NCBA Medicaid Transformation Panel PowerPoint FINAL 20160427

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Andrew Walsh

A
2016 Health Law Section Annual Meeting
April 29,2016
NCBA Health Law Section
Medicaid Reform in North Carolina -
Forecasting Structure and
Preparing for the Transition

 Representative Nelson Dollar:
NC General Assembly, House District 36
 Cody R. Hand:
VP & Deputy General Counsel,
North Carolina Hospital Association
 Lou Patalano IV:
VP & Deputy General Counsel,
Blue Cross Blue Shield NC
 Andrew Walsh:
Chief Legal Officer & General Counsel,
Partners Behavioral Health Management
5/5/2016 2
Panel

I. Materials & Highlights of New Law
II. Perspectives & Prognostications
 Legislative (Rep. Nelson Dollar)
 Hospital & Healthcare Systems (Cody Hand)
 Insurers and Commercial Plans (Lou
Patalano)
 Behavioral Health--LME/MCOs (Andrew
Walsh)
III. Q&A
5/5/2016 3
Overview

1. Seminar PDF -- Table of Contents (p.2)
 Mostly Articles and Legislative Reports (moving target)
2. Online Resources
 www.ncleg.net
 http://www.ncdhhs.gov/nc-medicaid-reform
3. Highlights of New Law (SL 2015-245)
 Integrated Medicaid Managed Care (PDF, pp. 4-16)
 PHPs (CPs and PLEs)
 Capitated Contracts
 Waivers, SPAs & Federal Approval
 DHB v DMA (+ DOI)
 JLOC Medicaid & JLOC HHS
 Timelines and Deadlines
5/5/2016 4
Materials & Highlights

 Legislative (Rep. Nelson Dollar)
 Hospital & Healthcare Systems (Cody Hand)
 Insurers and Commercial Plans (Lou
Patalano)
 Behavioral Health & LME/MCOs (Andrew
Walsh)
5/5/2016 8
Perspectives & Prognostications

MCE Population Medicaid
Members
Counties
Partners 909,394 296,658 8
Smoky 1,074,157 23
Cardinal 2,411,453 410,065 16
CenterPoint 542,516 4
Alliance 1,766,635 378,136 4
Sandhills 1,079,786 9
Eastpoint 829,229 351,696 12
Trillium 1,260,778 24
TOTALS 9,873,948 1,436,555 100
5/5/2016 9

Contact Information
5/5/2016 11
 Andrew M. Walsh,
awalsh@partnersbhm.org, 704-884-2634
 Other Panelists: On Request

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NCBA Medicaid Transformation Panel PowerPoint FINAL 20160427

1. A 2016 Health Law Section Annual Meeting April 29,2016 NCBA Health Law Section Medicaid Reform in North Carolina - Forecasting Structure and Preparing for the Transition

2.  Representative Nelson Dollar: NC General Assembly, House District 36  Cody R. Hand: VP & Deputy General Counsel, North Carolina Hospital Association  Lou Patalano IV: VP & Deputy General Counsel, Blue Cross Blue Shield NC  Andrew Walsh: Chief Legal Officer & General Counsel, Partners Behavioral Health Management 5/5/2016 2 Panel

3. I. Materials & Highlights of New Law II. Perspectives & Prognostications  Legislative (Rep. Nelson Dollar)  Hospital & Healthcare Systems (Cody Hand)  Insurers and Commercial Plans (Lou Patalano)  Behavioral Health--LME/MCOs (Andrew Walsh) III. Q&A 5/5/2016 3 Overview

4. 1. Seminar PDF -- Table of Contents (p.2)  Mostly Articles and Legislative Reports (moving target) 2. Online Resources  www.ncleg.net  http://www.ncdhhs.gov/nc-medicaid-reform 3. Highlights of New Law (SL 2015-245)  Integrated Medicaid Managed Care (PDF, pp. 4-16)  PHPs (CPs and PLEs)  Capitated Contracts  Waivers, SPAs & Federal Approval  DHB v DMA (+ DOI)  JLOC Medicaid & JLOC HHS  Timelines and Deadlines 5/5/2016 4 Materials & Highlights

5. 5/5/2016 5

6. 5/5/2016 6 Physical Health

7. 5/5/2016 7 Behavioral Health

8.  Legislative (Rep. Nelson Dollar)  Hospital & Healthcare Systems (Cody Hand)  Insurers and Commercial Plans (Lou Patalano)  Behavioral Health & LME/MCOs (Andrew Walsh) 5/5/2016 8 Perspectives & Prognostications

9. MCE Population Medicaid Members Counties Partners 909,394 296,658 8 Smoky 1,074,157 23 Cardinal 2,411,453 410,065 16 CenterPoint 542,516 4 Alliance 1,766,635 378,136 4 Sandhills 1,079,786 9 Eastpoint 829,229 351,696 12 Trillium 1,260,778 24 TOTALS 9,873,948 1,436,555 100 5/5/2016 9

10. Questions? 5/5/2016 10

11. Contact Information 5/5/2016 11  Andrew M. Walsh, awalsh@partnersbhm.org, 704-884-2634  Other Panelists: On Request

NCBA Medicaid Transformation Panel PowerPoint FINAL 20160427

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