Healthy Opportunities Pilots

Announcement: Healthy Opportunities Pilots Suspension

May 28, 2020—To support North Carolina health care and human service providers as they focus all available resources to respond to the COVID-19 pandemic, the Department of Health and Human Services has suspended the evaluation of the Healthy Opportunities Lead Pilot Entity proposals. Due to the uncertain nature of the pandemic, a new award date has not yet been determined. Lead Pilot Entity Offerors will be notified when additional information is available. 

Addressing the unmet resource needs of North Carolinians remains a key priority of the Department. This suspension is related only to the Healthy Opportunities Pilots and does not impact other Healthy Opportunities efforts, such as the NCCARE360 rollout and Community Health Worker initiative:

  • NCCARE360 will continue to serve as the network for connecting health care and human service organizations to a shared technology platform that allows for a coordinated, community-oriented, person-centered approach to delivering care in North Carolina. Onboarding to the platform and training will continue as planned. By participating in the network, providers can continue to electronically connect those with identified needs to community resources and allow for a feedback loop on the outcome of that connection. This solution ensures accountability around services delivered, provides an “any door” approach, closes the loop on every referral made and reports on outcomes of that connection. 
  • The North Carolina Community Health Worker Initiative will offer the next semester of coursework at educational institutions in the North Carolina Community College System in spring 2021. The course will provide individuals with the required knowledge, tools and resources to become recognized as a certified Community Health Worker in North Carolina working in a variety of health care and community settings (health departments, hospitals, federally qualified health centers, clinics, faith-based organizations, etc.). The nine core competencies covered in the course include communication, capacity building, service coordination, interpersonal advocacy, outreach and personal/professional skills. Students will also learn how to use NCCARE360 to connect community members to health and human service resources. 

As a part of North Carolina’s Section 1115 demonstration waiver, North Carolina received authority from the Centers for Medicare & Medicaid Services to conduct the Healthy Opportunities Pilot Program. The Pilots will create a unique opportunity to test the impact on health outcomes and health care costs by using Medicaid funds to pay for non-medical services specifically related to food, housing, transportation and interpersonal safety. Additionally, the Pilots will provide a mechanism for payers, providers and human service organizations (HSOs, e.g., community-based organizations or social service agencies) to have the tools, infrastructure and financing to integrate non-medical services into the delivery of health care for eligible Medicaid members.

Questions regarding the procurement of Lead Pilot Entities and the suspension of awards can be directed to Medicaid.Procurement@dhhs.nc.gov. Press inquiries can be directed to news@dhhs.nc.gov.
 

About the Healthy Opportunities Pilots

The Healthy Opportunities pilots will test the impact of providing selected evidence-based interventions to Medicaid enrollees. Over the next five years, the pilots will provide up to $650 million in Medicaid funding for pilot services in up to three areas of the state that are related to housing, food, transportation and interpersonal safety and directly impact the health outcomes and healthcare costs of enrollees.

Importantly, the pilots will allow for the establishment and evaluation of a systematic approach to integrating and financing evidence-based, non-medical services into the delivery of healthcare. If shown to be effective after rigorous evaluation, the NC Department of Health and Human Services will look to systematically integrate pilot services statewide through Medicaid managed care.

Sign up for the Healthy Opportunities listserv to receive updates about the Healthy Opportunities pilots by emailing healthyopportunities@dhhs.nc.gov.

Procurement of Lead Pilot Entities

On Nov. 5, 2019, the North Carolina Department of Health and Human Services (DHHS) released a Request for Proposals (RFP) for the Healthy Opportunities Pilots that will be implemented as a part of Medicaid managed care. 
 
The RFP is to select Lead Pilot Entities (LPEs) through a competitive procurement process and enter into contracts with LPEs to operate elements of the Healthy Opportunities Pilot program. LPEs will contract directly with other organizations to build a network of Human Services Organizations to deliver Pilot services in their geographic area.
 
The deadline to submit proposals was Feb. 14, 2020, at 2 p.m. The Department received proposals from nine Offerors. Please see the list of Healthy Opportunities Lead Pilot Entity Offerors for a list of organizations that submitted a proposal. The Department anticipates that LPEs will be selected in May 2020 and Pilot service delivery will begin in the spring of 2021. 

The RFP and all related information is available on the Requests for Proposals (RFPs) and Requests for Information (RFIs) page under REQUEST FOR PROPOSAL FOR HEALTHY OPPORTUNITIES LEAD PILOT ENTITY. 

