nc medicaid standard plans

It is the fastest and best way to submit a form. Medicaid beneficiaries will be assessed for Tailored Plan eligibility. Tailored Plans include coverage for physical health services, pharmacy services, care coordination and care management, behavioral health services, and added services, such as wellness programs. These levers include quality, culture, financial performance, opportunity for growth, geography, payor mix, and access to human capital. What is the Tailored Plan Criteria Review? The Contract (I.e., First Revised and Restated Request for Application (RFA)) reflects the original RFP issued Nov. 13. 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). Visit RelayNCfor information about TTY services. 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, , you may choose to enroll in the EBCI Tribal Option. A draft application for 1915 (c) NC Innovation Waiver is posted for a 30-day public comment period. You will need to have your NCID ready to log in and request to change your Standard Plan. Yes. Standard Plan members, refer to the companion . 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**. 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. The timeframe is typically 2-3 months and is highly dependent on the efficiency of the potential seller providing us with the information we request. State Government websites value user privacy. Standard Plan change request: You can request to change your Standard Plan in one of the following ways: Log in to your NC Medicaid Managed Care account. Approved In Lieu of Services, WellCare NC Attachment M.10. Who do I call if I am having trouble keeping my providers or getting the services I need? Use these resources to help you choose: For information about your local Department of Social Services (DSS), select your county below. 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. These regulations require states to develop and submit an access monitoring review plan (AMRP or Plan), every three years, for selected service categories. Added language that from 10/1 on, the six LME-MCOs will administer the Innovations Waiver for NC Department of Health and Human Services. If they are not, you will likely have to change to a different physical health provider. A lock icon or https:// means youve safely connected to the official website. NCDHHS has leveraged the move to managed care to build an innovative health care delivery system that puts the health of beneficiaries at the forefront. The NC Medicaid Enrollment Broker provides services to help NC Medicaid beneficiaries learn about their NC Medicaid health care options, find information about health care options and primary care providers, and enroll in a health care option. Beginning October 1, 2023, Tailored Plans will manage all Medicaid services for their members, including physical health services. To support a smooth transition of care for beneficiaries and providers, health plans will honor approvals beneficiaries have already received for care for the first 90 days after July 1 if those services are also covered by the plan. For provider referrals or general questions about coverage and services, please call 1-866-799-5318. Secure websites use HTTPS certificates. the beneficiary must sign the provider form. 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. To see the full list of NC Medicaid covered services provided by the health plans, go to ncmedicaidplans.gov. Contract #30-190029 Prepaid Health Plan Services and Draft Rate Book 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. 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), People who are blind or disabled and do not get Medicare. Use these numbers if you are in crisis. If you have a Medicaid health plan that RHA does not accept, use the contact information below to get connected with services that are in network for your plan. Words to know. NC Medicaid Ombudsman: If you are not getting the care you need or have been unable to resolve a problem with your health plan or provider, you can contact the NC Medicaid Ombudsman. How can I choose my PCP or Tailored Care Management provider? You can use this website to submit your form. Tailored Plans provide the same services as Standard Plans and provide additional services not available in Standard Plans. Overall, we are willing and able to pay prices representative of the fair market value of recent sales prices within our space. View health plans with thisHealth Care Option Guide. Standard Plans. Throughout this process, NCDHHS has prioritized stakeholder engagement and transparent communication to ensure those most impacted by this change have an opportunity to share input and are informed at each step of the process. It is the fastest and best way to submit a form. (link coming soon), If you are a provider, you may ask for a person to move to NC Medicaid Direct. Additional information is available here. To learn more, call us at1-833-870-5500(TTY: 711 or RelayNC.com). You can use this website to submit your form. AmeriHealth Caritas of North Carolina - Prepaid Health Plan; Statewide The call is toll free. Medical benefits and services include: Ambulance services Cardiac procedures Some health plans also offer added services. Standard Plans offer some basic behavioral health services. 