New NC Medicaid Direct PCCM Participation Agreement
Effective July 1, 2021, most NC Medicaid beneficiaries who are not assigned to a Prepaid Health Plan (PHP) or the Eastern Band of Cherokee Indians (EBCI) Tribal Option continue to receive all covered benefits through NC Medicaid Direct. This population includes beneficiaries dually eligible for Medicaid and Medicare, beneficiaries with serious behavioral health conditions or developmental disabilities (I/DD) who will be eligible for the Behavioral Health I/DD Tailored Plan in July 2022, and beneficiaries in foster care. The Division of Health Benefits (DHB) continues to contract for primary care case management services for the NC Medicaid Direct population with North Carolina Community Care Networks (CCNC).
CCNC is also able to share quality measure results with Carolina Access practices for beneficiaries enrolled in NC Medicaid Direct. Examples of quality measures tracked by CCNC include well child visits, immunizations and HbA1c testing. For a Carolina Access practice to receive or continue to receive practice assignment data or quality data, it must sign the new 2-Party Agreement with CCNC, with the exception of Carolina Access providers participating in the EBCI Tribal Option.
During the week of October 11 or shortly thereafter, you will receive an email from CCNC through firstname.lastname@example.org or email@example.com with information about this agreement. DHB encourages all Carolina Access practices to sign this agreement to access quality data on beneficiaries in NC Medicaid Direct.