News & Announcements

• Network Operations Communications Bulletin FY-0910-NM-05 Provider Requests for Information about Peer Support
  Date posted: 11/16/2009

• PBH Administration Communication Bulletin FY-0910-AA-02 - Medicaid Cards
  Date posted: 9/22/2009

• Renewed - Final Approved Piedmont 1915b Waiver
  Date posted: 4/21/2009

• Medically Necessary Treatment
  Date posted: 4/6/2009

The State of North Carolina has provided tremendous support for the Piedmont demonstration. Under the direction of the NC Department of Health and Human Services, combined 1915(b) and 1915(c) waivers were developed and approved by the Center for Medicare and Medicaid Services. Under section 1915(b) States can request that the regulations governing comparability of services, state wideness and freedom of choice be waived in order to operate a managed care program where freedom of choice of providers is restricted to providers approved and designated by the Managed Care Organization (PBH) and in only certain counties of the state (the PBH catchment area). Section 1915(c) allows states to request that regulations dealing with comparability of services, state wideness, and community income and resource rules be waived so that individuals who qualify for Medicaid-funded institutional care (ICF-MR) can be cared for in the community through home and community based services.

1915(b) waivers are approved for two-year periods. 1915(c) waivers are approved for three years, initially, and must be renewed every five years thereafter. 1915(b) waivers must be cost effective in that service provision is based on historical utilization and adjusted for changes in trend; actual per capita expenditures cannot exceed these projections. 1915(c) waivers require that the average cost of care of all Medicaid services for persons participating in the waiver be no more than the average cost of care if the person were living in an ICF-MR.

Why did PBH choose a 1915 (b) Waiver?

• Better coordinate our system of care for consumers, families and providers.
• Be able to manage our system’s resource so that money can be directed to those most in need.
• Develop more complete range of services and supports in the community  so that most people can receive services in their community  with as little disruption to their lives as possible.
• Create new programs that are not available statewide by using money generated from savings produced by managing care and resources more effective