Tailored Care Management Implements Temporary Flexibilities and Program Changes

Temporary flexibilities and changes run from Dec. 1, 2022, to March 31, 2023.

Recognizing this is a time of substantial change for NC Medicaid enrollees, providers and health plans, NCDHHS will implement temporary flexibilities and program changes for the four-month period between the Dec. 1, 2022, Tailored Care Management launch and March 31, 2023, the day before the start of Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans.

These flexibilities and program changes give organizations providing Tailored Care Management (e.g., Advanced Medical Home + (AMH+s), Care Management Agencies (CMAs), Tailored Plans) time to gain experience with the model, engage as many eligible members as possible and identify and address unexpected challenges.

Members will continue to receive behavioral health services, I/DD and traumatic brain injury (TBI) supports through their LME/MCO and physical health and pharmacy services through NC Medicaid Direct, just as they do today. Nothing will change for members as of Dec. 1, 2022—except they’ll have access to Tailored Care Management through AMH+s, CMAs and LME/MCOs.

Additionally, the State is working with the Centers for Medicare and Medicaid Services (CMS) to obtain approval for 1915(i) services (start date to be determined).

As a reminder, LME/MCOs will be expected to share the following data in a machine-readable format with AMH+ practices and CMAs, or their designated Clinically Integrated Networks (CINs) or other partners, for their attributed members to support Tailored Care Management:

  1. Beneficiary assignment information, including demographic data and any clinically relevant and available eligibility info.
  2. Pharmacy Lock-in data
  3. Member claims/encounter data, including historical physical (physical health), behavioral health, and pharmacy (Rx) claims/encounter data with new data delivered monthly (physical health/behavioral health) or weekly (Rx).

The Department has published a Deployment Schedule for Tailored Care Management Interfaces for Tailored Plan and Prepaid Inpatient Health Plan to provide initial dates for the Tailored Care Management deployment of these interfaces.

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

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