Author: Medicaid Long-Term Services and Supports, 919-855-4340
NC Medicaid has approved the release of a Request for Proposal (RFP) for an independent assessment entity (IAE) that will streamline access to Medicaid Long-Term Services and Supports (LTSS) effective July 2019. The IAE will provide beneficiaries a much-needed single point of entry for accessing Medicaid LTSS services and streamline the processes between initial contact and service enrollment.
The RFP will seek a vendor to conduct intakes, assessments and other screenings to determine eligibility for the following LTSS programs:
- State Plan Personal Care Services (PCS)
- Community Alternatives Program for Children (CAP/C)
- Community Alternatives Program for Disabled Adults (CAP/DA)
In addition, the selected vendor will also provide management and oversight for the Pre-admission Screening and Resident Review process (PASRR) Level II and serve as North Carolina’s local contact agency (LCA) for nursing home (NH) residents who have requested information about options for less restrictive care settings. The LCA will provide NH residents with options for transitioning from institutional care to community-based living.
NC Medicaid LTSS currently utilizes an IAE, case management entities (CMEs), county departments of social services (DSSs), local management entities/managed care organizations (LME/MCOs) and hospitals to refer and authorize services for the above-mentioned programs. Medicaid is expanding the scope of the current IAE model to create a comprehensive assessment entity as a “single and uniform access point” for potential Medicaid enrollees and their caregivers to determine what services may support them in maintaining independence and stability in their health condition in the least restrictive setting possible.
NC Medicaid plans to initiate the IAE in three phases for each program. The phases are: 1) stakeholder/beneficiary training; 2) scheduling; and 3) assessments/interview completion. NC Medicaid is working on a tentative schedule to be released after the RFP posting.
Additional benefits of the implementation of a comprehensive independent assessment entity are improvements in timeliness and overall operational efficiency for all programs. The selected vendor will be required to have customer support service center capacity to direct the public to the appropriate service area and assist with all questions related to their LTSS needs and programs.
NC Medicaid anticipates posting the comprehensive assessment entity RFP in March 2019.