Sandhills Center awarded BH-I/DD Tailored Plan contract
Publication Date: July 26, 2021
Sandhills Center announced today that it was awarded a contract to administer the Behavioral Health-Intellectual/Developmental Disabilities (I/DD) Tailored Plan under the new Medicaid Managed Care model. The award was granted by the North Carolina Department of Health and Human Services (NCDHHS) and will go into effect on July 1, 2022.
For the last several years, Sandhills Center has operated as a Local Management Entity-Managed Care Organization (LME-MCO), serving individuals and families in Anson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph and Richmond counties in central North Carolina. Sandhills Center manages a network of providers who serve individuals with mental health conditions, substance use disorders and intellectual/developmental disabilities.
As directed by the North Carolina General Assembly, North Carolina has transitioned its Medicaid and NC Health Choice delivery system from a Medicaid fee-for-service model to an integrated Medicaid Managed Care model. Under the integrated Managed Care model, most Medicaid beneficiaries are served by one managed care plan that provides physical health, behavioral health, traumatic brain injury, long-term care and pharmacy services. Tailored Plans will manage physical and behavioral health services for North Carolina Medicaid individuals with a serious mental illness, serious emotional disturbance, severe substance use disorder, intellectual/developmental disability, or traumatic brain injury.
“Sandhills Center is honored by the trust that NCDHHS has put in us,” said Sandhills Center CEO Victoria Whitt. “Sandhills Center and other LME-MCOs have been in a unique position in that we already have the expertise in delivering specialized care to people with complex behavioral health needs. This Tailored Plan contract award confirms Sandhills Center’s ability to improve health outcomes in a cost-efficient manner. We appreciate NCDHHS having trust in us to continue benefiting individuals, families and communities within our region. We share a strong belief and understanding with NCDHHS, and we support its overall vision of creating a healthier North Carolina.”
As part of the contract, Sandhills Center has joined with AmeriHealth Caritas North Carolina, part of the AmeriHealth Caritas Family of Companies, to support Tailored Plan enrollees with their overall healthcare needs. Sandhills Center and AmeriHealth Caritas North Carolina will work in tandem with NCDHHS to advance integrated high-value care for Tailored Plan beneficiaries, improve population health, engage and support providers, and establish a sustainable program with more predictable costs.
AmeriHealth Caritas North Carolina will support Sandhills Center’s physical health services and physical health service network development, claims processing, care management, and other functions.
“Sandhills Center’s reputation, leadership and local support make it an ideal LME-MCO for us to work with to support the Tailored Plan component of Medicaid Transformation,” said AmeriHealth Caritas North Carolina Market President Heidi Chan. “We look forward to working with Sandhills Center to help North Carolinians facing complex health challenges get the most out of the state’s innovative approach to Medicaid.”
“AmeriHealth Caritas Family of Companies is highly regarded for its focus on communities, and whole-person approach to care,” Whitt said. “These qualities are especially important for our organization and the members we serve. We are pleased to form this relationship with AmeriHealth Caritas North Carolina as we enter this new era for the state’s Medicaid program.”
AmeriHealth Caritas North Carolina was chosen by NCDHHS to serve as a health plan for individuals on Medicaid and NC Health Choice enrolled in a Standard Plan. AmeriHealth Caritas North Carolina is managing physical health, behavioral health and pharmacy benefits for more than 300,000 Medicaid beneficiaries enrolled in the Standard Plan, which serves a majority of the NC Medicaid and NC Health Choice population.
When the Tailored Plans go into effect next year, Sandhills Center will serve individuals with more severe and long-term behavioral health conditions, substance use disorders, Intellectual/Developmental Disabilities (I/DD) and traumatic brain injuries.
“Our goal has always been to support individuals to be fully functioning members of their communities,” Whitt noted. “We are excited to continue our good work -- along with AmeriHealth Caritas North Carolina and the NCDHHS -- to facilitate each member’s ability to live where they choose, gain employment and engage in meaningful activities of their choice. We remain committed to assisting members to achieve their goals. Sandhills Center is honored to manage services and supports in the most therapeutically-appropriate and integrated settings for our members, while keeping our tradition of good stewardship of the Medicaid and state funding that is entrusted with us.”
About Sandhills Center
Sandhills Center is a publicly funded LME-MCO committed to helping the people of central North Carolina receive the best care possible for their mental health, substance use disorders and intellectual/developmental disabilities. Sandhills Center manages a network of service providers, ensures the quality of services being provided, and is a resource for behavioral healthcare information or assistance. Sandhills Center is fully-accredited by URAC in the areas of Health Network, Health Call Center, and Health Utilization Management. For more information, visit www.SandhillsCenter.org.
About AmeriHealth Caritas North Carolina
AmeriHealth Caritas North Carolina is a prepaid health plan offering a standard benefit plan to North Carolina Medicaid enrollees. AmeriHealth Caritas North Carolina helps North Carolinians get care, stay well, and build healthy communities by addressing the acute and broader social factors that drive health outcomes. For more information, visit www.amerihealthcaritasnc.com.
About AmeriHealth Caritas
AmeriHealth Caritas is one of the nation’s leaders in health care solutions for those most in need. Operating in 13 states and the District of Columbia, AmeriHealth Caritas serves nearly 5 million Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) members through its integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, and behavioral health services. Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with nearly 40 years of experience serving low-income and chronically ill populations. For more information, visit www.amerihealthcaritas.com