For more information, please visit the CAP/DA webpage. For 24/7 help in a crisis situation, please call 1-855-798-7093. Get email alerts on latest news and upcoming events. Below are the answers to frequently asked questions about Tailored Plans. Amend exclusions to Community Navigator definition, individuals may not receive this service unless they are self-directing one or more of their services through the Agency with Choice or Employer of Record Model. Tell us about your experience with this website, and how we could make it better. How do I get behavioral health, intellectual and developmental disability (I/DD) or traumatic brain injury services prior to Tailored Plan launch? In June, beneficiaries were mailed welcome packets with information from their health plan and new Medicaid ID cards. The Department's value -based payment strategy for Tailored Plans will be released in forthcoming policy papers. You can call us at 877-201-3750 from 8 a.m. to 5 p.m., Monday through Friday except for State holidays. On October 1, 2023, Tailored Plan members will begin to receive health services from their Tailored Plan. the option to choose the Tailored Plan, you will get a notice in themail to tell you. NC Medicaid Managed Care Design and Policy Proposed program design information. For facts sheets regarding Non-Emergency Medical Transportation (NEMT), please see theNEMT pageon theCounty Playbook. Today moves us closer to that goal as we begin to implement this important program. This Fact Sheet provides details on what Standard Plans are and who qualifies for Standard Plans. <>/Metadata 143 0 R/ViewerPreferences 144 0 R>> Information on the End of Continuous Medicaid Coverage & the federal COVID-19 PHE Our goal is to welcome the employees into the RHA family and help promote growth and development. You can read more here also: https://medicaid.ncdhhs.gov/transformation A lock icon or https:// means youve safely connected to the official website. Eastern Band of Cherokee Indians (EBCI) Tribal Option: If you are a federally recognized tribal member or qualify for services through Indian Health Service (IHS) and live in Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain or Transylvania counties, you may choose to enroll in the EBCI Tribal Option. As of July 1, 2021, RHA will accept three North Carolina Medicaid Standard Health Plans: AmeriHealth Caritas North Carolina Blue Cross & Blue Shield of NC - Healthy Blue UnitedHealthcare Community Plan of North Carolina Medicaid NC Medicaid Standard Plans RHA DOES NOT Accept To learn more, go to Submit forms online. How will potential Tailored Plan members receive health care services before Tailored Plan launch on October 1, 2023? Real-time, two-way interactive audio and video telehealth for the following services: Increase the Innovations Waiver cap to 157,000. Do all health plans offer the same services? Find and view primary care providers (PCPs) and health plans, Tips for choosing a primary care provider (PCP), Choose a health plan and primary care provider (PCP), To find meetings and events near where you live, go to, All health plans offer the same basicbenefits and services. To ensure beneficiaries can seamlessly receive care on day one, the North Carolina Department of Health and Human Services will delay the implementation of the NC Medicaid Managed Care Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans until October 1, 2023. How are Tailored Plans different from what the LMEs do now? Some will be able to opt-in to a Tailored Plan. Find and view primary care providers (PCPs) and health plans, Tips for choosing a primary care provider (PCP), Choose a health plan and primary care provider (PCP), Some services may require a copay. Tailored Plans Standard Plans are integrated health plans that provide: * People in the NC Health Insurance Premium Payment (HIPP) Program, except for those beneficiaries receiving the Innovations Waiver or TBI Waiver. Use the Request to Move to NC Medicaid Direct and LME-MCO: Beneficiary form. Only one Tailored Plan serves each county in North Carolina. Request to move toNC Medicaid Direct orLME-MCO: intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) support needs, you may ask to move to NC Medicaid Direct, including your Local Management Entity-Managed Care Organization. the option to choose the Tailored Plan, you will get a notice in themail to tell you. NC Medicaid Direct is a way to get your Medicaid benefits if you cannot enroll in a health plan through NC Medicaid Managed Care. Until that time, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. Allow relatives of individuals receiving Supported Living to continue providing this service. Member resources. A draft application for 1915 (c) NC Innovation Waiver is posted for a 30-day public comment period. If you are in danger or need immediate medical attention, call 9-1-1. Secure websites use HTTPS certificates. Well call you back by the next business day. Some people will be automatically