Healthy Opportunities Pilots The Healthy Opportunities Pilots is the nation’s first comprehensive program to test evidence-based, non-medical interventions designed to reduce costs and improve the health of Medicaid beneficiaries. The pilots will provide up to $650 million in Medicaid funding for pilot services related to housing, food, transportation and interpersonal safety and toxic stress in three regions of the state. A larger version of the map is available here. 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 NC Medicaid Managed Care. Services will launch as follows across all three pilot regions: March 15, 2022: Food services May 1, 2022: Housing and transportation services June 15, 2022: Interpersonal safety and cross-domain services Human Service Organizations Organizations interested in participating as part of a network of Human Service Organizations (HSOs) that will provide services in the Pilot regions should contact their local Network Lead about application details. Note: Application deadlines vary by pilot region. Applications: Access East, Inc. Counties: Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt. Access East Application Community Care of the Lower Cape Fear Counties: Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender. Community Care of Lower Cape Fear Application. Impact Health Counties: Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey). Impact Health Application. For additional information about HSO responsibilities, please go to Healthy Opportunities Pilots Webinar: Human Service Organizations (below). Frequently Asked Questions Program Eligibility PHPs are responsible for managing and maintaining Healthy Opportunities Pilots enrollment criteria. To qualify for and receive pilot services, members must: be enrolled in a PHP (Standard Plan) live in a pilot region (served by one of three Network Leads) Members must also have: at least one qualifying physical or behavioral health condition AND at least one qualifying social risk factor Please refer to the Eligibility Criteria document for a full list of qualifying physical/behavioral health criteria and social risk factors. Healthy Opportunities Pilots Webinar: Human Service Organizations This webinar was held on Tuesday, Aug. 31, 2021 and provided an overview of the Pilot program, with a focus on the essential roles and responsibilities of human services organizations that will provide Pilot services to eligible Medicaid members. The webinar also highlighted important upcoming implementation milestones and next steps. Recording Presentation Resources Healthy Opportunities and Medicaid Transformation Pilots Overview and Evaluation Healthy Opportunities Pilots Fact Sheet Healthy Opportunities Pilot Fee Schedule and Service Definitions Network Lead-HSO Model Contract PHP-Network Lead Model Contract CMS Pilot Evaluation Design Approval Letter and Evaluation Design Archive 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. Slides Webinar Recording 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. Slides Webinar Recording 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 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 On March 15, 2019, NCDHHS posted an addendum to the Request for Information (RFI): Addendum 3: Department Response to Questions, answering additional questions received about the RFI. On March 13, 2019, NC DHHS posted an addendum to the RFI: Addendum 2: RFI Submission Deadline Extension, extending the deadline for responses to the RFI to 2 p.m. EST on March 20, 2019. 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. Healthy Opportunities Network Lead Award Healthy Opportunities Network Lead Award The North Carolina Department of Health and Human Services has selected organizations to serve three regions of the state, marking a major milestone towards launching the nation’s first comprehensive program to test evidence-based, non-medical interventions designed to reduce costs and improve the health of Medicaid beneficiaries. Following a competitive selection process, the following organizations will reach three regions, two in eastern North Carolina and one in western North Carolina. Access East, Inc.: Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt Community Care of the Lower Cape Fear: Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender Dogwood Health Trust: Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey The Pilots will operate within the NC Medicaid Managed Care program and are an important part of fulfilling the Department’s commitment to buying health, not just health care. The Healthy Opportunities Pilots is a groundbreaking program that will begin in spring 2022 to cover the cost of approved services related to housing, food, transportation, interpersonal safety and toxic stress that directly impact people’s health outcomes and health care costs. Learn more about the Healthy Opportunities Pilots and the Healthy Opportunities Network Lead (formerly referred to as Lead Pilot Entity, or LPE) contract awards in the May 27 press release. Fact Sheet FAQs Procurement of Network Leads (formerly known as Lead Pilot Entities) Procurement of Network Leads (formerly known as 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 selected 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 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, 201. Healthy Opportunities Pilots In The News Centers for Medicare and Medicaid Services Administrator Seema Verma’s article about North Carolina’s Medicaid transformation and Healthy Opportunities pilots
