nc medicaid standard plans
The new start date is October 1, 2023. 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. The Contract (I.e., First Revised and Restated Request for Application (RFA)) reflects the original RFP issued Nov. 13. Choose your county: Alliance Health (Tailored Plan) Select About your health care choices or services provided by health plans: Go toncmedicaidplans.gov (chat feature available), use the NC Medicaid Managed Caremobile app or call toll free at 1-833-870-5500 (TTY: 711 or RelayNC.com) to learnmore about your choices, including the EBCI Tribal Option or NC Medicaid Direct. Until October 1, 2023, you will keep getting services the way you do now. Use the Request to Move to The Tailored Plan: Provider form. NC Medicaid Managed Care Design and Policy Proposed program design information. Information on the End of Continuous Medicaid Coverage & the federal COVID-19 PHE To learn more, go to Submit forms online. NC Medicaid Direct is a way to get your Medicaid benefits if you cannot enroll in a health plan through NC Medicaid Managed Care. Standard Plan Regional Map.pdf. 0938-0391 34g180 01/19/2023 name of provider or supplier street address, city, state, zip code 2600 pleasant ridge road guilford #3 summerfield, nc 27358 provider's plan of correction (each corrective action should be cross-referenced to the appropriate deficiency) (x5) completion date id prefix . Beneficiaries have several resources to help answer questions about their transition to NC Medicaid Managed Care. Medicaid beneficiaries will be assessed for Tailored Plan eligibility. Most beneficiaries will continue to get care from the same doctors they see today but will now be a member of a health plan. What enhanced services are only offered by Tailored Plan? You will need to have your NCID ready to log in and request to change your Standard Plan. NOTE: RHA will continue to serve members with NC Medicaid Direct (Tailored Plan group) as usual. NC Medicaid Division of Health Benefits. We have a best-in-class Acquisitions team that manages the entire acquisition process professionally, efficiently, and effectively. About 1.6 million Medicaid and NC Health Choice beneficiaries will enroll in a Standard Plan, which will provide integrated physical health, behavioral health and pharmaceutical services. There are also outside variables we cannot control specifically, the license transfer process. Standard plans provide integrated physical health, behavioral health, pharmacy and long-term services and support to most Medicaid beneficiaries, as well as other programs and services that address unmet health-related resource needs, We take calls 8 a.m. to 5 p.m., every Monday to Friday except for State holidays. k3p=:z5J3GCgOkyLv7ZXy. Other resources: In NC Medicaid Managed Care, you choose a primary care provider (PCP) and health plan. The public comment period is from June 30, 2023 through July 30, 2023. Most people in NC Medicaid must enroll in a Standard Plan in the NC Medicaid Managed Care program. <> A draft application for 1915 (c) NC Innovation Waiver is posted for a 30-day public comment period. 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. Use theRequest to Move to NC Medicaid Direct (Fee for Service) or LME-MCO Form. Enroll Choose a health plan and primary care provider (PCP) Contacts and links. More information regarding the beneficiary choice period and other key dates leading up to the October 1, 2023, launch will be shared by NCDHHS in the coming weeks. 2020 RHA Health Services 17 Church Street, Asheville, NC 28801 marketing@rhanet.org | Web Design & Development by Chariot Creative, Inc. As a member of the EBCI Tribal Option, you can still get services from any NC Medicaid provider. 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. If you are currently enrolled in NC Medicaid Direct, call 888-245-0179. For 24/7 help in a crisis situation, please call 1-855-798-7093. For provider referrals or general questions about coverage and services, please call 1-833-552-3876. Tailored Plan members will have a single designated care manager, supported by a multidisciplinary care team, to provide whole-person care to address physical health, behavioral health, intellectual/developmental disability (I/DD), traumatic brain injury (TBI), pharmacy, long-term service and supports (LTSS) and unmet health-related resource needs. Members will be able to request transition to the Tailored Plan if they have been placed on the Standard Plan and choose to be served by the Tailored Plan. Yes. - NC Medicaid Ombudsman Back to all FAQs What are Standard Plans? Learn more about Copays. To view health plans: Select your county View your choices Choose the best plan for you and your family. <> We understand that selling your business can be stress-inducing, and we have been through the process numerous times. 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. Tailored Plans Prior to Tailored Plan Launch October 2023, you can continue to receive your health services through NC Medicaid Direct and LME/MCO. Secure websites use HTTPS certificates. To learn more, call us at1-833-870-5500(TTY: 711 or RelayNC.com). 