enrolled in a Tailored Plan based on their needs. Requests for Proposal and Requests for Information NC Medicaid Managed Care procurement documents. An official website of the State of North Carolina, ProviderRecruitmentNC@amerihealthcaritas.com, Tailored Care Management including Request for Applications, Eastern Band of Cherokee Indians (EBCI) Tribal Option, Contract #30-190029Prepaid Health Plan Services and Draft Rate Book, Contract #30-190029 Prepaid Health Plan ServicesAmendment 1, Contract #30-190029 Prepaid Health Plan Services Amendment 2, Contract #30-190029 Prepaid Health Plan Services Amendment 2/3, Contract #30-190029 Prepaid Health Plan Services Amendment 3/4, Contract #30-190029 Prepaid Health Plan Services Amendment 4/5, Contract #30-190029 Prepaid Health Plan Services Amendment 5/6, Contract #30-190029 Prepaid Health Plan Services Amendment 6/7, Amerihealth Attachment M.10. Executive Summary Purpose: This paper describes the North Carolina Department of Health and Human Services' (the Department's) vision for moving from fee-for-service to value-based payments (VBP) between Prepaid Health Plans (PHPs) offering Standard Plans and providers in NC Medicaid Managed Care. These regulations require states to develop and submit an access monitoring review plan (AMRP or Plan), every three years, for selected service categories. Or use the chat tool to chat with us online. To learn more, view our full privacy policy. Standard Plan Launch -Day One Provider Quick Reference Guide- updated Feb.28, 2022, AmeriHealth Caritas North Carolinaamerihealthcaritasnc.com/provider/forms/index.aspx, Carolina Complete Healthnetwork.carolinacompletehealth.com/resources/manuals-and-forms.html, Healthy Blue (Blue Cross Blue Shield)provider.healthybluenc.com/north-carolina-provider/manuals-and-guides, United Healthcare Community Plan of North Carolinauhcprovider.com/en/health-plans-by-state/north-carolina-health-plans/nc-comm-plan-home/nc-cp-training.html, WellCare of North Carolinawellcare.com/North-Carolina/Providers/Medicaid, Tailored Plan Launch - Day One Provider Quick Reference Guide, Alliance Healthalliancehealthplan.org/providers/network/provider-quick-reference-guide/, Eastpointeeastpointe.net/providers/(Fact sheet can be found under the Eastpointe Contact Fact Sheet tab), Partnerspartnersbhm.org/wp-content/uploads/partners-health-management-quick-reference-guide.pdf, Sandhillssandhillscenter.org/for-providers/(Fact sheet can be found under the Quick Reference Guide Excel File tab), Trilliumtrilliumhealthresources.org/sites/default/files/docs/Medicaid-Transformation-Provider/Trillium-Tailored-Plan-Quick-Reference-Guide.pdf, Vayaproviders.vayahealth.com/resources/vaya-quick-reference-guide/, This page was last modified on 07/05/2023, An official website of the State of North Carolina, Introduction to Medicaid Transformation: Part 1 Overview, Introduction to Medicaid Transformation: Part 2 Enrollment and Timelines, What Providers Need to Know: Part 1 Before Managed Care Launch, What Providers Need to Know: Part 2 After Managed Care Launch, Eastern Band of Cherokee Indians (EBCI) Tribal Option Overview, What Providers Need to Know Before Tailored Plan Launch, What Providers Need to Know After Tailored Plan Launch, Tailored Plan Provider Contracting Deadlines Questions and Answers, Request to Move to NC Medicaid Direct Process, Member EnrollmentPart 1 - Health Plan Auto-Enrollment, Member Enrollment: Part 2 - Primary Care Provider (PCP)/Advanced Medical Home(AMH) Auto-Assignment, Tailored Plan Member Enrollment: PCP Auto-assignment, Tailored Plan Auto-Enrollment & Opt-In Scenarios, What providers need to know about NC Medicaid Beneficiary Recertification, Medicaid and NC Health Choice Provider and Health Plan Lookup Tool, Enrollee Report Updates for Primary Care Practices in Advance of Tailored Plan Launch, Managed Care Claims Submission: What Providers Need to Know Part 1, NC Health Choice Move to Medicaid Questions and Answers Fact Sheet, NC Medicaid Managed Care: Provider Training, Children and Youth Transitioning to Foster Care for Providers, What Providers Need to Know About Pharmacy. Call 1-877-201-3750 or visit ncmedicaidombudsman.org. NC Medicaid changed the start date for Tailored Plans. We encourage you to reach out to us with any questions you may have, and we genuinely look forward to working with you in a highly confidential manner. 