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NC Medicaid »   Tailored Care Management

Tailored Care Management

The Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Care Management (Tailored CM) model reflects the goal of whole-person care management in NC Medicaid Managed Care. Provider-based care management promotes integrated care and offers beneficiaries choice in how they receive care management. 

Through Tailored CM, Behavioral Health I/DD Tailored Plan beneficiaries will have a single designated care manager supported by a multidisciplinary care team to provide whole-person care management that addresses all of their needs, spanning: physical health, behavioral health, I/DD, traumatic brain injuries (TBI), pharmacy, long-term services and supports (LTSS) and unmet health-related resource needs. Tailored Care Management will:

  • Be available throughout the entire duration of a beneficiary’s enrollment in a Behavioral Health I/DD Tailored Plan; 
  • Be based in provider settings to the maximum extent possible, supporting integrated care and collaboration; Prioritize frequent in-person interactions between community-based care managers and beneficiaries; and 
  • Place additional emphasis on outcomes and population health management. 

Effective, integrated and well-coordinated care management depends on care team members having the ability to efficiently exchange member health information and use that information to monitor and respond to medical and nonmedical issues that could impact beneficiaries. 

The success of Tailored CM will depend upon Behavioral Health I/DD Tailored Plans, Advanced Medical Home Plus (AMH+) practices, Care Management Agencies (CMAs), pharmacies, and physical health, behavioral health and I/DD providers utilizing a coordinated approach to beneficiary care. 

Updates

Verifying Provider Information (NPI+Location Code) in NCTracks (May 16, 2022)

Prior to submitting an application for Advanced Medical Home/Care Management Agency (AMH+/CMA) Certification with the State of North Carolina, please download and utilize the Provider Directory Listing Report (not the NCTracks Provider Portal) to locate the NPI, Location Code and Practice Site Address for each of the locations that you would like to have certified. 

If you are an NC Medicaid enrolled provider and you are unable to find your practice’s information in the Provider Directory Listing Report, or if your practice’s information is outdated, please submit a Manage Change Request (MCR) to update the applicable NCTracks provider record. Visit the NCTracks Provider webpage or contact NCTracks Call Center for additional assistance. 

Tailored Care Management Updated Guidance (April 21, 2022)

NC Medicaid has published updated guidance, including Capacity Building Program Frequently Asked Questions, updates to the Use of Care Manager Extenders, revised Standard Terms and Conditions (STCs), updates to the Tailored Care Management Provider Manual and a summary of changes to the Provider Manual. 

Tailored Care Management Technical Support Educational Series Presentations Available

The Department conducted a Tailored Care Management Technical Support Educational Series on March 10, 2022, and March 17, 2022, to provide additional clarification on Tailored Care Management Data Flow. The presentations are available:

  • Tailored Care Management Technical Support Education Series presentation - March 10, 2022
  • Tailored Care Management Technical Support Education Series presentation - March 17, 2022

Tailored Care Management Updated Guidance (Jan. 28, 2022)

NC Medicaid has published updated guidance on Tailored Care Management, including updates to the Tailored Care Management Provider Manual, the use of Care Manager extenders, Tailored CM 101 Frequently asked Questions and updated guidance on rates. For more information, please see Medicaid bulletin article Tailored Care Management Updates – Jan. 28, 2022.

AMH+/CMA Certification Round Two Desk Reviews Completed (Jan. 28, 2022)

The Department has completed desk reviews of the Round Two Advanced Medical Home Plus (AMH+) practices/Care Management Agencies (CMAs) provider certification applications and has advanced 32 providers to the site review stage of the certification process. For more information, please see Medicaid bulletin article Tailored Care Management Update: AMH+/CMA Certification Round Two Desk Reviews Completed.

Resources

Webpages

  • Tailored CM Data Specifications Guidance page
  • Tailored CM TAG page
  • Tailored CM Training page

Manuals

  • Tailored CM Provider Manual | Summary of Updates (April 19, 2022)
  • Tailored CM Provider Manual: Community Inclusion Addendum (March 19, 2021)
  • Tailored CM Provider Manual (Dec 2, 2020) 

Other

  • Verifying Provider Information (NPI+Location Code) in NCTracks (May 17, 2022)
  • Standard Terms and Conditions for Tailored Plan Contracts with AMH+ Practices or CMAs (April 19, 2022)
  • Updated Tailored CM Rate Guidance (Jan. 28, 2022)
  • Use of Care Manager Extenders in Tailored CM (April 19, 2022)
  • Tailored CM Capacity Building Program 
  • Revised Tailored CM Application and Questions (Jan. 27, 2021)

Frequently Asked Questions

  • Data Strategy Questions and Answers (July 13, 2021)
  • Town Hall Meeting Frequently Asked Questions (Feb. 18, 2020)

Additional Information

  • Medicaid Transformation
  • Email questions or comments to: medicaid.tailoredcaremgmt@dhhs.nc.gov 

