As an integral component of the Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans, Tailored Care Management (TCM) is a new care management model that reflects the goal of whole-person care management in NC Medicaid Managed Care.
While the start of Tailored Plans was delayed until April 1, 2023, Local Management Entity/Managed Care Organizations along with TCM providers will begin providing TCM Dec. 1, 2022.
Beneficiaries receiving TCM will have a single designated care manager supported by a multidisciplinary care team to provide whole-person care management that addresses all their needs, including physical health, behavioral health, I/DD, traumatic brain injuries (TBI), pharmacy, long-term services and supports, and unmet health-related resource needs.
Letters were mailed beginning Nov. 14, 2022, to TCM-eligible beneficiaries and authorized representatives with the name and contact information of their TCM provider. The letter also explains TCM services and provides information on how beneficiaries can change their TCM provider or opt out of the service. A sample notice is available in the NC Medicaid Managed Care County Playbook under Other Beneficiary Notices. Beneficiaries can change their TCM provider at any time, without limits, prior to April 1, 2023, by calling their LME/MCO.
The Centers for Medicare & Medicaid Services (CMS) was not able to complete the request for the 1915(i) option to launch Dec. 1, 2022. The application is currently with CMS for review and approval, and we expect it to launch along with Tailored Plans April 1, 2023.
For more information on TCM, refer to the TCM Provider Fact Sheet, the TCM Beneficiary Fact Sheet (available in English and Spanish) or visit the TCM webpage on the Medicaid website.