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to find your practice’s information in the Provider Directory Listing Report, or if your practice’s information is outdated, please submit a Manage Change Request (MCR) to update the applicable NCTracks provider record.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 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

Manuals

Other

Frequently Asked Questions

Additional Information

Previous Updates

This page was last modified on 05/16/2022

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