Previous Updates

Medicaid Bulletin Articles
  • Tailored Care Management: Conflict-Free Care Management Guidance (Aug. 26, 2021)
  • Tailored Care Management Update: AMH+/CMA Certification Round One Desk Reviews Completed (Aug. 9, 2021)
  • Potential Clinically Integrated Networks or Other Partners Statement of Interest (Aug. 9, 2021
  • Data on Medicaid and NC Health Choice Beneficiary Eligibility for Behavioral Health I/DD Tailored Plans and Tailored Care Management (May 24, 2021)
  • Tailored Care Management Updates (May 14, 2021)
  • Community Inclusion Addendum Added to Tailored Care Management Provider Manual (March 19, 2021)
  • Tailored Care Management Certification Deadline Extended to June 1, 2021 (Feb. 15, 2021)
  • Application Period Open for Tailored Care Management Certification (Dec. 14, 2020)
  • Tailored Care Management Updates (June 9, 2020)
  • Provider Application Process for Tailored Care Management – extended deadlines (Feb. 17, 2020)
  • Update: Draft Provider Manual for Tailored Care Management (Jan. 17, 2020)
  • Draft Provider Manual for Tailored Care Management (Dec. 11, 2019)
Previous Updates

Tailored Care Management Technical Advisory Group (TAG) 

The Tailored CM TAG will serve as the primary venue for advisory conversations among these stakeholders and the Department, ahead of and after Tailored CM launch. The Department expects that members will take issues raised in the Tailored CM TAG back to their organizations and networks to promote dialogue and communication between the Tailored CM TAG and a broader group of stakeholders. Go to the Tailored CM TAG page. 

Tailored Care Management 101 Webinar Series

The Tailored Care Management 101 webinar series was designed to help develop a shared understanding of the model across the North Carolina provider community (including advanced medical homes and behavioral health, I/DD and TBI providers) and anyone interested. The webinar series will run from October through mid-December, on Fridays from noon to 1 p.m.

Register for the webinar series.

The topic schedule and previous trainings are available on the TCM Training page.

Tailored CM Data Specifications Guidance 

Effective, integrated and well-coordinated care management depends on care team members having the ability to efficiently exchange timely and actionable member health information and use that information to monitor and respond to medical and nonmedical events that could impact a member’s well-being. The success of Tailored Care Management will depend on Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans, Advanced Medical Home Plus (AMH+) practices, and Care Management Agencies (CMAs) having the technological capabilities to collect, use and share data in support of an integrated and coordinated approach to care. The Department is utilizing this page to ensure that all Tailored Care Management Providers have the most current guidance.

Tailored CM Data Specifications Guidance page.

Round 2 Application Period for Tailored Care Management Certification Closes Sept. 30, 2021 (Aug. 3, 2021)

The Round 2 application period for Tailored Care Management Certification is open. For providers looking to obtain certification prior to Behavioral Health and I/DD Tailored Plan launch in July 2022, the certification process will take place in two rounds. Interested providers should review the updated Provider Manual and application questions and may submit applications through Sept. 30, 2021, to Medicaid.TailoredCareMgmt@dhhs.nc.gov. 

Data on Medicaid and NC Health Choice Beneficiary Eligibility for Behavioral Health I/DD Tailored Plans and Tailored Care Management (May 24, 2021)

In response to stakeholder requests and feedback, the Department of Health and Human Services (the Department) is releasing data on the number of Medicaid and NC Health Choice beneficiaries, as of April 2021, who currently meet the eligibility criteria to enroll in Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans and receive Tailored Care Management scheduled to launch in July 2022.

The table included shows this information in aggregate, and broken down by county and condition. For more information, please see Data on Medicaid and NC Health Choice Beneficiary Eligibility for Behavioral Health I/DD Tailored Plans and Tailored Care Management.

Updated Guidance (May 14, 2021)

NC Medicaid has published updated guidance on Tailored Care Management, including updates on AMH+/CMA Certification, capacity building and rates.

  • Updated Guidance on Tailored Care Management
  • Historically Underutilized Provider Optional Supplement to Tailored Care Management Certification Application
  • Non-Binding Statement of Interest for Potential Clinically Integrated Networks and Other Partners

Tailored Care Management Certification Desk Review Guide and Scoring Tool Available (April 16, 2021)

DHHS is releasing the draft Tailored Care Management Desk Review Guide and Scoring Tool to support providers applying for AMH+ or Care Management Agency (CMA) certification. The Department is making this document publicly available to give applicants more guidance on what reviewers will be looking for when assessing an application. 

Application Period for Tailored Care Management Certification Closes June 1, 2021 

The application period for Tailored Care Management Certification is open. For providers looking to obtain certification prior to Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plan launch in July 2022, the certification process will take place in three rounds. Interested providers should review the updated Provider Manual and application questions and may submit applications to Medicaid.TailoredCareMgmt@dhhs.nc.gov. 

Previous Webinars and Meetings

Tailored Care Management Technical Support Educational Series 

  • Tailored Care Management Technical Support Education Series presentation - March 10, 2022
  • Tailored Care Management Technical Support Education Series presentation - March 17, 2022
 
Tailored Care Management Certification Webinar – Thursday, Dec. 17, 2020
 
This webinar walks through the certification process for AMH+ practices and CMAs looking to deliver services through the Tailored Care Management model.
  • Recording
  • Transcript
  • Presentation
  • Questions and Answers (Feb. 2, 2021)

Tailored Care Management: What Providers Need to Know - Dec. 18, 2019

  • Presentation
  • Recording

Care Management under the Behavioral Health I/DD Tailored Plan - August 30, 2019

  • Presentation 
  • Recording

Behavioral Health I/DD Tailored Plan Care Management - August 20, 2019

  • Recording
  • Presentation
  • Transcript
  • Questions and Answers 

Behavioral Health I/DD Tailored Plan Care Management - May 30, 2019

  • Recording
  • Presentation
  • Transcript

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

  • Presentation
  • Recording
  • Transcript

This page was last modified on 05/16/2022

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