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. LME-MCOs currently only manage behavioral health services. Behavioral health benefits and services include: Tailored Plan benefits and services include: You can get these services from a provider outside of the health plans network, if the provider takes NC Medicaid: You can get these services from a provider in the health plans network: If you have questions, call us at1-833-870-5500(TTY: 711 or RelayNC.com). NC Medicaid Direct is a way to get your Medicaid benefits if you cannot enroll in a health plan through NC Medicaid Managed Care. State Government websites value user privacy. We are here to help. Beneficiaries have until Sept. 30, 2021, to change plans for any reason. * Children who receive Community Alternatives Program for Children (CAP/C) services, * People who receive Community Alternatives Program for Disabled Adults (CAP/DA) services. Fact Sheet - Standard Plan and Tailored Plan Services . 2020 RHA Health Services 17 Church Street, Asheville, NC 28801 marketing@rhanet.org | Web Design & Development by Chariot Creative, Inc. Some people will be automatically enrolled in a Tailored Plan based on their needs. Below are the answers to frequently asked questions about Tailored Plans. Standard Plans are integrated health plans that provide: "From the start of this process, our goal has been to improve the health of North Carolinians through an innovative, whole-person centered, and well-coordinated system of care. Fact Sheet - Standard Plan and Tailored Plan Services. No. Tailored Plan members will not have the option to change their Tailored Plan. Requests for Proposal and Requests for Information NC Medicaid Managed Care procurement documents. Approved In Lieu of Services, UnitedHealthcare Attachment M.10. (link coming soon), If you are a provider, you may ask for a person to move to The Tailored Plan. When are Tailored Plan changes happening? If you move outside of your Tailored Plans service area, you will continue to receive services from your Tailored Plan. 2501 Mail Service Center Raleigh, NC 27699-2501 . NCMT-Fact Sheet-SP and TP Behavioral Health Services.pdf. Providers can access a Provider Day One Quick Reference Guide and a fact sheet on what providers need to know after Managed Care Launch. Yes. To learn more, go to, Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Beneficiary Form, Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO: Provider Form. Submit forms online. 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. There are six Tailored Plans: Alliance Health, Eastpointe, Partners Health Management, Sandhills Center, Trillium Health Resources, and Vaya Health. Only use it for. To learn more, go toView health plans. Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO Form. If you were eligible to join a Standard Plan, you should have received a letter from NC Medicaid. A lock icon or https:// means youve safely connected to the official website. At Tailored Plan launch on October 1, 2023, TBI Waiver services will only be available in the following counties: Cumberland, Durham, Johnston and Wake. Allow parents of minor children receiving Community Living and Support to continue providing this service to their children who have been indicated as having extraordinary support needs as evidenced by a Support Intensity Scale (SIS) score of E (Very High General Support), F (Extraordinary Medical Support), and G (Extraordinary Behavioral Support Need). 2020, with all addenda and negotiations documents included. Approved In Lieu of Services, Carolina Complete Health Attachment M.10. Email: medciaid.capcwaiver@dhhs.nc.gov or. Please be sure to note the request is for the EBCI PCCMe contract. Tell us about your experience with this website, and how we could make it better. For facts sheets regarding Non-Emergency Medical Transportation (NEMT), please see theNEMT pageon theCounty Playbook. Standard Plans are scheduled to go live July 1, 2021, while Behavioral Health I/DD Tailored Plans are scheduled to launch July 1, 2022. NC Medicaid Division of Health Benefits. To learn more, view our full privacy policy. Members who use certain services for their developmental disability . Instructions to where to send your comments and feedback are listed below. Our goal is to welcome the employees into the RHA family and help promote growth and development. The Traumatic Brain Injury (TBI) Waiver is a special federal program that provides long-term services and supports for people who experienced a traumatic brain injury (TBI). How do I get behavioral health, intellectual and developmental disability (I/DD) or traumatic brain injury services prior to Tailored Plan launch. (link coming soon). 