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

NC Medicaid Begins Tailored Care Management  

Local Management Entity/Managed Care Organizations along with Tailored Care Management providers begin providing Tailored Care Management Dec. 1, 2022.

Beneficiaries receiving Tailored Care Management will have a single designated care manager supported by a multidisciplinary care team to provide whole-person care management that addresses all their needs, including physical health, behavioral health, I/DD, traumatic brain injuries (TBI), pharmacy, long-term services and supports, and unmet health-related resource needs. 

Letters were mailed beginning Nov. 14, 2022, to TCM-eligible beneficiaries and authorized representatives with the name and contact information of their TCM provider. The letter also explains Tailored Care Management services and provides information on how beneficiaries can change their Tailored Care Management provider or opt out of the service. A sample notice is available in the NC Medicaid Managed Care County Playbook under Other Beneficiary Notices. Beneficiaries can change their Tailored Care Management provider at any time, without limits, prior to April 1, 2023, by calling their LME/MCO.  

The Centers for Medicare & Medicaid Services (CMS) was not able to complete the request for the 1915(i) option to launch Dec. 1, 2022. The application is currently with CMS for review and approval, and we expect it to launch along with Tailored Plans April 1, 2023.

Temporary Flexibilities and Program Changes

Recognizing this is a time of substantial change for NC Medicaid enrollees, providers and health plans, NCDHHS will implement temporary flexibilities and program changes for the four-month period between the Dec. 1, 2022, Tailored Care Management launch and March 31, 2023, the day before the start of Behavioral Health and Intellectual/Developmental Disabilities (I/DD) Tailored Plans.

These flexibilities and program changes give organizations providing Tailored Care Management (e.g., Advanced Medical Home + (AMH+s), Care Management Agencies (CMAs) and LME/MCOs) adequate time to gain experience with the model, engage as many eligible beneficiaries as possible and identify and address unexpected challenges.

Beneficiaries will continue to receive Behavioral Health Services, I/DD and traumatic brain injury (TBI) supports through their LME/MCO and physical health and pharmacy services through NC Medicaid Direct, just as they do today. Nothing changes for beneficiaries on Dec. 1, 2022—except they will have access to Tailored Care Management through AMH+s, CMAs and LME/MCOs.

For more information, please see Medicaid provider bulletin article Tailored Care Management Implements Temporary Flexibilities and Program Changes.
 

Tailored Care Management Beneficiary Assignment Update

LME/MCOs will begin mailing Tailored Care Management assignment letters to eligible beneficiaries beginning the week of Nov. 14, 2022. A sample letter for NC Medicaid Direct beneficiaries who qualify for Tailored Care Management is available on the NC Medicaid website.

Beneficiaries are free to change their assigned Tailored Care Management provider at any time, with no limit on the number of changes, prior to April 1, 2023.

  • If a beneficiary/family/legal guardian wants to change the Tailored Care Management provider for any reason, they should contact their LME/MCO, whose contact number is included in the letter.
  • When beneficiaries call, LME/MCOs will share all Tailored Care Management providers certified in their region they can chose from.  

Resources

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Other

Frequently Asked Questions

Additional Information

Previous Updates

This page was last modified on 12/02/2022

https://medicaid.ncdhhs.gov/tailored-care-management