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Behavioral Health I/DD Tailored Plans

North Carolina will launch specialized managed care plans, called BH I/DD Tailored Plans, starting in 2021. These plans are designed for those with significant behavioral health (BH) needs and intellectual/developmental disabilities (I/DDs). BH I/DD Tailored Plans 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 has issued several updates to the March 2019 eligibility and enrollment policy guidance for Behavioral Health I/DD Tailored Plans. Updates include:

  • Additional claims/ecounter data markers to determine eligiblity based on functional impairment for qualifying diagnoses of serious mental illness or serious emotional disturbance.
  • New forms for beneficiries assigned to Standard Plans to request to stay in NC Medicaid Direct (fee for service) and the LME-MCO.
  • 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 Behavioral Health I/DD Tailored Plans, instead of both Standard Plans and Behavioral Health I/DD Tailored Plans.

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 also will be available on the Enrollment Broker website mid-August.

Upcoming Meetings

There are no scheduled meetings at this time. 

Resources

 

Previous Meetings

2019

2019

Care Management under BH I/DD Tailored Plans - August 30, 2019

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

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

BH 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 BH I/DD Tailored Plan Design Subcommittee - March 6, 2019

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

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

2018

2018

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