Transition of Care

The North Carolina Department of Health and Human Services (DHHS) developed policies and procedures for Transition of Care to support beneficiaries who transition between Medicaid Direct (fee-for-service) and Medicaid Managed Care delivery systems. The Transition of Care design intends to maintain continuity of care for each beneficiary and minimize the burden on providers during transition.

Along with the established Transition of Care policy, the Department has established technology and process requirements for all stakeholders to support the Transition of Care design.

Update

Transition of Care Draft Policy Posting & Webinar 

On Feb. 5, 2020, the Department of Health and Human Services issued the NC DHHS Transition of Care Draft Policy for public comments detailing the requirements under which the Standard Plan Prepaid Health Plans (PHPs) will facilitate transition of care for members transitioning between PHPs or service delivery systems. The Transition of Care design intends to maintain continuity of care for each beneficiary and minimize the burden on providers during transition.

Due to the suspension of NC Medicaid Managed Care, this policy will go into effect when Medicaid Managed Care goes live. The webinar and related materials can be found on the Provider Playbook: Training Courses page, under Completed Training, and MCT 119 - Transition of Care Draft Policy Webinar. 

The Department welcomes feedback on the policy at Medicaid.Transformation@dhhs.nc.gov by March 6, 2020. 

Resources

Transition of Care Data Specification Guidance