Advanced Medicaid Home Update

Nearly 2,900 North Carolina Medicaid providers have already certified as Advanced Medical Homes (AMHs). It is important that practices understand the meaning of this designation and the associated requirements on primary care providers (PCPs).

About the AMH Program

The AMH program is the platform for practices to provide care management to Medicaid patients in their practice who need it when North Carolina transitions its Medicaid program to managed care in November 2019.

The AMH program is open to any PCP who is enrolled in Medicaid and is certified by the Department as an AMH. The program has three “tiers,” with each subsequent tier involving greater care management responsibility and higher corresponding reimbursement:

• In AMH Tiers 1 and 2, practice care delivery requirements and Medical Home Fees will remain unchanged from Carolina ACCESS (commonly referred to as “CCNC”)
• AMH Tier 3 requires practices to take on additional care management responsibility either through in-house capabilities or in partnership with a Clinically Integrated Network (CIN) or another partner. In exchange, Tier 3 practices will have the opportunity to receive additional payments from Medicaid Managed Care Prepaid Health Plans (PHPs). PHPs will be required to contract with all Tier 3 AMHs in each region.
• To learn more about AMH payments, see questions P1 – P12 of the AMH FAQs.

How does a Practice Become Certified as an AMH?

Practices become certified as AMHs in two ways:

• Grandfathering into Tier 1 or Tier 2. All Medicaid providers that were enrolled in Carolina ACCESS as of 9/9/2018 were automatically given an AMH certification status into AMH Tier 1 or Tier 2 (see questions A1 – A13 of the AMH FAQs for more information on this process).
• Attestation. Practices can become certified into a higher tier by completing an attestation through NCTracks. Attestation is the only route into AMH Tier 3.
   

Program Updates

The AMH attestation portal opened Oct. 1, 2018. Attestation into AMH Tier 3 is seeing high participation from practices across the state.

In early April, the Department will the share with PHPs the list of certified AMHs in each tier. At that time, more information will be released about the statewide and regional counts of practices in each tier.

What do Practices Need to do Next?

1. Make sure you know your AMH tier status. Confirm your AMH tier status by logging into NCTracks (see here for a guide to accessing AMH information through NCTracks).
2. Begin or continue PHP contracting. The State’s Medicaid Managed Care PHPs were recently selected and are beginning to form their provider networks. All providers serving Medicaid patients (regardless of AMH status) should begin communicating with PHPs. There is no need to wait for the Department’s release of AMH information to PHPs for your practice to begin communicating with PHPs. To learn more about PHP contracting, see questions C1 – C9 of the AMH FAQs.

Learn more about the AMH program by visiting the AMH homepage, or email medicaid.transformation@dhhs.nc.gov with any questions.