Tailored Plan Provider Manual and Webinar

DHHS has released its BH I/DD Tailored Plan Provider Manual for Tailored Care Management as well as the application questions that providers will be required to answer. While the implementation of managed care has been suspended as legislative action is needed to move forward, the Department continues to work on the design of Tailored Plans. One of the Department’s key areas of focus in Medicaid Transformation is building robust and effective models for managing beneficiaries’ comprehensive needs
through local care management. Provider-based care management will promote whole-person care, foster high-functioning integrated care teams, and drive towards better health outcomes. Additional information can be accessed on DHHS website- Tailored Plan information, the manual, and the application questions.
DHHS will host a webinar for providers entitled Tailored Care Management: What Providers Need to Know on December 18 from 11:30am-12:30pm. This webinar will explore the provider manual in more detail, walk through the application process, and address questions for you to consider. Register here.

What is Medicaid Transformation?

The North Carolina Department of Health and Human Services is dedicated to improving the health and well-being of all North Carolinians. In support of this goal, the Medicaid and NC Health Choice programs are transitioning to Medicaid Managed Care this year. This is the most significant change to the NC Medicaid program in over 40 years.

Beneficiaries will transition to one of two types of prepaid health plans (PHP’s), customized to the population they serve.

The two plans are Standard Plans and Tailored Plans.

Standard Plans will launch starting in July 2021 and they will serve the vast majority of Medicaid beneficiaries.

Behavioral Health and Intellectual/Developmental Disability (BH/IDD) Tailored Plans will launch in July 2022 and will serve individuals with more serious behavioral health disorders (serious mental illness (SMI), serious emotional disturbance (SED), and/or substance abuse disorders (SUD), intellectual/developmental disabilities (I/DDs), and traumatic brain injuries (TBIs).