Healthy Opportunities Pilot - HSO Network Application (PDA06-HO)

Thank you for your interest in participating in the Healthy Opportunities Pilot (HOP) as a Human Service Organization (HSO). All HSOs (community based or social service agencies) that engage in the application process must plan to join the HSO Network for the length of this pilot and be willing to invest time and resources using capacity building funds to participate in implementation, training, and service delivery. The HSOs in the Network will serve one or more counties in the approved six-county region in one or more approved service delivery areas.

If you have not yet connected with a member of the HOP Implementation Team prior to receiving this application or would like technical assistance in completing the application process, please contact Meaghan Lewis at mlewis@capefearcollective.org. Sector Program Managers and Care Council Leads are available to assist HSOs throughout the implementation process. We will also have a recorded “How to” session available to all applicants including guidance on capacity building budgets, permissible uses of HSO capacity building funding, and the process for distributing funds.

Max number of characters per response is 32,000.

Applications are due by midnight, October 12, 2021.

Please download and save the documents below, if needed, before you begin application process.

Click this link to download HSO Capacity Building Funding Distribution Approach and Permitted Use of HSO Capacity Building Funds

Click this link to download the capacity building budget template.

Service delivery for the Pilot is slated to begin on February 1, 2022. However, the NC Department of Health & Human Services is considering a phased approach in rolling out services. This means some HSOs accepted into the Network would begin all or a portion of the services in February while other HSOs that may require additional time to prepare for service delivery would phase in at a later time. There is no penalty or incentive given to HSOs depending on when they start service delivery.

The Implementation Team will be looking for early adopters to begin services on February 1, 2022. These organizations should consider the following when indicating their readiness to rollout services in February:      

• NCCARE360, the platform through which a HSO receives and closes referrals and invoices for services will have some functionality on February 1, 2022 but we anticipate updates and improvements as the Pilot progresses. HSOs starting services in February may have to work with us on glitches and be flexible to iterations of the system as it progressively becomes fully functional.

• HSOs that are early adopters ideally should already be providing some services that align with the 29 reimbursable services. An HSO that is launching or starting new services, which is allowable under the Pilot, may not be prepared to deliver that service or services on February 1, 2022.

• Similar to the consideration above, HSOs should be providing services in the county or counties where they have applied to provide services in February. An HSO scaling to a new geographic region, also allowable under the Pilot, may have challenges being ready to deliver those services in a new county by February 1.      

NCDHHS and CCLCF are committed to prohibiting discrimination and will require all entities to comply with State and Federal laws, regulations, guidelines, and standards prohibiting discrimination. Provide your organizations non-discrimination policy to include:

1. The definition of discrimination under Federal law; 
2. Policies and procedures to identify resources and address the needs of individuals with disabilities;
3. Procedures to ensure that the policy is available to share with staff and program participants as requested.

DHHS and CCLCF require that all HSOs in our regions network have the ability to meet time, distance, and wait time standards. In our network:

• All NCCARE360 referrals from PHP/Care Management Entities must be responded to within 2 business days (48 hours).
• HSOs must make best efforts to provide services within 3 business days (72 hours) or must contact client within 3 business days (72 hours) after accepting referral from NCCARE360.
• Services provided in which a client must travel to receive services should be within 10 miles of person's residence, if at all possible. If it is not possible (for example: in our more rural and underserved areas) an explanation should be provided.
• Where distance standards cannot be met, telephonic services, enhanced transportation services, or home-based delivery systems must be maximized.

In order to be considered to participate in the HSO Network, the following commitments must be made.  

Commitment to NCCARE360 Platform

NCCARE360 is the first statewide coordinated care network to electronically connect those with identified needs to community resources and allow for a feedback loop on the outcome of that connection. Prepaid Health Plans (PHPs) and care management entities are expected to use NCCARE360 to connect all Medicaid Managed Care Members to necessary community resources and track closed loop referrals. HOP HSOs are required to use NCCARE360 as well. PHPs and care management entities will use NCCARE360 to connect Pilot Participants to HSOs that are in CCLCF’s network for the delivery of authorized Pilot services. HSOs will also use NCCARE360 as an invoicing system for service delivery fee payment.

Commitment to NCTracks

NCTracks is the muti-payor Medicaid Management Information System for the North Carolina Department of Health and Human Services. NCTracks processes health care claims for about 70,000 enrolled DHHS providers who serve over 1 million North Carolina citizens. All contracted HSO’s must enroll as a Medicaid provider into NCTracks and adhere to any guidance issued by the Department or its NCTracks vendor to ensure timely enrollment.

Program Integrity Exclusion List Monitoring

To promote program integrity, the Network Lead (CCLCF) will check the exclusion status of its own and the Pilot Network HOP HSO employees, directors, governing bodies, agents and subcontractors on a monthly basis to ensure that the Department and PHP’s do not pay federal funds to excluded persons or entities, or persons or entities otherwise prohibited from receiving such payments. The contracted HSO must agree for the Network Lead or the organization contracted to check exclusion status of all HOP HSO employees on a monthly basis. The following lists are:

• U.S. Department of the Treasury’s Office of Foreign Assets Control Sanction Lists
• Social Security Administration Death Master File
• System of Award Management
• U.S. Department of Health and Human Services, Office of Inspector General’s List of Excluded Individual and Entities
• North Carolina Medicaid Exclusion List

Training and Technical Assistance

Contracted HSO’s would commit to training and technical assistance in preparation for Service Delivery beginning February 1, 2022. Continued training and technical assistance will take place during Service Delivery. Training may include: health equity, cultural competency, Value Based Care 101, HIPAA, NCCARE360 referral, NCCARE360 invoicing, Network Lead/HSO/PHP collaboration and work flow, Fraud/Waste/Abuse, Community Resiliency Model training.