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. Additional information is available here. If the county that manages your Medicaid case (administrative county) changes, you may be moved to a different Tailored Plan. Print application selector for 1915(b) Waiver: NC.0002.R05.02, NC.1326.R01.02 - (b)(c) Concurrent TBI Amendment Approval Letter, NC.0423.R03.10 - (b)(c) Concurrent Innovations Amendment Approval Letter. endobj 2016-2018 Access Monitoring Review Plan (AMHRP), State Plan under Title XIX of the Social Security Act Medical Assistance Program, Child Health Plan under Title XXI of the Social Security Act Children's Health Insurance Program, This page was last modified on 07/06/2023, An official website of the State of North Carolina, Application for 1915(c) HCBS Waiver: Draft NC.025.03.07, (effective Oct. 1, 2023, posted Jun. Learn Learn about NC Medicaid Managed Care. Find Find and view primary care providers (PCPs) and health plans. To learn more, view our full privacy policy. 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. State Government websites value user privacy. State Government websites value user privacy. Use this website to submit your form. During the due diligence process, we will work with you to gain an understanding of the potential talent pool associated with your organization. Will any beneficiaries stay in NC Medicaid Direct? The provider form includes a Service Authorization Request (SAR). Secure websites use HTTPS certificates. If you are currently enrolled in a Standard Plan and need to access behavioral health, I/DD, or substance use disorder services, you may submit a Request to Move to The Tailored Plan. If you enroll in a Standard Plan, you may not be able to get certain NC Medicaid Direct services. Mail: Attn: CAP/C Unit; 2501 Mail Service Center Raleigh, NC 27699-2501. * Children who receive Community Alternatives Program for Children (CAP/C) services, * People who receive Community Alternatives Program for Disabled Adults (CAP/DA) services. The call is toll free. Most beneficiaries will continue to get care from the same doctors they see today but will now be a member of a health plan. When are Tailored Plan changes happening? Benefits and services All health plans offer the same basic benefits and services. Or use the chat tool to chat with us online. Unfortunately, there is no specific formula to determine what your business is worth. Tailored Plan eligibility can be based on either diagnosis or what services the person is receiving. Within NC Medicaid Managed Care, there are Standard Plans (plans that offer integrated physical and behavioral health services) and Behavioral Health I/DD Tailored Plans (specialized plans that offer integrated physical and behavioral health services for members with significant behavioral health needs, intellectual/developmental disabilities (I. 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. Contract #30-2020-052 Behavioral Health and I/DD Tailored Plan Amendment 1, #30-2022-007-DHB_MDPIHP_Contract_Model_20220804. Beneficiaries set to receive care through the Tailored Plans will continue to receive behavioral health services and I/DD and TBI supports through their LME/MCO and physical health and pharmacy services through NC Medicaid Direct, just as they do today. You or your provider can contact the NC Medicaid Enrollment Broker at 833-870-5500 or ncmedicaidplans.gov to learn more about your health care options. 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. Some services may only be available with prior authorization (pre-approval) or if medically necessary. Some services may only be available with prior authorization (pre-approval) or if medically necessary. Health Care Option Guide:All health plans offer the same basicbenefits and services. Who do I call if I am having trouble keeping my providers or getting the services I need? Beneficiaries have until Sept. 30, 2021, to change plans for any reason. The Plan must present an access monitoring analysis including data sources, methodologies, baselines andassumptions. (link coming soon). Tailored Plans will start October 1, 2023 NC Medicaid changed the start date for Tailored Plans to October 1, 2023. . Well call you back by the next business day. Until that time, NC Medicaid will continue to operate under the current fee-for-service model administered by the Department. Summary of changes included in the 10/1/23 Innovation Waiver draft amendment: Application for 1915(c) HCBS Waiver: Draft NC.025.03.07 (effective Oct. 1, 2023, posted Jun. State Government websites value user privacy. Standard plans will be required to cover the same physical health, behavioral health and pharmacy services as Medicaid fee-for-service, except for a small number of services excluded from Medicaid managed care by statute and, pending authorization from the NCGA, a subset of behavioral health services that will be only available through BH I/DD T. 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. 2020, with all addenda and negotiations documents included. Get email alerts on latest news and upcoming events. 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. 3 0 obj LME-MCOs currently only manage behavioral health services. 