Healthy Opportunities Pilots The Healthy Opportunities Pilots is the nation’s first comprehensive program to test evidence-based, non-medical interventions designed to reduce costs and improve the health of Medicaid beneficiaries. The pilots will provide up to $650 million in Medicaid funding for pilot services related to housing, food, transportation and interpersonal safety and toxic stress in three regions of the state. A larger version of the map is available here. 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 NC Medicaid Managed Care. Services will launch as follows across all three pilot regions: March 15, 2022: Food services May 1, 2022: Housing and transportation services June 15, 2022: Interpersonal safety and cross-domain services Human Service Organizations Organizations interested in participating as part of a network of Human Service Organizations (HSOs) that will provide services in the Pilot regions should contact their local Network Lead about application details. Note: Application deadlines vary by pilot region. Applications: Access East, Inc. Counties: Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt. Access East Application Community Care of the Lower Cape Fear Counties: Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender. Community Care of Lower Cape Fear Application. Impact Health Counties: Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey). Impact Health Application. For additional information about HSO responsibilities, please go to Healthy Opportunities Pilots Webinar: Human Service Organizations (below). Frequently Asked Questions Program Eligibility PHPs are responsible for managing and maintaining Healthy Opportunities Pilots enrollment criteria. To qualify for and receive pilot services, members must: be enrolled in a PHP (Standard Plan) live in a pilot region (served by one of three Network Leads) Members must also have: at least one qualifying physical or behavioral health condition AND at least one qualifying social risk factor Please refer to the Eligibility Criteria document for a full list of qualifying physical/behavioral health criteria and social risk factors. Healthy Opportunities Pilots Webinar: Human Service Organizations This webinar was held on Tuesday, Aug. 31, 2021 and provided an overview of the Pilot program, with a focus on the essential roles and responsibilities of human services organizations that will provide Pilot services to eligible Medicaid members. The webinar also highlighted important upcoming implementation milestones and next steps. Recording Presentation Resources Healthy Opportunities and Medicaid Transformation Pilots Overview and Evaluation Healthy Opportunities Pilots Fact Sheet Healthy Opportunities Pilot Fee Schedule and Service Definitions Network Lead-HSO Model Contract PHP-Network Lead Model Contract CMS Pilot Evaluation Design Approval Letter and Evaluation Design Archive 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. Slides Webinar Recording 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. Slides Webinar Recording 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 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 On March 15, 2019, NCDHHS posted an addendum to the Request for Information (RFI): Addendum 3: Department Response to Questions, answering additional questions received about the RFI. On March 13, 2019, NC DHHS posted an addendum to the RFI: Addendum 2: RFI Submission Deadline Extension, extending the deadline for responses to the RFI to 2 p.m. EST on March 20, 2019. 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. Healthy Opportunities Network Lead Award Healthy Opportunities Network Lead Award The North Carolina Department of Health and Human Services has selected organizations to serve three regions of the state, marking a major milestone towards launching the nation’s first comprehensive program to test evidence-based, non-medical interventions designed to reduce costs and improve the health of Medicaid beneficiaries. Following a competitive selection process, the following organizations will reach three regions, two in eastern North Carolina and one in western North Carolina. Access East, Inc.: Beaufort, Bertie, Chowan, Edgecombe, Halifax, Hertford, Martin, Northampton, Pitt Community Care of the Lower Cape Fear: Bladen, Brunswick, Columbus, New Hanover, Onslow, Pender Dogwood Health Trust: Avery, Buncombe, Burke, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey The Pilots will operate within the NC Medicaid Managed Care program and are an important part of fulfilling the Department’s commitment to buying health, not just health care. The Healthy Opportunities Pilots is a groundbreaking program that will begin in spring 2022 to cover the cost of approved services related to housing, food, transportation, interpersonal safety and toxic stress that directly impact people’s health outcomes and health care costs. Learn more about the Healthy Opportunities Pilots and the Healthy Opportunities Network Lead (formerly referred to as Lead Pilot Entity, or LPE) contract awards in the May 27 press release. Fact Sheet FAQs Procurement of Network Leads (formerly known as Lead Pilot Entities) Procurement of Network Leads (formerly known as 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 selected 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 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, 201. Healthy Opportunities Pilots In The News Centers for Medicare and Medicaid Services Administrator Seema Verma’s article about North Carolina’s Medicaid transformation and Healthy Opportunities pilots
