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Behavioral Health I/DD Tailored Plan

North Carolina will launch the Behavioral Health and Intellectual/Developmental Disability Tailored Plan in 2021. This plan is designed for individuals with significant behavioral health needs and intellectual/developmental disabilities (I/DDs). The Behavioral Health I/DD Tailored Plan will also serve other special populations, including Innovations and Traumatic Brain Injury (TBI) waiver enrollees and waitlist members.

News about Eligibility & Enrollment Policy Updates

Aug. 2, 2019–In response to stakeholder feedback, the Department issued several updates to the March 2019 eligibility and enrollment policy guidance for the Behavioral Health I/DD Tailored Plan. Updates include:

  • Additional claims/encounter data markers to determine eligibility based on functional impairment for qualifying diagnoses of serious mental illness or serious emotional disturbance.
  • New forms for beneficiaries assigned to the Standard Plan to request to stay in NC Medicaid Direct (fee-for-service) and the Local Management Entities – Managed Care Organizations (LME-MCOs).
  • Updated enrollment policy to transition Standard Plan enrollees who urgently need a service covered only by NC Medicaid Direct/LME-MCO. A new policy is added for urgent transfer requests.
  • Change reflecting Substance Abuse Intensive Outpatient Program (SAIOP) and Substance Abuse Comprehensive Outpatient Treatment Program (SACOT) services will be covered only by the Behavioral Health I/DD Tailored Plan, instead of both the Standard Plan and Behavioral Health I/DD Tailored Plan.
  • The full text of the update, changes to Appendix B of the policy guidance, and the new provider and beneficiary attestation forms are available on the DHHS Medicaid Transformation Policy Papers web page. The forms are also available at: https://ncmedicaidplans.gov/member-resources.

Upcoming Meetings

No meetings scheduled at this time. 

Resources

 

Previous Meetings

2019

2019

Care Management under the Behavioral Health I/DD Tailored Plan - August 30, 2019

Behavioral Health I/DD Tailored Plan Care Management - August 20, 2019

Behavioral Health I/DD Tailored Plan Care Management - May 30, 2019

Behavioral Health I/DD Tailored Plan Eligibility and Enrollment - March 26, 2019
Note: Eligibility and enrollment policy was updated July 16, 2019. Please refer to the update documents for accurate information.

MCAC Behavioral Health I/DD Tailored Plan Design Subcommittee - March 6, 2019

MCAC Behavioral Health I/DD Tailored Plan Design Subcommittee - Feb. 4, 2019

Integration of Behavioral and Physical Health Care in Tailored Plan - Jan. 24, 2019

2018

2018

Stakeholder Update on Tailored Plan Design - Nov. 28, 2018