NOTE: This bulletin has been replaced by Payment Detail: Enhanced Medical Home Payments for Advanced Medical Homes Serving Members Eligible for Tailored Care Management on Jan. 13, 2023.
On Dec. 1, 2022, $20 per member per month (PMPM) Medical Home Payments for Advanced Medical Homes (AMHs) serving members eligible for Tailored Care Management (TCM) referenced in the Aug. 5, 2022, Medicaid bulletin article Enhanced Medical Home Payments for Advanced Medical Homes Serving Members Eligible for Tailored Care Management will begin.
Effective Dec. 1, 2022, through June 30, 2023, AMHs 1, 2 and 3 that are serving as the assigned primary care provider for NC Medicaid beneficiaries eligible for TCM will receive a medical home payment of $20 PMPM. Continuation of the payment after June 30, 2023, is anticipated, but is dependent on available funding. In the future the $20 PMPM fee may be tied to additional performance expectations for primary care engagement.
- Between Dec. 1, 2022, and March 31, 2023, NC Medicaid will pay this $20 PMPM to AMHs 1, 2 and 3 for all TCM members assigned to the practice. These payments will be made in the same way that the current $5.00 ABD and $2.50 Non-ABD Medical Home payments are administered to Carolina Access (CCNCCA) providers today.
- Between April 1, 2023, and June 30, 2023, this payment will be included in capitation for Tailored Plans. Tailored Plans will pay the $20 PMPM directly to AMHs 1, 2 and 3 for all Tailored Plan members assigned to the practice who are eligible for TCM. NC Medicaid will continue to make these payments for TCM eligible beneficiaries remaining in NC Medicaid Direct. Payments from NC Medicaid will be made in the same way that the current $5.00 ABD and $2.50 Non-ABD Medical Home payments are administered to CCNCCAs providers today.
For information on medical home payments and management fees, please visit the common questions webpage on NCTracks.
Contact
NCTracks Call Center: 800-688-6696