Shared Savings Plan

As originally announced in the January 2014 Medicaid Bulletin, the Shared Savings Plan was enacted by North Carolina Session Law 2013-360, Sections 12H.18 (b). The details are outlined below.

Effective January 1, 2014, reimbursement rates for the following services rendered to Medicaid and NC Health Choice recipients will be reduced by 3%.

  • Inpatient hospital
  • Physician (excluding primary care providers who have attested for the enhanced reimbursement until January 1, 2015)*
  • Dental
  • Optical services and supplies
  • Podiatry
  • Chiropractors
  • Hearing aids
  • Personal care services
  • Nursing homes
  • Adult care homes
  • Dispensing drugs

*Because of changes required to separate the ACA physicians from the non-ACA physicians, the payments to the non-ACA physicians have not yet been reduced. Once the changes are completed, the previously paid claims for the non-ACA physicians will be adjusted back to January 1, 2014.

DMA is consulting with providers to develop a shared savings plan to implement by July 1, 2014, with provider payments beginning January 1, 2015. The shared savings plan shall provide incentives to provide effective and efficient care that result in positive outcomes for Medicaid and NC Health Choice recipients.
 

DMA will host a series of webinars in order to provide stakeholders with an overview of the Shared Savings Plan as well as solicit ideas on the shared savings methodology. More information regarding the Shared Savings Plan, including upcoming webinar dates, is available at http://www.ncdhhs.gov/dma/plan/index.htm.
 

Questions, comments and/or recommendations regarding the Shared Savings plan can be sent to DMA.NCSharedSavings@lists.ncmail.net.