1 0 obj Providers can access a Provider Day One Quick Reference Guide and a fact sheet on what providers need to know after Managed Care Launch. Services provided by Local Education Agencies that are included in your child's: Individualized Family Service Plan (IFSP), Section 504 Accommodation Plan (504 Plan), The fabrication of eyeglasses including complete eyeglasses, eyeglass lenses and eyeglass frames, A provider in the health plan's network will fit the NC Medicaid Direct eyeglasses and give them to you, Some health plans also offer added services. State Government websites value user privacy. In both cases, beneficiaries will receive a notice from the NC Medicaid Enrollment Broker letting them know about Tailored Plans. If they are not, you will likely have to change to a different physical health provider. Alliance Health is the only Tailored Plan that currently offers TBI Waiver services. State Government websites value user privacy. No. Overall, we are willing and able to pay prices representative of the fair market value of recent sales prices within our space. Eastern Band of Cherokee Indians (EBCI) Tribal Optionis the Primary Care Case Management entity (PCCMe) created by the Cherokee Indian Hospital Authority (CIHA). Tailored Plans provide the same services as Standard Plans and provide additional services not available in Standard Plans. What is the Traumatic Brain Injury (TBI) Waiver? Tell us about your experience with your health plan, including your ability to access and change it. An LME-MCO coordinates services for mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI) for NC Medicaid Direct beneficiaries and EBCI Tribal Option members. What is the Tailored Plan Criteria Review? Who do I call if I am having trouble keeping my providers or getting the services I need? Questions about benefits and coverage can be answered by calling their health plan at the number listed in the welcome packet or on the What Beneficiaries Need to Know on Day One fact sheet. We do our best to answer every call, but if we are unable to answer, please leave a message with your name and phone number. To view health plans: Select your county View your choices Choose the best plan for you and your family. There are six Tailored Plans: Alliance Health, Eastpointe, Partners Health Management, Sandhills Center, Trillium Health Resources, and Vaya Health. Hours of operation: 7 a.m. to 5 p.m., Monday through Saturday. All beneficiaries moving to NC Medicaid Managed Care were enrolled in one of five health plans or the Eastern Band of Cherokee Indians (EBCI) Tribal Option by either selecting a health plan during open enrollment or through the auto-enrollment process. Federally recognized tribal members or others who qualify for services through Indian Health Service (IHS), Federally recognized tribal members or others who qualify for services through Indian Health Service (IHS) who live in the following counties: Buncombe, Clay, Cherokee, Graham, Haywood, Henderson, Jackson, Macon, Madison, Swain, Transylvania, People who get Innovations Waiver services, People who get Traumatic Brain Injury (TBI) Waiver services, People who may have a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI), Children/youth who get adoption assistance, Children who get Community Alternatives Program for Children (CAP/C) services, People in the Health Insurance Premium Payment (HIPP) program, People in the Program for All-Inclusive Care for the Elderly (PACE), People who get Community Alternatives Program for Disabled Adults (CAP/DA) services, People who get Family Planning Medicaid only. Features of the states program include establishing a payment structure that rewards better health outcomes, integrating physical and behavioral health, and investing in non-medical interventions aimed at reducing costs and improving the health of Medicaid beneficiaries. Mail: Attn: CAP/C Unit; 2501 Mail Service Center Raleigh, NC 27699-2501. * Children and youth in foster care, except for those beneficiaries receiving the Innovations Waiver or TBI Waiver. Instructions to where to send your comments and feedback are listed below. Tailored Plans will start October 1, 2023. Tailored Plan enrollment is based on the county that manages your Medicaid case (administrative county). They provide physical health, pharmacy, care management and behavioral health services for beneficiaries who may have significant mental health needs, severe substance use disorders, intellectual/developmental disabilities (I/DD) or traumatic brain injury (TBI). Raleigh Jun 30, 2021 Starting July 1, nearly 1.6 million Medicaid beneficiaries in North Carolina will begin receiving the same Medicaid services in a new way through NC Medicaid Managed Care health plans. endobj Some services may only be available with prior authorization (pre-approval) or if medically necessary. We have found the most effective way to help a seller manage this process is to be transparent regarding the positions which potentially may be contained post-close. It provides amount, scope and duration of services, as well as eligibility requirements. Standard Plans offer integrated physical health, pharmacy, care coordination and basic behavioral health for most people receiving NC Medicaid. Some health plans also offer added services. Tailored Plan eligibility can be based on either diagnosis or what services the person is receiving. WHAT ARE STANDARD PLANS? The contract (i.e., Revised and Restated Request for Proposal (RFP)) reflects the original RFP issued Aug. 9, 2018, with all addenda and negotiation documents incorporated. Secure websites