Provider Playbook: Training Courses

New Webinar Series for Medicaid Providers and Practice Leaders Begins Oct. 1, 2020

The North Carolina Department of Health and Human Services and North Carolina AHEC are offering two monthly evening webinar series to help prepare providers, practice managers and quality managers engage with NC Medicaid. One series is specifically for Medicaid Managed Care going live on July 1, 2021 and the second is a focus on Quality and Performance on clinical criteria.

Hosted by the Chief Medical Officer of the NC Division of Health Benefits, Shannon Dowler, MD, the two series will feature changing topics on Medicaid Managed Care on the first Thursday of each month and Clinical Quality on the third Thursday of each month. 

For webinar dates, topics and registration, please visit the NC AHEC Medicaid Managed Care web page. Previous webinars will also be posted on the page when available.

 

Please note: Training prior to the suspension of Medicaid Managed Care (archived at the bottom of this page) may not reflect changes in timing, schedules and other details due to the suspension of Managed Care. Managed Care is now scheduled to launch in North Carolina on July 1, 2021. 

Training Prior to Suspension of Managed Care

MCT 101 - Provider Transition to NC Medicaid Managed Care 101

MCT 101 - Provider Transition to NC Medicaid Managed Care 101

A high-level overview for providers of the transition to NC Medicaid Managed Care. The webinar covers the vision and context of North Carolina's transformation to a managed care system, provides a close look at managed care key initiatives, and highlights opportunities for providers to be part of the process.

MCT 102 - Provider Payment and Contracts, NC Medicaid Managed Care 102

MCT 102 - Provider Payment and Contracts, NC Medicaid Managed Care 102

This webinar helps providers understand what and how they will be paid under managed care contracting arrangements. It gives providers an understanding of changes in financing and implications for their net revenue, what information they need to submit to be paid, protections implemented by the State (such as rate floors) and “any willing provider” requirements.

MCT 103 - Value Based Payments and Quality Measurement in Medicaid Managed Care, NC Medicaid Managed Care 103

MCT 103 - Value Based Payments and Quality Measurement in Medicaid Managed Care, NC Medicaid Managed Care 103

This webinar serves as the initial guidance on Value Based Payments (VBP), focusing on early standards that the NC DHHS is using to assess VBP as well as plans for measurement of quality within NC Medicaid Managed Care.

MCT 104 - Provider Policies, NC Medicaid Managed Care 104

MCT 104 - Provider Policies, NC Medicaid Managed Care 104

This webinar facilitates understanding of NC Medicaid Managed Care requirements, expectations and implications specific to credentialing, network adequacy, appeals and provider ombudsman processes.

MCT 105 - Beneficiary Policies, NC Medicaid Managed Care 105

MCT 105 - Beneficiary Policies, NC Medicaid Managed Care 105

This webinar provides participants with an overview of key policies affecting beneficiaries who will be enrolling in Medicaid Managed Care. The materials cover beneficiary-related topics that have an impact on providers such as: 1) beneficiary eligibility and enrollment, 2) PCP selection, 3) beneficiary supports, 4) grievances & appeals, 5) and how to address the social needs of patients.

MCT 106: Behavioral Health Services: Standard Plans and Transition Period

MCT 106: Behavioral Health Services: Standard Plans and Transition Period

Providers can expect to receive a high degree of clarification and information related to behavioral health billing transition, including: services transitioning to Standard Plans; those services that will continue to be billed to LME-MCOs; and transition timing for Tailored Plans. In addition, providers will receive guidance on contracting with Standard Plans as well as how to avoid process issues that prevent beneficiaries enrolled in Standard Plans from accessing necessary services (especially crisis services) only covered under future Tailored Plans.

MCT 107: Contracting with AMH Practices

MCT 107: Contracting with AMH Practices

This webinar provides contracting guidance and reminders to Advanced Medical Home (AMH) Tier 3 practices as they consider provider network participation with PHPs. Established DHHS contracting guardrails are reviewed with AMH Tier 3 practices, including payment, and standard terms and conditions. Clarification will be provided on expectations for practices that attested to Tier 3 and options available to ensure that they can meet the content of the attestations in anticipation of Medicaid Managed Care go-live (November, 2019). The webinar also reviews timeliness for contracting.

MCT 108: Clinical Policies

MCT 108: Clinical Policies

This webinar provides an overview of key clinical policies that providers will need to be familiar with during the transition to managed care. The webinar reviews the managed care benefit package, the approach to utilization management and how appeals and grievances will work under managed care.

MCT 109: Healthy Opportunities

MCT 109: Healthy Opportunities

North Carolina DHHS believes that access to high-quality medical care is critical, but research shows up to 80 percent of a person’s health is determined by social and environmental factors and the behaviors that emerge as a result. DHHS is focusing on tackling these fundamental drivers of health. DHHS is committed to addressing the conditions in which people live that directly impact health, known as “social determinants of health,” or SDOH. This webinar focuses on the ways in which DHHS is embedding strategies to address the social needs of Medicaid beneficiaries, into the managed care platform.

