties will transition to Sandhills; and Mecklenburg <br /> and Orange Counties will transition to Alliance. Specific effective dates for each of these three <br /> realignments will be announced by the Department and communicated to the relevant stakeholders <br /> within the next week. All movement of Cardinal counties not transitioning to Vaya will be complete by <br /> December 15, 2021. Alamance, Caswell, Franklin, Granville, Person, Rowan, and Vance Counties will <br /> remain with Cardinal and transition to Vaya. <br /> NC MEDICAID <br /> NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF HEALTH BENEFITS <br /> LOCATION:1985 Umstead Drive, Kirby Building,Raleigh NC 27603 <br /> MAILING ADDRESS:2501 Mail Service Center, Raleigh NC 27699-2501 <br /> www.ncdhhs.gov • TEL:919-855-4100 • FAX:919-733-6608 <br /> AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER <br />
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