Frequently Asked Questions

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Frequently Asked Questions

General Pilot Information

What is HOP?

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.

Where can I find more information on the Healthy Opportunities Pilot?

Pilot Entities

Who is Impact Health?

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.

What is an HSO?

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.

What type of organization may apply as an HSO for this program?

HSOs must meet the following qualifications:

Operating as a legal entity in North Carolina
Provide social services covered by the Pilot program to Medicaid-eligible individuals residing within the Pilot region high-quality non-medical services to vulnerable, high-risk individuals in the following Priority Domains: housing, transportation, food insecurity, interpersonal violence and toxic stress.
HSOs will enroll in NCTracks

What are the roles and responsibilities of HSOs?

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.

Geographic Service Area

What is an eligible service geographic area?

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).

WNC map

Eligibility

Who is eligible to receive Pilot Services?

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.

Pilot Eligibility: Physical/Behavioral Health Criteria.

NC Medicaid Managed Care members must meet at least one physical/behavioral health criteria and one social risk factor to be eligible for the Pilot program.

Eligibility Category	Age	Needs-Based Criteria (at least one, per eligibility category)
Adults	21+	2 or more chronic conditions. Chronic conditions that qualify an individual for pilot enrollment include: BMI over 25, blindness, chronic cardiovascular disease, chronic pulmonary disease, congenital anomalies, chronic disease of the alimentary system, substance use disorder, chronic endocrine and cognitive conditions, chronic musculoskeletal conditions, chronic mental illness, chronic neurological disease, chronic infectious disease, cancer, autoimmune disorders, chronic liver disease and chronic renal failure, in accordance with Social Security Act section 1945(h)(2). Repeated incidents of emergency department use (defined as more than four visits per year) or hospital admissions. Former placement in North Carolina’s foster care or kinship placement system. Previously experienced three or more categories of adverse childhood experiences (ACEs)
Pregnant Women	n/a	Multifetal gestation Chronic condition likely to complicate pregnancy, including hypertension and mental illness Current or recent (month prior to learning of pregnancy) use of drugs or heavy alcohol Adolescent ≤ 15 years of age Advanced maternal age, ≥ 40 years of age Less than one year since last delivery History of poor birth outcome including: preterm birth, low birth weight, fetal death, neonatal death Former or current placement in NC’s foster care or kinship placement system Previously experienced or currently experiencing three or more categories of ACEs
Children	0-3	Neonatal intensive care unit graduate Neonatal Abstinence Syndrome Prematurity, defined by births that occur at or before 36 completed weeks gestation Low birth weight, defined as weighing less than 2500 grams or 5 pounds 8 ounces upon birth Positive maternal depression screen at an infant well-visit
Children	0-20	One or more significant uncontrolled chronic conditions or one or more controlled chronic conditions that have a high risk of becoming uncontrolled due to unmet social need, including: asthma, diabetes, underweight or overweight/obesity as defined by having a BMI of <5th or >85th percentile for age and gender, developmental delay, cognitive impairment, substance use disorder, behavioral/mental health diagnosis (including a diagnosis under DC: 0-5), attention-deficit/hyperactivity disorder, and learning disorders Experiencing or previously experienced three or more categories of adverse childhood experiences (e.g. Psychological, Physical, or Sexual Abuse, or Household dysfunction related to substance abuse, mental illness, parental violence, criminal behavioral in household)

In addition to the above criteria, Medicaid enrollees must have at least 1 Social Risk Factor within the following categories:

Pilot Eligibility: Social Risk Factors

Risk Factor	Definition
Homelessness and housing insecurity	Homelessness, as defined in 42 C.F.R. § 254b(h)(5)(A), or housing insecurity, as defined based on the principles in the questions used to establish housing insecurity in the Accountable Health Communities Health Related Screening Tool or the North Carolina Social Determinants of Health (SDOH) screening tool.^1,2</sup
Food insecure	As defined by the US Department of Agriculture commissioned report on Food Insecurity in America:³ Low Food Security: reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake. Very low food security: Reports of multiple indications of disrupted eating patterns and reduced food intake Or food insecure as defined based on the principles in the questions used to establish food insecurity in the North Carolina Social Determinants of Health (SDOH) screening tool.⁴
Transportation insecure	Defined based on the principles in the questions used to establish transportation insecurities in the Accountable Health Communities Health Related Screening Tool or the North Carolina SDOH screening tool.5
At risk of, witnessing or experiencing interpersonal violence	Defined based on the principles in the questions used to establish interpersonal violence in the Accountable Health Communities Health Related Screening Tool or the North Carolina SDOH screening tool.⁶

¹ The Accountable Health Communities Health-Related Social Needs Screening Tool. Available https://innovation.cms.gov/files/worksheets/ahcm-screeningtool.pdf.

