Information for Tailored Care Management Providers

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This page has technical information for providers of Tailored Care Managment.

Not a provider? Visit Tailored Care Management instead.

About the Tailored Care Management model

The 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 members a choice in how they receive care management.

Through TCM, members have a single designated Tailored Care Manager supported by a care team to provide care management that addresses all of their needs including physical health, behavioral health, intellectual/developmental disabilities (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 member’s enrollment in a Tailored Plan or NC Medicaid Direct.
  • Be based in provider settings to the maximum extent possible, supporting integrated care and collaboration.
  • Prioritize frequent in-person interactions between Tailored Care Managers and members.
  • Place additional emphasis on outcomes and population health management.

Local Management Entity/Managed Care Organizations (LME/MCOs) and TCM providers began 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 members.

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 member care.

For an overview of Tailored Care Management, go to the page for members.

Tab/Accordion Items

Archive

Tab/Accordion Items

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. 

Tailored Care Management

Need help?

Providers should contact the Tailored Plan for specific concerns and issues:

Providers may also contact the Medicaid Provider Ombudsman at 1-866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov.

Visit the NC Medicaid Help Center, an online source of information about NC Medicaid Managed Care and Medicaid.

This page was last modified on 11/13/2024