This bulletin updates the Jan. 13, 2023, Medicaid bulletin Payment Detail: Enhanced Medical Home Payments for Advanced Medical Homes Serving Members Eligible for Tailored Care Management.
Enhanced medical home payments of $20 per member per month (PMPM) for Advanced Medical Homes (AMHs) serving members eligible for Tailored Care Management (TCM) will continue through Sept. 30, 2023.
These funds are continued to cover initial implementation time spent and costs incurred by primary care offices engaging with care managers serving beneficiaries eligible for TCM.
Primary care offices are expected to respond to communications from Tailored Care Managers reaching out to the practice to support their patients. To verify a caller is with an approved TCM provider, refer to Certified CMAs and AMH+ providers on the NC Medicaid webpage. The patient’s assigned TCM provider also is listed in NCTracks.
Continuation of Enhanced Medical Home Payments
NC Medicaid will continue to deliver an incremental PMPM payment to AMH tier 1, 2, and 3 locations for all Medicaid Direct TCM beneficiaries assigned to the AMH as a primary care provider through Sept. 30, 2023. The incremental PMPM payment will be equal to the total Enhanced Medical Home $20 PMPM less the TCM beneficiary’s $5.00 Aged, Blind and Disabled (ABD) or $2.50 non-ABD monthly medical home payment.
NC Medicaid will distribute the April, May, June, July, August and September 2023, payments via monthly management fee checkwrites. Please see below for anticipated checkwrite dates.
| Month | Anticipated Checkwrite Dates |
|---|---|
| June | 6/21/2023 |
| July | 7/18/2023 |
| August | 8/15/2023 |
| September | 9/19/2023 |
NC Medicaid Payment Distribution
The enhanced payment amounts are itemized by month on the FINANCIAL TRANSACTIONS page of the Remittance Statement but were then combined with regular claims payments into a single EFT transaction. For example:
Remittance Statement: "DEC 2022 TCM-MEDICAL HOME: SEE DETAIL IN ENHANCED MEDICAL HOME BULLETIN PUBL 1/23/23"
As a reminder, NC Medicaid based the incremental payments on the monthly enrollment used for the current ABD and non-ABD PMPM management fee payments. AMH tier 1, 2, 3 locations assigned as the primary care provider (PCP) for NC Medicaid beneficiaries eligible for TCM will receive the PMPM difference between the current $5.00 ABD and $2.50 Non-ABD management fee payments to reach the $20 PMPM enhanced medical home payment.
The table below shows a breakdown of the incremental payment amounts that will be made regardless of beneficiary ABD status:
| TCM Beneficiary ABD Status | Current ABD/Non-ABD PMPM | Incremental PMPM Payment 12/1/22-9/30/23 | Total Enhanced Medical Home PMPM 12/1/22-9/30/23 |
|---|---|---|---|
| ABD | $5.00 | $15.00 | $20.00 |
| Non-ABD | $2.50 | $17.50 | $20.00 |
The table below shows an example of these calculations and the resulting monthly incremental payment:
| ABD Status | Total Monthly Beneficiary Count | Incremental PMPM Payment | Total Monthly Incremental Medical Home Payment |
|---|---|---|---|
| ABD | 2 | $15.00 | $30.00 |
| Non-ABD | 4 | $17.50 | $70.00 |
| Total Financial Transaction | 6 | $100.00 |
Resources
- NCTracks Common Questions: Management Fees: What are they and why are they on my RA?
- Fact Sheet: Panel Management for Primary Care Providers