HomeMy WebLinkAboutAgenda - 09-02-2021; 12-7 - Information Item - Memorandum - LME-MCO Realignment Status INFORMATION ITEM 1
ORANGE COUNTY
NORTH CAROLINA
COUNTY MANAGER'S OFFICE
300 West Tryon Street Bonnie B. Hammersley, County Manager Phone(919) 245-2300
Post Office Box 8181 Travis Myren, Deputy County Manager Fax(919) 644-3004
Hillsborough, North Carolina 27278
August 25, 2021
To: Board of Orange County Commissioners
From: Travis W. Myren
Deputy County Manager
RE: LME/MCO Realignment Status
In early August,the Department of Health and Human Services approved Orange County's request
to disengage from Cardinal Innovations Healthcare and to realign with Alliance Health as the
County's Local Management Entity/Managed Care Organization (LME/MCO). This approval
(attached) was granted amid the merger of Cardinal Innovations Health Care and Vaya Health
which had primarily served counties in the western part of the State.
Following the initial notification from the State, County staff and Alliance Health staff have been
communicating to ensure a smooth transition. Alliance Health, Cardinal Innovations Healthcare,
and the County have agreed to an effective transition date of December 15, 2021. This will allow
adequate time to transition providers and members to the Alliance Health network.
The Department of Health and Human Services also issued a transition playbook that outlines the
responsibilities and obligations of each of the LME/MCO's in terms of data transfer and other
matters related to transition. As part of that playbook, the County will be regularly updated on
progress and will have the ability to convey feedback we are receiving from residents.
If you receive any questions or feedback related to the LME/MCO transition, please send those
inquiries to me. I will continue to serve as the County's primary liaison through the transition.
Attachment: Letter from DHHS Approving County Realignment
An Equal Opportunity/Affirmative Action Employer
www.orangecountVnc.gov
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STATE
NC DEPARTMENT OF ROY COOPER • Governor
HEALTH AND
- HUMAN SERVICES MANDY COHEN, MD, MPH • Secretary
Division of Health Benefits DAVE RICHARD • Deputy Secretary, NC Medicaid
August 6, 2021
Dear County Managers:
On July 29, 2021, Secretary Cohen approved the Transition, Consolidation, and Dissolution Agreement to
effectuate the consolidation of Cardinal Innovations ("Cardinal") and Vaya Health ("Vaya"). The
Dissolution Agreement contemplates that the consolidation will be completed no later than April 1,
2022; however,the day-to-day operations of Cardinal will be assumed by Vaya prior to that date as
described in the Dissolution Agreement. Adding significant complexity to the consolidation, several
counties have either been approved to disengage from Cardinal Innovations, indicated an intent to
remain with Cardinal Innovations and ultimately align with Vaya Health, or indicated an intent to realign
with a different LME/MCO.
As the consolidation proceeds it is critically important that the individuals served by all LME/MCOs
continue to receive services with as little disruption as possible. It is also vital both for the individuals
served,for the providers serving those individuals, and for the operations of the LME/MCOs that a clear
timeline be in place to ensure that Cardinal and Vaya are best positioned to hand off outgoing counties
to the receiving LME/MCOs,which also must be best positioned to serve the individuals residing in
realigning counties.
The purpose of this communication is to share the Department's overall timeline for ensuring a
transition that is most suitable for the individuals served and the continued stability of the LME/MCOs.
The Department has reviewed the requests of Forsyth, Davie, Davidson, Rockingham, Orange, and
Mecklenburg counties, and approves those counties' requests to leave Cardinal LME/MCO and align
with other LME/MCOs, as set out below.
To effectuate a transition that meets the goals of ensuring minimal disruption for the individuals served
by the dissolving LME/MCO (Cardinal),the LME/MCOs taking on new counties, and their provider
networks, as well as to promote the stability of the LME/MCO system,the Department approves the
following overall timeline for transition.
Cabarrus, Stanly, and Union Counties have already been approved for transition to Partners effective
September 1, 2021. Between October 1, 2021 and December 15, 2021, Forsyth and Davie Counties will
transition to Partners; Rockingham and Davidson Counties will transition to Sandhills; and Mecklenburg
and Orange Counties will transition to Alliance. Specific effective dates for each of these three
realignments will be announced by the Department and communicated to the relevant stakeholders
within the next week. All movement of Cardinal counties not transitioning to Vaya will be complete by
December 15, 2021. Alamance, Caswell, Franklin, Granville, Person, Rowan, and Vance Counties will
remain with Cardinal and transition to Vaya.
NC MEDICAID
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF HEALTH BENEFITS
LOCATION:1985 Umstead Drive, Kirby Building,Raleigh NC 27603
MAILING ADDRESS:2501 Mail Service Center, Raleigh NC 27699-2501
www.ncdhhs.gov • TEL:919-855-4100 • FAX:919-733-6608
AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER
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LME/MCO Area Boards must approve the addition of the counties set out above before the effective
date of the transition if they have not already done so.
All parties must cooperate fully in this dissolution process, including the sharing of client information
necessary to ensure continuity of care, without disruption for the providers and consumers in the
affected counties.
Warren County announced its request to leave Cardinal on August 3, 2021. Halifax, Chatham and Stokes
Counties have not announced their plans. The Department will evaluate these counties and make a
determination in the coming weeks.
Sincerely,
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Dave Richard
Deputy Secretary, NC Medicaid
NC MEDICAID
NC DEPARTMENT OF HEALTH AND HUMAN SERVICES • DIVISION OF HEALTH BENEFITS
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