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. ", Since the passage of legislation in 2015 that began the states transition to managed care, NCDHHS has worked closely with health plans, providers, beneficiaries and community-based organizations to design and prepare for implementation, including developing benchmarks for quality care that plans must meet, building systems to share data across organizations, ensuring plans have enough providers to maintain access to care and developing policies to support beneficiaries as they transition to this new model. Under managed care, Medicaid providers enroll with one or more health plan networks. Make sure your local DSS has your current mailing address, phone number and email address to ensure you get all important information from your Tailored Plan. Today moves us closer to that goal as we begin to implement this important program. Tailored Plans are health plans that offer integrated physical health, pharmacy, care coordination and behavioral health services for members who may have significant mental health needs, intellectual/developmental disabilities (I/DDs), traumatic brain injuries (TBIs) or severe substance use disorders. Tailored Plan enrollment is based on the county that manages your Medicaid case (administrative county). Most people in NC Medicaid must enroll in a Standard Plan in the NC Medicaid Managed Care program. <> For 24/7/365 help in a crisis situation, please call 1-833-207-4240. 30, 2023), Community Alternatives Program for Disabled Adults Approved Letter/Final Waiver, 1915(c) HCBS Waiver: NC.4141.R07.01 Final Waiver, 1915(c) Community Alternatives Program for Children (CAP/C) Waiver - NC.4141.R07.01 Approval Letter, 2016-2018 Access Monitoring Review Plan (AMHRP), SPA 23-0013 10-Day Public Notice (Physician's Services), SPA 23-0016 10- Day PN (Disaster SPA Extension), SPA 23-0017 10-Day PN (CHIP Health Service Initiatives), 2022 Ten-Day Posting for Submission to CMS, 2021 Ten-Day Posting for Submission to CMS, SPA 23-0001 Proposed Amendment (Estate Recovery), SPA 23-0002 Proposed Amendment (ED Bed Hold), SPA 23-0003 Proposed Amendment (Home Health EVV), SPA 23-0004 Proposed Amendment (8B Inpatient Behavioral Health Services), SPA 23-0006 Proposed Amendment (Opioid Treatment Program), SPA 23-0007 Proposed Amendment (Former Foster Care Coverage), SPA 23-0008 & SPA 23-0010 Proposed Amendment (SCHIP to MCHIP), SPA 23-0009 Proposed Amendment to CMS (MCHIP Expansion), SPA 23-0011 Proposed Amendment to CMS (Home Infusion Therapy -HIT), SPA 23-0012 Proposed Amendment to CMS (Eligible Medical Professionals-Physician's Services). 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. ePASS is North Carolina's secure self-service website where you can apply for various benefits, view your case details, renew your Medicaid and update your information without having to visit your local DSS. To make sure beneficiaries have choices for care, the North Carolina Department of Health and Human Services (NCDHHS) changed the start of the NC Medicaid Managed Care Behavioral Health and Intellectual/ Developmental Disabilities (I/DD) Tailored Plans (Tailored Plans) to October 1, 2023. Application for 1915(c) HCBS Waiver: NC.0423.R03.10, Application for 1915(c) HCBS Waiver: NC.1326.R01.02, Community Alternatives Program for Disabled Adults Approved Waiver. Prior to Tailored Plan Launch October 2023, you can continue to receive your health services through NC Medicaid Direct and LME/MCO. What should I do to prepare for Tailored Plan launch? The public comment period is from June 22, 2023 through July 21, 2023. Learn Learn about NC Medicaid Managed Care. Alliance Health is the only Tailored Plan that currently offers TBI Waiver services. Leading the Way to Better Healthcare What makes Carolina Complete Health different is that we are a provider-led Medicaid plan with doctors and other providers guiding how we deliver the high-quality, coordinated care you and your family needs. More information on Medicaid Managed Care can be found on the NC Medicaid website at medicaid.ncdhhs.gov/transformation. Standard Plans offer integrated physical health, pharmacy, care coordination and basic behavioral health for most people receiving NC Medicaid. How do I get behavioral health, intellectual and developmental disability (I/DD) or traumatic brain injury services prior to Tailored Plan launch?
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