Note: Community feedback is requested by April 21, 2025, on the AMH Standardized Performance Incentive program draft policy guide.
This bulletin applies to NC Medicaid Managed Care.
The Advanced Medical Home (AMH) is NC Medicaid’s cornerstone primary care program, serving more than two million Medicaid members across the state. Innovative primary care payment is critical to supporting practice improvements that lead to the outcomes that matter to Medicaid beneficiaries and their families.
Prepaid health plans (PHPs) are currently required to offer performance incentive payment arrangements to AMH practices based on a defined set of AMH quality measures. However, provider feedback and formal PHP reporting indicate that each PHP’s individual approach to these arrangements vary widely. This variability makes it difficult for AMH practices to consistently participate in incentive arrangements across plans, and to focus and align their quality improvement efforts for Medicaid beneficiaries.
To address these administrative and clinical challenges, NC Medicaid plans to implement the AMH Standardized Performance Incentive program in 2026. Additional details can be found in the draft AMH Standardized Performance Incentive Program Policy Guide, which is being shared for community partner input.
Starting in January 2026, NC Medicaid intends to require Standard Plans and BH I/DD Tailored Plans to offer this program to all AMHs; however, this policy may depend on funding and CMS approvals. Participation in the program is optional for AMH practices, and PHPs and AMHs may agree to other VBP models in addition to or in lieu of this program, if desired.
Proposed AMH Standardized Performance Incentive Program
The AMH Standardized Performance Incentive program will establish a consistent framework that includes:
- Performance periods and payment timelines
- Broad AMH practice eligibility to participate
- A single, common set of quality performance measures for each practice type (i.e., Adult Practice, Child Practice, Family Practice)
- Quality performance attribution methodology
- Measure performance targets
- Methodology for calculating incentives
Additional details on each of these proposed program elements are found in the draft Policy Guide.
North Carolina’s Participation in the Making Care Primary Model
The AMH Standardized Performance Incentive program was developed as a feature of North Carolina’s participation in the Centers for Medicare & Medicaid Services (CMS) Making Care Primary (MCP) model. North Carolina was selected to participate in the MCP model in June 2023, in recognition of the state’s innovations and leadership in primary care, care management and addressing health-related social needs. On March 12, 2025, CMS announced the MCP model will be ending by Dec. 31, 2025, nine years earlier than planned.
While the Medicare MCP model will not be continuing, the Department’s proposed AMH Standardized Performance Incentive program remains an important step to advance NC Medicaid’s goals of reducing provider burden and improving health outcomes. NC Medicaid welcomes stakeholder feedback on the proposed program, and we appreciate input on whether the discontinuation of the Medicare MCP model has an impact on the likelihood of primary care practices participating in the AMH Standardized Performance Incentive program as it is designed.
Next Steps and Request for Feedback on the AMH Standardized Performance Incentive Program
NC Medicaid is seeking additional feedback from community partners on the design of the AMH Standardized Performance Incentive Program and will continue to meet and collaborate with community partners and CMS in the consideration and design of this proposal.
We encourage community partners to provide feedback on the draft AMH Standardized Performance Incentive Program Policy Guide by emailing Medicaid.NCEngagement@dhhs.nc.gov (subject line “AMH Standardized Performance Incentive Program Feedback”) by April 21, 2025.