Tailored Care Management

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

Through Tailored Care Management, 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 Care Management 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

Community Inclusion Addendum Added to Tailored Care Management Provider Manual (March 19, 2021)

DHHS is releasing an addendum to the Tailored Care Management Provider Manual on community inclusion that addresses the in-reach and transition requirements for AMH+ practices and CMAs delivering Tailored Care Management.

Tailored Care Management Certification Deadline Extended to June 1, 2021 (Feb. 15, 2021)

To continue supporting providers interested in obtaining certification as an Advanced Medical Home Plus (AMH+) practice or Care Management Agency (CMA), the Department is extending the Round 1 application deadline from March 1, 2021 to June 1, 2021. 

The Department plans to use this additional time to engage stakeholders in additional listening sessions and educational opportunities.  More information will also be provided on the certification process, capacity-building funds, technical assistance and the rate model for AMH+/CMAs.

Application Period Open for Tailored Care Management Certification (Dec. 14, 2020)

The application period for Tailored Care Management Certification is open. For providers looking to obtain certification prior to Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plan launch in July 2022, the certification process will take place in three rounds. Interested providers should review the updated Provider Manual and application questions located under the Resources section below, and may submit applications to Medicaid.TailoredCareMgmt@dhhs.nc.gov

Tailored Care Management Certification Webinar – Thursday, Dec. 17 

This webinar walks through the certification process for AMH+ practices and CMAs looking to deliver services through the Tailored Care Management model.

Previous Updates

Tailored Care Management Updates (June 9, 2020)
Provider Application Process for Tailored Care Management – extended deadlines (Feb. 17, 2020)
Update: Draft Provider Manual for Tailored Care Management (Jan. 17, 2020)
Draft Provider Manual for Tailored Care Management (Dec. 11, 2019)

Resources

Revised Tailored Care Management Application Questions (Jan. 27, 2021)
Tailored Care Management Provider Manual (Dec 2, 2020) 
Tailored Care Management Provider Manual: Community Inclusion Addendum (March 19, 2021)
Revised Tailored Care Management Application Questions (Dec. 2, 2020) 
Tailored Care Management Provider Manual (June 9, 2020) 
Revised Tailored Care Management Application Questions (June 9, 2020) 
Town Hall Meeting Frequently Asked Questions (Feb. 18, 2020)

Previous Meetings - 2019

Previous Meetings - 2019

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