Behavioral Health I/DD Tailored Plan

North Carolina will launch the Behavioral Health and Intellectual/Developmental Disability Tailored Plan July 1, 2022. This plan is an integrated health plan designed for individuals with significant behavioral health needs and intellectual/developmental disabilities (I/DDs). The Behavioral Health I/DD Tailored Plan will also serve other special populations, including Innovations and Traumatic Brain Injury (TBI) waiver enrollees, and waitlist members, and be responsible for managing the state’s non-Medicaid behavioral health, developmental disabilities and TBI services for uninsured and underinsured North Carolinians.

As North Carolina transitions its Medicaid and NC Health Choice program from a predominately fee-for-service delivery system to managed care, the Department is focused on building effective models for managing member’s comprehensive needs through care management.  The Department is investing in the Tailored Care Management model, a community based, provider driven model aimed at whole person care and driving towards better health outcomes.  

Through Tailored Care Management, Behavioral Health I/DD Tailored Plan beneficiaries will have a single designated care manager supported by a multidisciplinary care team to provide integrated care management that addresses all of their needs, spanning: physical health, behavioral health, I/DD, TBIs, pharmacy, long-term services and supports (LTSS) and addresses their unmet health-related resource needs. For more information, please visit the Tailored Care Management webpage.
 

Updates

Behavioral Health I/DD Tailored Plan Request for Applications (RFA) Closed; Silent Period in Effect

Applications for Behavioral Health I/DD Tailored Plan were opened Feb. 2, 2021, at 4 p.m. ET. NCDHHS is in a silent period through the award of the Behavioral Health I/DD Tailored Plan contracts. Please direct procurement-related questions to Medicaid.Procurement@dhhs.nc.gov

Behavioral Health I/DD Tailored Plan Memo on Eligibility and Enrollment Updates

DHHS has held ongoing discussions with stakeholders to refine the Behavioral Health I/DD Tailored Plan eligibility criteria used in claims/encounter data reviews. Through these discussions and with consultation from DHHS clinical leadership, additional encounter/claims data markers were identified as being indicative of I/DD or functional impairment and have been added to the criteria used for identifying beneficiaries as eligible for Behavioral Health I/DD Tailored Plans. 

For more information about eligibility changes, please see the Behavioral Health I/DD Tailored Plan Memo on Eligibility and Enrollment Updates and Appendix B - Behavioral Health I/DD Tailored Plan Criteria under "Final Policy Guidance" on the Medicaid Transformation Policy Papers webpage.

Addendum 6 and 7 Issued for Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plan RFA

The Department has issued Addendum 6 and 7 to the Behavioral Health I/DD Tailored Plans RFA (Request for Applications #: 30-2020-052-DHB). Addendum 6 provides responses to questions submitted by applicants, and Addendum 7 provides revision to the Behavioral Health I/DD Tailored Plan RFA. The RFA and Addendums are available here.

Request for Applications Issued for Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans

On Friday, Nov. 13, 2020, NCDHHS issued a Request for Applications (RFA) for Behavioral Health I/DD Tailored Plans as part of North Carolina’s transition to Medicaid Managed Care.

As directed by the North Carolina General Assembly, for the first contract term, only LME/MCOs are eligible to respond to the RFA to serve as Behavioral Health I/DD Tailored Plans. The first Behavioral Health I/DD Tailored Plan contract term will last four years. NCDHHS will award no more than seven and no fewer than five regional Behavioral Health and I/DD Tailed Plan contracts and will not award any statewide tailored plan contracts.  

Behavioral Health and I/DD Tailored Plans will provide physical health, behavioral health, long-term care, pharmacy services and unmet health related resource needs to qualifying North Carolinians under one plan. These plans will provide the same services as Standard Plans but will also provide additional specialized services that serve individuals with significant behavioral health conditions, I/DDs and traumatic brain injuries (TBI).

RFA Questions and Answers Meeting

Behavioral Health I/DD Tailored Plan Memo on State-Funded Services Design Updates

memo regarding North Carolina’s Design for State-Funded Services Under Behavioral Health and Intellectual/Developmental Disability Tailored Plans white paper has been released.

DHHS appreciates the stakeholder feedback received. Based on that feedback, this memo includes updates to eligibility for State-funded Services, the set of core and non-core State-funded Services that will be offered within available funding limits following Behavioral Health I/DD Tailored Plan launch, the eligibility for State-funded care management for recipients with I/DD and TBI, and considerations for maximizing the impact of limited state funds available to support these services. 

Please send any comments or questions to Medicaid.transformation@dhhs.nc.gov.
 

Previous Updates

Behavioral Health Crisis System Memo for Standard Plans - March 6, 2020
Comment Period Extended - Behavioral Health I/DD Tailored Plan Request for Applications Pre-Release Policy Paper - Feb. 14, 2020
Behavioral Health I/DD Tailored Plan Request for Applications (RFA) Pre-Release Policy Paper - Jan. 30, 2020

Resources

Behavioral Health I/DD Tailored Plan Request for Applications Fact Sheet - Feb. 17, 2021
Behavioral Health I/DD Tailored Plan Fact Sheet for Beneficiaries - Feb. 17, 2021
Behavioral Health I/DD Tailored Plan Fact Sheet for Providers - Feb. 17, 2021
Town Hall Meeting Frequently Asked Questions - Feb. 18, 2020

Previous Meetings

2020

2020

Behavioral Health I/DD Tailored Plan Webinar - Oct. 28, 2020

This webinar provides an overview about what is happening in North Carolina, review key information about Behavioral Health I/DD Tailored Plans and highlight what's next for beneficiaries.

Behavioral Health I/DD Tailored Plan Request for Applications Pre-Release Policy Paper Webinar - Feb. 10, 2020

This webinar walks stakeholders through the following remaining aspects of the Behavioral Health I/DD Tailored Plan design, including the procurement process, administration and entity management, financial management and monitoring, provider participation/contracting, quality and other programmatic features under Behavioral Health I/DD Tailored Plans. 

State-funded Services Design Under Behavioral Health I/DD Tailored Plans Webinar - Jan. 24, 2020 

This webinar provides background and guiding principles on the transition to Medicaid Managed Care and the Department's vision for State-funded services. It also provides information on care management requirements, community integration, local health functions and accountability. 

 

2019

2019

How Beneficiaries Move Between the Standard Plan and Behavioral Health I/DD Tailored Plan - Nov. 6, 2019

Presentation. Recording will be added when available.

Behavioral Health I/DD Tailored Plan Eligibility and Enrollment - March 26, 2019
Note: Eligibility and enrollment policy was updated July 16, 2019. Please refer to the update documents for accurate information.

MCAC Behavioral Health I/DD Tailored Plan Design Subcommittee - March 6, 2019

MCAC Behavioral Health I/DD Tailored Plan Design Subcommittee - Feb. 4, 2019

Integration of Behavioral and Physical Health Care in Tailored Plan - Jan. 24, 2019

2018

2018

Stakeholder Update on Tailored Plan Design - Nov. 28, 2018