The North Carolina Department of Health and Human Services (DHHS) continues to prepare for the launch of Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans on July 1, 2022.
Through Tailored Care Management, Behavioral Health I/DD Tailored Plan beneficiaries will have a single designated care manager supported by a multidisciplinary care team to provide whole-person care management that addresses all of their needs, spanning: physical health, behavioral health, I/DD, traumatic brain injuries (TBI), pharmacy, long-term services and supports (LTSS) and unmet health-related resource needs.
The Department is releasing the draft Tailored Care Management Desk Review Guide and Scoring Tool to support providers applying for AMH+ or Care Management Agency (CMA) certification. The tool can be found on the NC Medicaid Tailored Care Management webpage under Resources.
The Department will use this document during the desk review phase of the certification process to score providers submitting the AMH+ and CMA Certification Application for Tailored Care Management. Providers that pass this desk review will move on to the site review portion of the certification process. The Department is making this document publicly available to give applicants more guidance on what reviewers will be looking for when assessing an application.
As a reminder, the purpose of the desk review is to determine that the applicant organization has given serious thought as to how it will operationalize the Tailored Care Management model, including an overview of the policies and procedures that will be needed or revised to efficiently operate the model.
In addition to describing the organization’s proposed approach to implementing Tailored Care Management, applicants should ensure that their applications identify perceived challenges to implementation and associated mitigation strategies to address each challenge. The information will help the Department confirm applicants’ understanding of the complexity of this undertaking and awareness of the potential changes to their organizations’ existing financial and clinical operations that may be required to be successful.
When evaluating an application, reviewers will look for details on how the applicant will address each Tailored Care Management requirement. Applicants’ answers should not merely repeat the Tailored Care Management Provider Manual language accompanied by a commitment that their organization will perform the requirements. Instead, answers should specify the processes, personnel, outside resources, etc. that the organization will use to operationalize each aspect of the Tailored Care Management model and achieve its objectives.
Applications for the first round of AMH+ and CMA certification are due on June 1, 2021 to Medicaid.TailoredCareMgmt@dhhs.nc.gov.
For more information on Tailored Care Management, please visit NC Medicaid’s Tailored Care Management webpage, and send any comments or questions to Medicaid.TailoredCareMgmt@dhhs.nc.gov.