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Advanced Medical Home

The North Carolina Department of Health and Human Services (DHHS) developed the Advanced Medical Home (AMH) program as the primary vehicle for delivering care management as the state transitions to Medicaid managed care. The AMH program builds on the Carolina ACCESS program.

The AMH program requires prepaid health plans (PHPs) to delegate certain care management functions to AMHs at the local level. In order to provide these care management functions, AMHs may work with their affiliated health care system or make an arrangement, with an entity called a Clinically Integrated Network, a Care Management vendor or other population health entity. To ensure that beneficiaries across the state are receiving high quality care management, DHHS developed standards for AMHs and will be responsible for initially certifying that practices meet AMH criteria.

Advanced Medical Home Technical Advisory Group

As part of ongoing Medicaid Transformation in North Carolina, DHHS has convened a Technical Advisory Group (TAG) to support the AMH program. The role of the AMH TAG will be to advise and inform DHHS on key aspects of the design and evolution of the AMH program. For more information on the AMH TAG, please click here

New Updates

Nov. 8, 2019 - DHHS is in the process of implementing a high-performing managed care program in which the AMH program plays a key role. AMHs will be the foundational primary care component of North Carolina’s Medicaid system following the transition to managed care and are at the heart of our policy goal of providing local care management to high-need Medicaid beneficiaries. 

Over the last few months, we have listened to feedback from the AMH TAG, as well as many others in the market regarding the AMH payment model, practice readiness, and PHP oversight methodologies. In light of this feedback, we are issuing an amendment to the North Carolina Medicaid Managed Care PHP Contract. DHHS is providing advance notice of key provisions contained in this contract amendment. Information about the changes can be found here, AMH Contract Amendment Guidance
 

Oct. 15, 2019 - NC Medicaid has published information for AMH providers who believe they are not ready to meet program requirements to perform at the tier level to which they attested. Providers may now submit a request to change their AMH Tier status from Tier 3 to Tier 2. The AMH Tier 3 providers may not downgrade lower than AMH Tier 2. For more information, visit https://medicaid.ncdhhs.gov/blog/2019/10/15/protocol-changing-advanced-medical-home-tier-status

Training

No training is currently scheduled, please check back regularly for updates. Previous training is available on the AMH Training Page

Resources

AMH Data Specification Guidance
AMH Provider Manual
Supporting Provider Transition to Medicaid Managed Care

Policy Papers

Clinically Integrated Networks and Other Partners Support of Advanced Medical Homes Care Management Data Needs
Data Strategy to Support the Advanced Medical Home Program in North Carolina
North Carolina's Care Management Strategy under Managed Care

Programmatic Guidance

Programmatic Guidance on Care Management Component of PHP Capitation Rates
Programmatic Guidance on Risk Stratification for Tier 3 AMH Practices
Protocal for Changing Advanced Medical Home Tier Status

Frequently Asked Questions

AMH Frequently Asked Questions
Data Strategy Frequently Asked Questions

    Additional Information