Draft Provider Manual for Tailored Care Management

Author: Medicaid Transformation, Medicaid.transformation@dhhs.nc.gov

We are pleased to share for comment the draft provider manual and application process for care management for people with Behavioral Health and I/DDs who will be served by Tailored Plans. While the implementation of managed care has been suspended as legislative action is needed to move forward, the Department continues to work on the design of Tailored Plans.   

As you know from our conversations throughout this year, one of the Department’s key areas of focus in Medicaid Transformation is building robust and effective models for managing beneficiaries’ comprehensive needs through local care management. Provider-based care management will promote whole-person care, foster high-functioning integrated care teams, and drive towards better health outcomes.  

We recognize that it will take time to build up a delivery system to support Tailored Care Management that is fully integrated with primary care and other providers. This manual supports providers by describing the model requirements and initiating the certification application process for Advanced Medical Homes and Care Management Agencies. As described in the manual, we will have a schedule for reviewing applications throughout 2020 in four “batches.” The first deadline for providers to apply will be Feb. 7, 2020.  

For more information on the provider webinar and application process, see the webinar "Tailored Care Management: What Providers Need to Know" below.

For now, North Carolina’s move to Medicaid Managed Care has been suspended. All health providers enrolled in Medicaid are still part of the program and will continue to submit claims through NCTracks as they do today. Beneficiaries will continue to access Behavioral Health and I/DD services through LME-MCOs. These services will continue to be provided as they are today.

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