Justice Involved Care Management Frequently Asked Questions

No, claims for CAA 5121 services should be submitted only to NCTracks. Claims are not submitted to EPS because the LME/MCO is acting as a vendor rather than a managed care entity.

Consistent with the standard 365-day timely filing requirement for Medicaid services, pre-release claims may be submitted within one year of the date of service. Plans are not required to submit these claims during the pre-release period and may submit them after the member appears on the 834 eligibility file following release.

The monthly billing events occur on a calendar-month basis rather than rolling 30-day cycle.

Yes. For example, if a youth receives pre-release services on the first of the month, then is released, and then receives post-release services on the 20th of the month, a claim for pre-release and a claim for post-release can both be submitted.

In NCTracks, the member's Medicaid eligibility will remain suspended until release. NCTracks will still allow billing of pre-release services for the CAA 5121 population.

The member's Medicaid eligibility will be unsuspended retroactively to the date of release. NCTracks will allow billing for pre-release services even while Medicaid is suspended.

The EBCI Tribal Option will provide its own care management services through Cherokee Indian Hospital Authority (CIHA). Tribal care managers will support eligible members and coordinate ongoing care through tribal service delivery systems.

The program is expected to have a low statewide enrollment, approximately five members per month. The non-Tailored Care Management (TCM) eligible population is expected to be even smaller.

When a youth is released from a Youth Development Center (YDC), Medicaid benefits are unsuspended effective on the release date. However, because a manual update is required by Department of Social Services (DSS) caseworkers, there may be a delay before the member appears on the 834 file.

The "FI" Managed Care Status indicator will appear on the 834 after the youth is released. Prior to release, the assigned help center ticket is the primary method for identifying the youth as part of the CAA 5121 population.

CMAs and AMH+ are not allowed to provide post-release care management. If a member decides they would like to be served by a community provider, then they would receive Tailored Care Management (TCM) and would opt-out of the CAA 5121 program. Therefore, reporting is still required but these members would not be indicated as CAA.

If the release date is extended, care management services should pause until the youth is once again within 30 days of the revised release date. Medicaid cannot pay for services when the youth is outside the approved pre-release eligibility period.

As long as the LME/MCO was working with the information they had that the release date was within 30 days, they will still get paid for that service even if the release date gets pushed back and the service rendered no longer falls within the 30 days pre-release.

Policy allows DSS caseworkers up to 30 days to update the Medicaid case information.

No, if care management is declined no additional outreach attempts are required.

Yes, following initial post-release outreach, the Care Manager should make three documented, strategic follow-up attempts. If consent is still not obtained, the member should be discharged from care management services.

After release, the help center ticket will close. Communication and coordination should continue through email or another mutually agreed-upon method.

No, current contract amendment requirements specify completion of both the Comprehensive Care Management Assessment (CMCA) and the Care Needs Screening (CNS).

The reporting cadence remains unchanged. BCM051 reports should continue to be submitted monthly using data that is aged by two months.

High-Priority status for Justice Involved individuals as it relates CAA5121 referrals is intended to indicate that the PIHP should acknowledge receipt of the referral quickly and begin post release care/case management activities. High-priority status tickets related to JI will not count toward plans’ score cards.

The Pre-Release Help Center Ticket template should only be submitted/attached to the members’ ticket one time, once all pre-release activities have been completed.

The temporary Post-Release Care Management Activities Report will be requested on a monthly basis through the help center until the new BCM051 templates go into effect on May 31, 2027. 

No, LMEs will report all members actively served in the post-release reporting period as well as any cases that were closed during that period until the new BCM051 template goes into effect on May 31, 2027.

"If you choose to receive services through a PLE, you will be opting out of Targeted Case Management (Re-entry Care Management). This choice does not allow you to transfer to your assigned Standard Plan or CFSP, as you are required to remain in NC Medicaid Direct for the first 12 months following your release. However, by opting out, you will lose access to Targeted Case Management services unless you qualify for Tailored Care Management. If you are not eligible for Tailored Care Management, you will receive care coordination services only from the health plan."

At this time, NC Medicaid has not determined whether additional training will be required. If training becomes necessary, NC Medicaid will provide at least 60 days' notice and work with health plans regarding training materials and implementation.

Answer:

• Pre-release: Escalate to director of social work if information is not received from the social work supervisor.
• Post-release: Escalate to the court services supervisor, if necessary, escalate further to the chief court counselor.