use HTTPS certificates. Tailored Plans are responsible for managing two of the States Medicaid Section 1915(c) Home and Community-Based Services (HCBS) waivers: the North Carolina Innovations Waiver for individuals with I/DD and the TBI Waiver for individuals with a TBI: * Tailored Plan Information for Providers, * Tailored Plan Information for Beneficiaries. Generally, an eligible member has a significant mental health disorder, substance use disorder, intellectual/developmental disability, or traumatic brain injury. We view potential acquisitions as opportunities to gain top-tier human capital to improve our overall delivery of high-quality services to the individuals we serve. Learn more about Copays. Added language that from 10/1 on, the six LME-MCOs will administer the Innovations Waiver for NC Department of Health and Human Services. Beneficiaries have several resources to help answer questions about their transition to NC Medicaid Managed Care. If you were eligible to join a Standard Plan, you should have received a letter from NC Medicaid. Standard Plans. Some health plans also offer added services. Use these numbers if you are in crisis. View health plans with this, Use this website to submit your form. Most beneficiaries will continue to get care from the same doctors they see today but will now be a member of a health plan. The Plan must present an access monitoring analysis including data sources, methodologies, baselines andassumptions. How do I access enhanced services only offered by Tailored Plans if I am required to enroll in a Standard Plan after Tailored Plans launch October 2023? AmeriHealth Caritas North Carolina Health Plan Quick Reference Guides - Standard Plans: Standard Plan Launch - Day One Provider Quick Reference Guide - updated Feb. 28, 2022. Visit RelayNCfor information about TTY services. Learn more about Copays. PDF 213.95 KB - October 08, 2021. These include enhanced behavioral health services, services for a mental health disorder, substance use disorder, intellectual/developmental disability (I/DD) or traumatic brain injury (TBI). Flexibilities NC Medicaid anticipates requesting be made a permanent part of the TBI Waiver Service array: Home Delivered Meals (up to 1 meal per day). Additional information is available here. We can quickly tell you if your organization is a good fit, and we encourage you to reach out. Starting July 1, nearly 1.6 million Medicaid beneficiaries in North Carolina will begin receiving the same Medicaid services in a new way through NC Medicaid Managed Care health plans. NC Department of Health and Human Services For a list of NC Medicaid Direct behavioral health, I/DD and TBI services, go to NC Medicaid Direct services. Through Tailored Care Management, eligible beneficiaries will have a single designated care manager supported by a multidisciplinary team to provide integrated care management that addresses the beneficiarys whole-person health needs. A draft application for 1915 (c) NC TBI waiver is posted for a 30-day public comment period. Health plans also have added services. You can also visit, Behavioral Health Crisis Line: 1-833-712-2262, Behavioral Health Crisis Line: 1-844-594-5076, Behavioral Health Crisis Line: 1-877-334-1141, Member Services Nonemergency: 1-844-594-5070, Member Services Nonemergency: 1-800-349-1855. Other resources: In NC Medicaid Managed Care, you choose a primary care provider (PCP) and health plan. Direct care services may be provided in a hotel, shelter, church, or alternative facility-based setting or the home of a direct care worker because of COVID-19-related issues. A lock icon or https:// means youve safely connected to the official website. Assessment for Tailored Plan will be based on the following criteria, but not limited to: * Enrolled in the Innovations or TBI Waivers, or on the waiting lists, * Enrolled in the Transition to Community Living (TCL) program, * Have used a Medicaid service that will only be available through the Tailored Plan, * Have used a mental health, substance use, I/DD or TBI service funded with state, local, federal or other non-Medicaid funds, * Have a qualifying mental illness or SUD diagnosis code, and used a Medicaid-covered enhanced behavioral health service during the lookback period*, * Have a diagnosis of a psychotic disorder (primary or secondary to a mood disorder), use of clozapine or a long-acting injectable antipsychotic medication, or receive electroconvulsive therapy (ECT) during the lookback period**, * Have had an admission to a state psychiatric hospital or Alcohol and Drug Abuse Treatment Center (ADATC), including but not limited to, individuals who have had one or more involuntary treatment episodes in a State-owned facility, * Have had two or more visits to the emergency department for a psychiatric problem; two or more psychiatric hospitalizations; or two or more episodes using behavioral health crisis services during the lookback period**.
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