BH/IDD Tailored Plan Care Management a Work in Progress

The care management function under the BH/IDD Tailored Plan (Tailored Plan) appears to be evolving.  The care management function under the Standard Plan and BH/IDD Tailored Plan have significant differences in requirements based on the needs of the members of these plans.  An initial difference is that an Advanced Medical Home under the Standard Plan requires an attestation to NC DHHS that the practice meets the requirements.  To be a care manager under the BH/IDD Tailored Plan, an agency must be certified by NC DHHS to meet the requirements as an Advanced Medical Home Plus (AMH+) or Care Management Agency (CMA).  NC DHHS is now providing more information about the Tailored Plan care management role and has extended the Round 1 application deadline from March 1, 2021 to June 1, 2021. 

Most recently NC DHHS has published an addendum to the Tailored Care Management Provider Manual around Community Inclusion and specifically in-reach and transition services.  In-reach and transition services have been a part of the Transition to Community Living Initiative provides eligible adults living with serious mental illnesses the opportunity to choose where they live, work and engage in their community. 

In December a NC DHHS webinar included in-depth information regarding the State expectations for care management under the Tailored Plan, including:

• Each AMH+ applicant must attest that it has a patient panel with at least 100 active Medicaid patients who have an SMI, SED, or severe SUD; an I/DD; or a TBI;

• AMH+ organizations must intend to be a part of the primary care provider network for the BH/IDD Tailored Plan;

• Certifications for AMH+ and CMAs will be done by population (e.g. MH/SUD child or adult, I/DD, Innovations, TBI, co-occurring);

• CMAs will be certified at the level of the entire organization or at the regional level is they work with multiple LME/MCOs;

• Details around certification requirements, health information technology, quality measurement/improvement and training. 

NC DHHS has a webpage for more information about Tailored Care Management.