MCT 110: Overview of Long-Term Services and Supports Populations

MCT 110: Overview of Long-Term Services and Supports Populations

This webinar provides a Long-Term Services and Supports (LTSS)-specific overview of key elements related to NC Medicaid Managed Care. Topics include:

  • NC’s goals for supporting LTSS members in NC Medicaid Managed Care
  • Brief overview of NC Medicaid Managed Care regions
  • LTSS member eligibility for NC Medicaid Managed Care
  • Identified  LTSS-related requirements
  • Safeguards and resources being established for LTSS members during the transition to NC Medicaid Managed Care
  • How to access provided-related information about NC Medicaid Managed Care
MCT 111: Care Management for Long-Term Services and Supports Populations

MCT 111: Care Management for Long-Term Services and Supports Populations

Long-Term Services and Supports members transitioning to NC Medicaid Managed Care may have access to care management support for the first time. This webinar provides an overview of the NC Medicaid Managed Care’s care management design.

MCT 112: Supporting the LTSS Community Through the Transition to Managed Care

MCT 112: Supporting the LTSS Community Through the Transition to Managed Care

This webinar continues the Long-Term Services and Supports (LTSS) webinar series launched in July 2019 and focuses on crossover-related activity specific to LTSS providers.

 

MCT 113: Care Management under BH I/DD Tailored Plans: Information for Providers

MCT 113: Care Management under BH I/DD Tailored Plans: Information for Providers

BH I/DD Tailored Plans, scheduled to be implemented in Summer 2021, will offer members a model of integrated, whole person care management (“Tailored Care Management”) that will be customized to their individualized needs. NC DHHS is committed to implementing provider based care management as a way of promoting integrated care that is grounded in the community. To move towards this vision, DHHS will roll out a process for interested providers to become certified to provide Tailored Care Management, ahead of procurement of the BH I/DD Tailored Plans. There will be two types of provider certifications: “Advanced Medical Home Plus” for qualified AMH Tier 3 practices, and “Care Management Agencies” for other qualified BH/IDD providers. Building on DHHS’ May 2019 concept paper, this webinar provides updates and information on this process for interested providers.

MCT 114: NC’s Transition to Managed Care: Crossover

MCT 114: NC’s Transition to Managed Care: Crossover

This provides a brief review of topics previously covered and additional guidance for supporting beneficiaries through the transition to Medicaid Managed Care.
The presentation, recording and transcript will be posted when available.

MCT 115 - Tailored Care Management: What Providers Need to Know

MCT 115 - Tailored Care Management: What Providers Need to Know

This webinar explores the Tailored Care Management provider manual in more detail and walk through the application process and important questions for your organization to consider. 

MCT 116: State-funded Services Design Under Behavioral Health I/DD Tailored Plans 

MCT 116: State-funded Services Design Under Behavioral Health I/DD Tailored Plans 

This webinar walks through aspects of state-funded services design under Behavioral Health I/DD Tailored Plans detailed in the recently released “North Carolina’s Design for State-funded Services Under Behavioral Health and Intellectual/Developmental Disability Tailored Plans,” including the delivery of state-funded behavioral health, I/DD and TBI services, as well as the continuation of critical “local health functions” (functions focused on health prevention and promotion) under Behavioral Health I/DD Tailored Plans. 

MCT 117: NC Medicaid’s Value-Based Payment Strategy and ACO Program for Standard Plans and Providers 

MCT 117: NC Medicaid’s Value-Based Payment Strategy and ACO Program for Standard Plans and Providers 

This webinar provides an overview of NC Medicaid’s proposed strategy for shifting Medicaid payments from fee-for-service to value under managed care. It also reviews an optional Medicaid Accountable Care Organization (ACO) program that the Department is proposing as a way for Standard Plans and providers to partner together to provide greater value to Medicaid members. The webinar discusses the content of two policy papers recently released by the Department for public comments: North Carolina’s Value-Based Payment Strategy for Standard Plans and Providers in Medicaid Managed Care and North Carolina’s Medicaid Accountable Care Organizations for Standard Plans and Providers: Building on the Advanced Medical Home Program to Drive Value-Based Payment. 

MCT 118 - Behavioral Health I/DD Tailored Plan Request for Applications Pre-Release Policy Paper Webinar 

MCT 118 - Behavioral Health I/DD Tailored Plan Request for Applications Pre-Release Policy Paper Webinar 

The 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. 

MCT 119 - Transition of Care Draft Policy Webinar 

MCT 119 - Transition of Care Draft Policy Webinar 

The webinar details the requirements under which the Standard Plan Prepaid Health Plans (PHPs) will facilitate transition of care for members transitioning between PHPs or service delivery systems. The Transition of Care design intends to maintain continuity of care for each beneficiary and minimize the burden on providers during transition. 

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