Lead Pilot Entities Request for Proposals Fact Sheet - Nov. 5, 2019

Resources

Healthy Opportunities and Medicaid Transformation

Pilots Overview and Evaluation

Healthy Opportunities Pilots Fact Sheet

The Commonwealth Fund/Manatt Health Advisory Panel for the Healthy Opportunities Pilot Service Fee Schedule

Centers for Medicare and Medicaid Services Administrator Seema Verma’s article about North Carolina’s Medicaid transformation and Healthy Opportunities pilots

CMS Pilot Evaluation Design Approval Letter and Evaluation Design

Archive

Webinars

Webinars

The Healthy Opportunities Pilots and RFI Overview Webinar from Feb. 20, 2019 provided an overview of North Carolina’s Healthy Opportunities Pilots, including key stakeholders’ roles and responsibilities, and a review of the recently released companion RFI.

The Healthy Opportunities Pilots RFI “Deep Dive” Webinar from Feb. 22, 2019 provided a closer look into select, technical parts of the RFI that solicit information on the definition and cost of Pilot or Pilot-like services. DHHS encourages human service organizations (HSOs) to listen to the recording of this webinar, especially HSOs’ finance or accounting team members. DHHS recommends that listeners have a copy of the RFI and Cost Report Worksheet open when listening to the recording to follow along a deep dive into the materials.

Stakeholder Feedback Request

Stakeholder Feedback Request

Stakeholder Feedback Requested

On July 15, 2019, NC released important technical documents for stakeholder feedback related to the Healthy Opportunities Pilots. The documents include:

1. Healthy Opportunities Pilots Service Definitions and Pricing Methodology: A request for feedback on detailed pilot service definitions and pricing information, especially from frontline human service providers. Stakeholder feedback on this document will inform the development of an equitable and transparent fee schedule for Pilot services. DHHS encourages stakeholders to use this template to provide feedback to healthyopportunities@dhhs.nc.gov by 5 p.m. Aug. 2, 2019.

2. Healthy Opportunities Lead Pilot Entity (LPE) Statement Of Interest and Supplementary Guidance: A request for a non-binding Statement of Interest (SOI) to bid from organizations interested in serving in the pilots as an LPE, plus more information about entities that may serve as an LPE. DHHS envisions that LPEs will serve as the essential connection between traditional healthcare and human service organizations and will play a crucial "behind the scenes" role by establishing a network of frontline human service providers to provide pilot services and connect that network to Pre-paid Health Plans. DHHS encourages potential LPE applicants to use this template to submit their SOI to healthyopportunities@dhhs.nc.gov by the updated deadline of 5 p.m. Aug. 12, 2019.

3. Healthy Opportunities Pilot LPE Statement of Interest Submissions: The compiled list of Statements of Interest (SOIs) will serve as a tool to promote community awareness and collaboration among organizations interested in bidding to serve as an LPE and other organizations (healthcare and human services organizations, among others) in its region. Healthy Opportunities is in the process of developing a request for proposals (RFP) to procure two to four LPEs through a competitive bidding process. DHHS anticipates releasing the LPE RFP in fall 2019 and selecting LPEs in early 2020.  As a reminder, the inability to submit an SOI does not preclude entities from submitting an RFP response. Submission of an SOI does not obligate an organization to submit a response to the LPE RFP and will not impact the evaluation of RFP responses. Please continue to check the Healthy Opportunities Website for updates and news.

Request for Information and Policy Paper Posted

Request for Information and Policy Paper Posted

On Feb. 15, 2019, NC DHHS released a policy paper and RFI on the Healthy Opportunities Pilots. The policy paper describes the preliminary Healthy Opportunities Pilot program design. The RFI and accompanying Cost Worksheets seek feedback on considerations related to Pilot design and implementation. More information about the Healthy Opportunities Pilots can be found in the RFI and the Healthy Opportunities Pilots Frequently Asked Questions (FAQs).

On March 5, 2019, NC DHHS posted an addendum to the RFI: Addendum 1: Department Response to Questions and Revisions to the RFI. This addendum responds to questions received about the RFI and makes some revisions to the RFI regarding submission.

Respondents may respond to the RFI using a Fillable PDF Version of the Healthy Opportunities Pilots RFI. Respondents seeking to submit multiple service description templates can also submit a standalone Fillable PDF of the Healthy Opportunities Pilots RFI Service Description Template and may submit as many services as preferred.

NC DHHS recently hosted two webinars that provided additional information on the policy paper and RFI.

Addendums Posted

Addendums Posted