Tailored Care Management Updates – Jan. 28, 2022

Provider manual updated, guidance on the use of extenders, updated rate guidance and webinar series FAQs.

Provider Manual Updated

While the launch of Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans has been delayed until December 2022, the Department continues to work on the design and implementation of the Tailored Plans and the provision of Tailored Care Management (Tailored CM). This vital service will provide care management for people with Behavioral Health and Intellectual and Developmental Disabilities (I/DDs) who will be served by Tailored Plans. We are pleased to announce the updated Tailored Care Management Provider Manual to reflect changes to the Tailored Care Management model since the December 2020 version of the manual. Notable changes include updates to the Tailored Care Management certification process, care management staffing, care management assignment methodology, transitional care management, health information technology and care management payments approach.

Guidance on the Use of Extenders in Tailored Care Management

NC Medicaid has published updated guidance on the use of extender staff in the provision of Tailored Care Management. This document is to provide guidance on how “care manager extenders” can support care managers in delivering Tailored Care Management and fulfilling the member contact requirements. The care manager extender guidance provides details on extender qualifications, functions, contact requirements, training requirements and payment considerations.

Updated Tailored Care Management Rate Guidance

The Department has recently published updated guidance on rated for Tailored CM services.  This guidance is an updated version of previous guidance released on May 14, 2021. Through this update, we provide the final Tailored Care Management rates for Contract Year 1 and provide additional detail on the development of the rates. Key updates include final rates by acuity tier for Contract Year 1, the inclusion of care manager extender, caseload and cost assumptions in the final rates, as well as an Innovations/Traumatic Brain Injury (TBI) Waiver Add-On payment. Additional details are available in the full Tailored CM Rate Guidance document.

Tailored Care Management 101 Webinar Series FAQs

On Jan. 21, 2022, NC Medicaid published a compendium of questions posed during the Tailored Care Management 101 webinar series in a Frequently Asked Questions (FAQs) documents. The Tailored Care Management 101 webinar series which ran from October through mid – December 2021 was designed to help develop a shared understanding of the model across the North Carolina provider community (including advanced medical homes and behavioral health, I/DD and TBI providers) and anyone interested. Additional Tailored Care Management training information can be found on the program’s training page.

All updates can be found on the Tailored Care Management webpage.



Related Topics: