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.
Transition of Care Policy
Consistent with federal requirements and NC Medicaid’s vision to ensure continuity of care for members transitioning between prepaid health plans (PHPs) or service delivery systems, NC Medicaid has released the NCDHHS Transition of Care Policy. The draft policy was released for public comment in February 2020 and finalized on Feb. 25, 2021.
Transition of Care Data Transfer:
Processes Impacted by 42 CFR Part 2
June 7 webinar
May 24, 2021 webinar
March 11, 2021: Transition of Care Policy Overview
For questions about the Transition of Care Policy, please email Medicaid.NCEngagement@dhhs.nc.gov.
Transition of Care Disenrollment Protocols
- TOC Protocol between Standard Plan Health Plans and LME MCOs
- TOC Protocol Disenrollment due to Dual Eligibility
- TOC Protocol Disenrollment due to Extend NF Stay
- TOC Protocol Disenrollment Due to Foster Care Enrollment