Tailored Care Management Updated Guidance (April 21, 2022)

Capacity building FAQs, guidance on the use of extenders, standard terms and conditions, and Provider Manual updates.

NC Medicaid has published the following updated Tailored Care Management guidance:

Capacity Building Program FAQs

To ensure the successful implementation of Tailored Care Management, the Department has launched the Tailored Care Management Capacity Building program, under which approximately $90 million in funding will be distributed across the state starting in 2022. Providers certified as Advanced Medical Home Plus (AMH+) practices and Care Management Agencies (CMAs) are eligible to receive capacity building funding for investments in: 

  • Care management-related health information technology (HIT) infrastructure, 
  • Hiring and training care managers, and
  • Activities related to operational readiness (e.g., developing policies/procedures/workflows). 

Capacity Building Program FAQs provide answers to common questions regarding the Tailored Care Management Capacity Building Program. Additional information on the program can be found on the Tailored Care Management Capacity Building webpage

Guidance on the Use of Extenders in Tailored Care Management

The Department published updated guidance on the use of extender staff in the provision of Tailored Care Management. It provides guidance on how “care manager extenders” can support care managers in delivering Tailored Care Management and fulfilling the member contact requirements. It also provides details on extender qualifications, functions, contact requirements, training requirements and payment considerations.

Standard Terms and Conditions

Tailored Plans will be required to include certain programmatic language in contracts with AMH+ practices and CMAs. The Department will require Tailored Plans to submit template contracts for use with AMH+ practices and CMAs to ensure that the standard contract terms are incorporated. The Standard Terms and Conditions reflect the Tailored Care Management requirements for providers and cover the following areas: staffing, population health and quality measurement, delivery of Tailored Care Management, transitions, community inclusion, diversion, payments, oversight and panel limits. The Standard Terms and Conditions also include additional requirements for providers serving members enrolled in the 1915(c) Innovations and TBI waivers.

Provider Manual Updated

The Department published an updated Tailored Care Management Provider Manual to reflect changes to the Tailored Care Management model since the January 2022 version of the manual. Notable changes include Standard Terms and Conditions information, Final guidance on the use of Care Manager Extenders, and additional training requirements.

All updates can be found in the Summary of Tailored CM Provider Manual Updates document.

For more information, please visit the NC Medicaid Tailored Care Management webpage.


NC Medicaid Contact Center, 888-245-0179

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