By OPEN MINDS Circle
The Alabama Medicaid Agency is rebidding its contracts for the Alabama Coordinated Health Network (ACHN) program, which is the state’s primary care case management (PCCM) entity. The ACHN contractors do not deliver or pay for medical services, rather the contractors provide care coordination services for approximately 695,000 beneficiaries annually. For the rebid, the Alabama Medicaid Agency released a request for proposals (RFP 24000000055) on December 27, 2023. Proposals are due by March 4, 2024, and the state intends to announce awards on April 19, 2024.
The new contracts are slated to begin October 1, 2024, and will run for one initial term followed by four one-year renewal options. The maximum amount payable per region for per-member per-month (PMPM) payments and care management services totals about $55.5 million. Across the state’s seven regions, that ranges from $7.1 million for the Central region to up to $9.2 million for the state’s Southwest region.
The ACHN contractors serve the following populations: beneficiaries considered medically complex, those receiving maternity care, children under age 19, parents or other caretaker relatives, foster children, individuals with breast and cervical cancer, and American Indians. The current seven ACHN contractors, under contracts awarded in 2019, each serve one of the state’s regions: MyCare Alabama Northwest, North Alabama Community Care, Gulf Coast Total Care, Alabama Care Network Southeast, Alabama Care Network MidState, MyCare East, and MyCare Central. When it was implemented in 2019, the ACHN streamlined the state’s many care coordination programs through four programs into a single program with seven region-specific managing entities (one per region). The four prior programs were: Family Planning Care Coordination services, Patient 1st State Plan Amendment (SPA) Care Coordination services, Health Home (HH) functions, and Maternity Care (1915(b) Waiver) functions.
In their proposals, interested organizations must identify the specific region for their proposal. Bids for multiple regions must be submitted separately. The ACHN contractors for each region will provide the following services:
- Population health management
- Comprehensive care management to include case management and care coordination
- On-going monitoring
- Quality improvement programs
- Comprehensive transitional care for recipients leaving inpatient care
- Network adequacy development and maintenance
Through the ACHN, the state seeks a Medicaid delivery system that allows for seamless person-centered case management and care coordination across eligibility categories and incentivizes quality outcomes. At the same time, the system should be able to address statewide and regional health outcome goals; conduct outcome-focused population management activities; and facilitate timeliness of key health activities such as screenings, flu shots, early entry to prenatal care, and care for addiction disorder. The ACHN contractors should focus on identifying and addressing health disparities and service needs considered social determinants of health; and should focus on health literacy and educate beneficiaries on their conditions, medications and importance of compliance, medical compliance, healthy eating, and the importance of exercise in driving quality health outcomes. The ACHN contractors will have flexibility to facilitate services to address regional issues such as asthma or a higher than average incidence of neonatal abstinence syndrome.
For more information about the RFP, contact: Joseph Showalter, Alabama Medicaid Agency, 501 Dexter Avenue, Montgomery, Alabama 36104; 334-353-3652; Email: joseph.showalter@medicaid.alabama.gov; Website: https://medicaid.alabama.gov
For general information about the current Medicaid framework, contact: Melanie Cleveland, Communications Director, Alabama Medicaid Agency, 501 Dexter Avenue, Montgomery, Alabama 36104; 334-353-9363; Email: Melanie.cleveland@medicaid.alabama.gov; Website: https://medicaid.alabama.gov