² North Carolina’s SDOH Screening Questions. Available:
https://www.ncdhhs.gov/about/department initiatives/healthy-opportunities/screening-questions

³ USDA Economic Research Service [Internet]. Washington: USDA Economic Research Service; [updated 2017 Nov 27]. Definitions of Food Insecurity; [updated 2017 Oct 4; cited 2017 Nov 27]. Available from: https://www.ers.usda.gov/topics/food nutrition-assistance/food-security-in-the-us/definitions-of-food-security/

⁴ North Carolina SDOH Screening Tool. Available: https://www.ncdhhs.gov/about/department-initiatives/healthy opportunities/screening-questions

⁵ Ibid

⁶Ibid.

For more specific information on eligibility criteria, please visit the DHHS Healthy Opportunities Pilot RFP, starting on page 160.

Covered Services

What types of services are eligible for reimbursement?

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.

Housing	Housing and Navigation Support and Sustaining Services Inspection for Housing Safety and Quality Housing Move-in Support Essential Utility Set-up Home Remediation Services Home Accessibility and Safety Modifications Healthy Home Goods One-time Security Deposit and First Month’s Rent Short-Term Post Hospitalization Housing
Food	Food and Nutrition Access Case Management Services Evidence-Based Group Nutrition Class Diabetes Prevention Program (DPP) Fruit and Vegetable Prescription Healthy Food Box (Delivery and/or Pick-up) Health Meal (Delivery and/or Pick-up) Medically Tailored Home Delivered Meals
Transportation	Reimbursement for Health-Related Public Transportation Reimbursement for Health-Related Private Transportation Reimbursement for Gas Mileage Transportation PMPM Add-on for Case Management Vehicle repairs may be reimbursable
Interpersonal Violence/ Toxic Stress	IPV Case Management Violence Intervention Services Evidence-Based Parenting Curriculum Home Visiting Services Dyadic Therapy
Cross Domain	Holistic High Intensity Enhanced Case Management Services Medical Respite Linkages to Heath-Related Legal Supports

Fee Schedule

Are the rates within the fee schedule final? Are there negotiable rates?

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.

What is reimbursable?

Refer to the list of services on the NCDHHS fee schedule.

Invoicing & Payments

How do we (HSOs) get paid for services?

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

What is NCCARE360?

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.

What do I use NCCARE360 for?

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.

Do I have to use NCCARE360?

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.

How do I register for NCCARE360?

To join NCCARE360, please fill out the form on the registration page.

Will training be provided on NCCARE360?

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.

Application Process

How do I obtain an application?

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].

When are the application submission deadlines?

This round of applications will consist of two phases to choose from:

Phase 1: Organizations that are ready to apply and can meet a short deadline.

Application submission window closed June 3, 2022
Target launch date: Summer 2022

Phase 2: Organizations that are almost ready, but need a little bit more time to complete the application.

Application deadline to Impact Health: July 14, 2022
Target launch date: Fall 2022

Evaluation Criteria

How long will the application review process take?

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.

What are the evaluation criteria?

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.

Contracting

What do I need to know about contracting?

A copy of the executed Network Lead-HSO Model Contract will be delivered to the signatory for your organization via email once both parties have signed.
To review the model contract prior to generation, please refer to this example contract.
For organizations that subcontract out portions of service delivery, further discussions will be had about the subcontractor’s potential role in your delivery of service method. Please note that all use of subcontractors must be approved by Impact Health prior to Pilot Service Delivery authorization.

Capacity Building Funds

How can I apply for capacity building funds?

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.

How may capacity grant funds be used?

Pilot Capacity Building funds can be utilized in the following categories only:
- Operationalizing day-to-day Pilot-related responsibilities
- Developing necessary infrastructure/systems
- Pilot service delivery enhancements
- Participation in learning collaboratives
- Participation in Pilot Program Evaluation activities

Who can I contact with questions?

For general questions & information contact:

Laurie Stradley, DrPH
Executive Director
[email protected]
828.688.0422

Amanda Bauman
Director of Programs
[email protected]
828.564.6427

Rachel Walker
Community Engagement Manager
[email protected]
828.688.0432

Punam Medina
Community Engagement Manager
p.[email protected]
828.378.4860

Am I Eligible?

Frequently Asked Questions

HSO Network Introduction

Ready to apply?

Frequently Asked Questions

General Pilot Information

Pilot Entities

Geographic Service Area

Eligibility

In addition to the above criteria, Medicaid enrollees must have at least 1 Social Risk Factor within the following categories:

Covered Services

Fee Schedule

Invoicing & Payments

NCCARE360

Application Process

Phase 1: Organizations that are ready to apply and can meet a short deadline.

Phase 2: Organizations that are almost ready, but need a little bit more time to complete the application.

Evaluation Criteria

Contracting

Capacity Building Funds

Who can I contact with questions?

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