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HOP stands for Healthy Opportunities Pilot, a North Carolina Department of Health and Human Services contract. Serving as the Network Lead for Western North Carolina (WNC), Impact Health will support, oversee, and coordinate the work of participating HSOs. The pilot will evaluate health outcomes as well as healthcare costs by using Medicaid funds to pay for services specifically related to food, housing, transportation, interpersonal safety and toxic stress. The HOP will provide a mechanism for payers, providers, and HSOs to develop the tools, infrastructure, and financial means to integrate these essential services into the delivery of healthcare for eligible Medicaid members.
Impact Health is serving as the Network Lead for Region 1 in WNC. A Network Lead is an organization responsible for contracting with the Department and Prepaid Health Plans to develop and manage a network of HSOs providing Pilot services to Pilot Participants.
An HSO is a Human Services Organization that has contracted with Network Lead to participate in its network for the purposes of delivering Contracted Pilot Services. Network Lead establishes the network and monitors and oversees its HSOs under the terms of this Agreement.
HSOs must meet the following qualifications:
HSOs act as frontline social service providers that contract with the Network Lead to deliver authorized, cost effective, evidence-based Pilot services to Pilot enrollees. Additionally, HSOs participate in the healthcare delivery system, including submitting invoices and receiving reimbursement for more information on the services delivered.
This is the defined service area where your organization (the HSO) provides services. Impact Health was awarded a contract for Region 1 in WNC (highlighted in purple below).
Medicaid managed care enrollees in Standard Plans and Behavioral Health I/DD Tailored Plans must live in a Pilot Region and have at least one of the below physical/behavioral health criteria. See below table for more details.
|Eligibility Category||Age||Physical/Behavioral Health Criteria (at least one, per eligibility category)|
|Homelessness and Housing Insecurity||
Patients who are experiencing food insecurity – defined as the disruption of food intake or eating patterns because of lack of money and other resources – including those who:
|Transportation Insecurity||Patients for whom, within the past 12 months, a lack of transportation has kept them from medical appointments or from doing things needed for daily living.|
|At risk of, witnessing, or experiencing interpersonal violence||Patients who report that they felt physically or emotionally unsafe where they currently live; within the past 12 months have been hit, slapped, kicked or otherwise physically hurt by anyone; or within the past 12 months have been humiliated or emotionally abused by anyone.|
For more specific information on eligibility criteria, please visit the DHHS Healthy Opportunities Pilot RFP, starting on page 160.
Below is a list of the Pilot services in each of the domains. You can also refer to the list of services on the NCDHHS fee schedule.
|Interpersonal Violence/ Toxic Stress||
These rates are final and are not negotiable. Once published by the CMS, these are the reimbursable rates. Prior to Service Delivery I, no changes will occur to published rates. After Service Delivery I, the Department may update the fee schedule based on the results from the evaluations and increase HOP service payments to a greater value.
After the service is delivered by the HSO, the HSO transmits their invoice to Impact Health (the Network Lead). Impact Health reviews the invoices for completeness and sends validated invoices to the health plan for payment. From there, HSOs are paid directly (either via check or direct deposit) from the health plans. Once the invoice is authorized, a remittance is sent with payment so that the HSOs can reconcile what services have been paid vs. those pending. The health plan then sends authorized encounter data to DHHS for tracking purposes.
NCCARE360 is a statewide network that unites healthcare and human services organizations with a shared technology that enables a coordinated, community-oriented, person-centered approach for delivering care in North Carolina. It will be a key tool for HSOs in our Healthy Opportunities Pilot because it helps providers electronically connect those with identified needs to community resources and allow for feedback and follow-up. This ensures accountability for services delivered, provides a “no wrong door” approach, closes the loop on every referral made and reports outcomes of that connection. NCCARE360 is available in all 100 counties across North Carolina.
Your organization will accept/decline referrals from care managers within the system. Additionally, after your service delivery is completed, you will update the status to indicate that the service was either completed or not. You will also communicate with care managers through this system for any additional information requested.
Yes, all HSOs participating in the Pilot Program must have a functional use and understanding of NCCARE360. Serving as an essential communication platform, NCCARE360 will allow for referrals, reports on service deliveries, and related outcomes for Pilot services to be shared seamlessly.
To join NCCARE360, please fill out the form on the registration page.
NCCARE360 has training videos for some of the functions that the system provides. If you are contracted with the network, training opportunities will also be available.
If your organization previously submitted an LOI or has been in contact with Impact Health regarding submission, you should have received an invitation via JotForm to apply. You can request an invitation by emailing [email protected].
This round of applications will consist of two phases to choose from:
Application submission window closed June 3, 2022
Target launch date: Summer 2022
Application deadline to Impact Health: July 14, 2022
Target launch date: Fall 2022
The application review process is approximately 2-3 weeks, from initial review for completeness, Readiness Reviews, and Application Committee Review. For a more detailed timeline, please review the timeline below.
Each HSO is scored related to the following areas:
|1. Diversity & Equity||Up to 5 points|
|2. Services||Up to 15 points|
|3. Geographic Reach||Up to 5 points|
|4. Capacity||Up to 15 points|
|5. Clients||Up to 15 points|
|6. Staffing||Up to 5 points|
|7. Community & Partner Relationships||Up to 5 points|
|8. Technical Capacity||Up to 5 points|
|9. Budget||Up to 5 points|
|10. Additional questions focused on unique population or under-represented area(s) served||N/A|
Scoring: There is a maximum score of 75. If an organization scores below 15 points, the application will be put on hold and a staff member from Impact Health will reach out regarding your application.
Please refer to the HSO Network application. This will also be evaluated during the Readiness Reviews. As a reminder, only contracted HSOs are eligible to apply for capacity building funds.
For general questions & information contact: