Tailored Care Management

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

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

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

Local Management Entity/Managed Care Organizations (LME/MCOs) and TCM providers begin providing TCM Dec. 1, 2022.

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 TCM will depend upon Tailored Plans, Advanced Medical Home Plus (AMH+) practices, Care Management Agencies (CMAs), pharmacies, and physical health, behavioral health and I/DD providers using a coordinated approach to beneficiary care.

Certified TCM Providers (April 1, 2024)

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NC Medicaid Begins Tailored Care Management

Local Management Entity/Managed Care Organizations (LME/MCOs) 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.

The Centers for Medicare & Medicaid Services (CMS) was not able to complete the request for the 1915(i) option to launch Dec. 1, 2022. 

Healthy Opportunities Pilot Trainings

Department-Sponsored Live Trainings: 

Training Session #1: The Role of Tailored Care Management Teams in HOP 

Training Session #2: Deeper Dive on HOP Responsibilities for Care Management Teams 

Training Session #3: Assessing Member Eligibility for Participation in HOP 

Mountain Area Health Education Center (MAHEC)-Sponsored Trainings:

Healthy Opportunities Pilot Training for PIHPs and Tailored Care Managers Part 1

  • Intended Audience: Care Management teams who will provide HOP Care Management to Tailored Care Management eligible members. 
  • Register for this session here.
Trainings in Part 1 include:
  1. HOP Overview for Care Managers
  2. How Care Managers Can Obtain Pilot Consent
  3. Tracking Enrollee Progress, Reviewing Service Mix and Reassessing Pilot Eligibility
  4. How Care Managers Can Choose Appropriate Interpersonal Violence Services
  5. How Care Managers Can Choose Appropriate Interpersonal Violence Services, Part 2
  6. NC AHEC Diversity, Equity and Inclusion (DEI) for Primary Care Clinical Providers and Non-clinical Staff, Module 2 - Cultural Humility

Healthy Opportunities Pilot Training for PIHPs and Tailored Care Managers Part 2

  • Intended Audience: Care Management teams who will provide HOP Care Management to Tailored Care Management eligible members. 
  • Register for this session here.
Trainings in Part 2 include:
  1. How Care Managers Can Choose Appropriate Housing Services
  2. How Care Managers Can Choose Appropriate Transportation Services, Version 2
  3. How Care Managers Can Choose Appropriate Health Related Legal Supports
  4. How Care Managers Can Choose Appropriate Food Services within the Healthy Opportunities Pilot Programs
  5. Understanding the Medical Respite Cross Domain Service
  6. How Care Managers Can Choose Appropriate Toxic Stress Services

Healthy Opportunities Resources

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  • The Department encourages TCM providers to contact their LME/MCO for specific concerns and issues. TCM providers can also contact the Provider Ombudsman.
  • Inquiries can be submitted to the Provider Ombudsman by:
  • Responses to inquiries are autogenerated from ServiceNow and sent directly to the inquirers email address. The subject line will read “NC Medicaid Inquiry COM00XXXXX Has Been Closed” and be sent from this email address: IT Service Desk Medicaid.HelpCenter@dhhs.nc.gov. 

Success Stories

TCM Meets You Where You Need It

In one situation, a Care Manager met an individual where he was standing outside a homeless shelter. The care manager worked with the individual and was able to have him connected to a temporary room. Currently, the Care Manager is working with the individual to establish permanent housing, in addition to sustained employment.

The shelter had arranged the housing but he had no way to get to the rooming house, so the Care Manager supported in getting him there. He also had nothing with him but a trash bag of clothes. The Care Manager and Care Manager extender supported him with resources for furnishing the room, including a mattress, and household essentials. TCM also has connected him to medication management services. He has had ups and downs since beginning the program but throughout it all remains in contact with his team due to the rapport that was built.

The individual takes a lot of initiative in his own treatment and life goals such as employment, but it is so helpful to have a service that is available to him when needed.

Care Managers Work with you in Urgent Situations

TCM efforts of getting people primary care visits are working. One individual was completely blind in one eye. Yearly, Medicaid covers the replacement of the individual's specially made contact. Unfortunately, before the next time insurance covered the cost, the individual lost their contact. With the help of TCM, the individual was able to get a replacement lens at no cost.1

TCM Supports People in Building a Brighter Future

One Care Manager began working with a formerly incarcerated young man. She has assisted with his transition, provided transportation as he got things in order for his new job, and is ensuring his physical health needs are met by lining up a needed dental appointment. This young man recently shared that he is excited about his future, and these are the stories that continue to drive our Tailored Care Management efforts!

TCM Connects You to the Right Care and Resources

A hard to engage individual with TCM had significant unmet needs and was facing housing issues. The individual was in and out of the emergency room weekly, sometimes daily. The Care Manager was made aware that the individual was in the emergency room. The Care Manager was able to establish trust with the emergency room staff and was put in contact with a hospital social worker. The Care Manager worked collaboratively with the social worker to identify a close family member for support. Due to the Care Manager's efforts, the individual engaged in TCM. Through TCM, the Care Manager located safe housing in addition to daily meals for the member. Prior to this connection, the individual shared that they had gone years without health care. The Care Manager is now working to link the individual to a Primary Care Provider.2

TCM Supports Whole Person Needs: Both Mental Health and Physical Health

An individual who had been going through many health issues related to her stomach began losing a lot of weight. A Care Manager engaged her, and she shared that this issue has been going on for the past year. Because of her mental health, doctors in her area refused to do an endoscopy and treatments she needed. The individual would get upset, as she was denied many appointments and surgery. At a certain point, she had begun to lose her vision. The Care Manager and Care Manager extender helped her get connected to a doctor in Charlotte. The Care team set up her free transportation to the appointment. The doctor found out she had a virus that was treatable with an antibiotic. Her health has greatly improved.  

1 Primary Care Solutions, Inc.
2 Daymark Recovery Services, Inc.

Archive

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Webinar: Transition to Tailored Care Management for Children/Youth Served by the Child Welfare System:
A Resource for County DSS and Other Stakeholders - Nov. 29, 2022

Tailored Care Management Technical Support Educational Series

 
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.

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

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

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

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

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

Temporary Flexibilities and Program Changes

The Tailored Care Management program launched on December 1, 2022. Recognizing that it would take providers some time to ramp up and meet the full set of program requirements, on November 2, 2022,  the Department released a memo permitting temporary flexibilities and program changes for the period between December 1, 2023, and March 31, 2023. The majority of these flexibilities came to an end on March 31, 2023, and some will continue until June 30, 2023. This memo seeks to clarify the current status of each flexibility and outlines several additional program updates.

NOTE: Until Tailored Plan launch, the State’s local management entity/managed care organizations (LME/MCOs) will continue to operate the Tailored Care Management model. Individuals eligible for the model will still have the option to obtain Tailored Care Management from an Advanced Medical Home Plus (AMH+) practice, Care Management Agency (CMA), or plan-based care manager. Until an eligible individual engages in Tailored Care Management, their LME/MCO will be responsible for care coordination functions. In the future, Tailored Care Management will be offered by LME/MCOs in their role as both Tailored Plans and prepaid inpatient health plans (PIHPs).

To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services (NCDHHS) is delaying the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities Tailored Plans (Tailored Plans), now scheduled for July 1, 2024. Beneficiaries who will be covered by the Tailored Plans will continue to receive care as they do today. 

This page was last modified on 04/12/2024