August 18, 2021

BH/IDD Tailored Plan Contracts Awarded and Potential PHP Partners

NC DHHS announced on July 26th that all seven of the current LME/MCOs received the awards to become BH/IDD Tailored Plans beginning on July 1, 2022.  This will shift to six Tailored Plans assuming the merger between Cardinal Innovations and Vaya Health progress as well as the other county disengagements that are underway.  In this interim one-year period, Medicaid beneficiaries who are eligible for a Tailored Plan will receive physical health services through Medicaid Direct and BH/IDD services through the LME/MCOs. 

As a part of the responses to the Request for Application (RFA), each LME/MCO provided the name of a Standard Plan (PHP) with which they intend to partner to provide integrated physical, BH, IDD, SUD care.  It is important to note that they may be in different stages of formalizing these partnerships so there could be a possibility of change.  For the purposes of the RFA, the intention of partnership went as follows:

Alliance – Wellcare

Cardinal Innovations – HealthyBlue**(they have announced intent to merge with Vaya)

Eastpointe – Wellcare

Partners – Carolina Complete Health

Sandhills – AmeriHealth Caritas

Trillium – Carolina Complete Health

Vaya – Wellcare

There is still work to be done before these LME/MCOs will officially become Tailored Plans on July 1, 2022.  NC DHHS has prescribed a Readiness Review process that can result in the LME/MCO being allowed to commence full operations on 7/1/22.  The Readiness Review process could also mean that an LME/MCO receives conditional acceptance that requires a corrective action plan and possibly limited acceptance that would reduce the level of participation in Medicaid managed care and State-funded BH/IDD/SUD/TBI services based on the results of the review and any resulting corrective action plan. 

NC DHHS continues to work on education and information sharing for Medicaid beneficiaries who are eligible for the Tailored Plan.  As of June 30th, 7,500 Tailored Plan eligible individuals had chosen a Standard Plan.  This would, of course, prohibit them from receiving those higher level BH/IDD/SUD services that are only available through the LME/MCOs and later the Tailored Plans without undergoing a transition of care.  NC DHHS leaders made the decision to postpone the enrollment in Standard Plans of those 7,500 Tailored Plan eligible individuals until they had received further choice counseling.  After receiving written materials and conversing with an Enrollment Broker Specialist, the Medicaid beneficiary may still choose a Standard Plan and will then complete the Informed Consent Process. 

NC Medicaid has two Tailored Care Management updates for providers as preparation continues for the launch of the Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans July 1, 2022.

Tailored Care Management Update: AMH+/CMA Certification Round One Desk Reviews Completed

The Department has conducted desk reviews of round one Advanced Medical Home Plus (AMH+) practices/Care Management Agencies (CMAs) provider applications and advanced 54 providers to the site review stage.

Providers will be able to receive technical assistance from NC AHEC to prepare for site reviews. The Department will share more information on preparation and timing for site reviews with providers moving to this stage. See Medicaid bulletin article Tailored Care Management Update: AMH+/CMA Certification Round One Desk Reviews Completed for more information.

Potential Clinically Integrated Network or Other Partners Statement of Interest

Advanced Medical Home Plus (AMH+) practices and Care Management Agencies (CMAs) may choose to contract with a Clinically Integrated Network (CIN) or other partners to share responsibility for specific functions and capabilities required to operate as an AMH+ practice or CMA and meet the requirements of the Tailored Care Management.

To give providers additional information about the North Carolina CIN or other partners market, in May and June 2021, the Department solicited responses to a voluntary, non-binding Statement of Interest on the type of services that CINs and other partners offer to providers applying to become certified as AMH+ practices and CMAs.

The Department has compiled all responses received from CINs and other partners and is making this information available to prospective AMH+ practices and CMAs and other stakeholders on the Tailored Care Management webpage.