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. This STANDARD is not met as evidenced by: W 262 Based on observation, record review and . Updated Jul 3, 2023 12:54pm MDT Colorado will join a pilot with the federal Medicaid and Medicare programs that offer primary care providers up-front reimbursements and additional resources in. Approved In Lieu of Services, Contract #30-190029 Prepaid Health Plan Services Amendment 7/8, Contract #30-190029 Prepaid Health Plan Services Amendment 8/9, Contract #30-190029 Prepaid Health Plan Services Amendment 9/10, Contract #30-190029 Prepaid Health Plan Services Amendment 10/11, Contract #30-190029 Prepaid Health Plan Services Amendment 11/12, Contract #30-190029 Prepaid Health Plan Services Amendment 12/13, Contract #30-190029 Prepaid Health Plan Services Amendment 13/14, 30-2021-061-DHB CCNC PCCMe Contract Amendment 2, 30-2021-061-DHB CCNC PCCMe Contract Amendment 3. Today moves us closer to that goal as we begin to implement this important program. Tell us about your experience with your health plan, including your ability to access and change it. Beginning August 1, 2022, NC Medicaid beneficiaries will be assessed for the Tailored Plan with a lookback period of 24 months. Standard Plans offer some basic behavioral health services. Beginning October 1, 2023, Tailored Plans will manage all Medicaid services for their members, including physical health services. 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. Added language that from 10/1 on, the six LME-MCOs will administer the Innovations Waiver for NC Department of Health and Human Services. centers for medicare & medicaid services omb no. Tailored Plans will now start October 1, 2023. 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. Alliance Health is the only Tailored Plan that currently offers TBI Waiver services. There are six Tailored Plans: Alliance Health, Eastpointe, Partners Health Management, Sandhills Center, Trillium Health Resources, and Vaya Health. Visit RelayNCfor information about TTY services. What should I do to prepare for Tailored Plan launch? 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. It is the fastest and best way to submit a form. 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. What if I disagree with the decision to enroll me or not to enroll me in a Tailored Plan? All health plans offer the same basic benefits and services. Use these numbers to find routine information regarding your plan coverage. Tailored Plans will start October 1, 2023. What is a Local Management Entity-Managed Care Organization (LME-MCO)? Submit your comments via email to Medicaid.WaiverComment@dhhs.nc.gov. You can use this website to submit your form. 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. How are Tailored Plans different from what the LMEs do now? 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. AmeriHealth Caritas North Carolina, Inc. Prepaid Health Plan; Statewide, Healthy Blue of North Carolina Prepaid Health Plan; Statewide, UnitedHealthcare of North Carolina, Inc. Prepaid Health Plan; Statewide, WellCare of North Carolina, Inc. Prepaid Health Plan, Statewide, Carolina Complete Health, Inc. Prepaid Health Plan, Regions 3, 4 and 5. 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. 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. You can call us at 877-201-3750 from 8 a.m. to 5 p.m., Monday through Friday except for State holidays. Tailored Plans will now start October 1, 2023. Member resources. Requests for Proposal and Requests for Information NC Medicaid Managed Care procurement documents. Some health plans also offer added services. (link coming soon). The North Carolina Department of Health and Human Services (NCDHHS) transitioned most Medicaid beneficiaries to Standard Plans on July 1, 2021. If you move outside of your Tailored Plans service area, you will continue to receive services from your Tailored Plan. Most families and children Children who get NC Health Choice Pregnant women People who are blind or disabled and do not get Medicare 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. For other questions, beneficiaries can call the NC Medicaid Contact Center at 888-245-0179 or visit the Beneficiaries section of the Medicaid website. Tailored Plans offer enhanced behavioral health services that are not available in Standard Plans, including Innovations and TBI Waiver services and State-funded services. Fact Sheet - Standard Plan and Tailored Plan Services . How do I get behavioral health, intellectual and developmental disability (I/DD) or traumatic brain injury services prior to Tailored Plan launch? 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. Request to Move to NC Medicaid Direct (Fee for Service) or LME-MCO Form. Health plans will also pay providers who may be outside their network at the same rate as their own providers for the first 60 days after launch. To learn more, view our full privacy policy. Tell us about your experience with your health plan, including your ability to access and change it. We frequently encounter situations where the owner of a business also owns several operations-related properties affiliated with the business. Standard Plan change request: You can request to change your Standard Plan in one of the following ways: Request to move toNC Medicaid Direct orLME-MCO: If you have mental healthdisorder,substance use disorder, 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 (LME-MCO). 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 * Report all changes, including your address and any changes such as income or a change in household that may impact the type of coverage you qualify for. 30, 2023). Some health plans also offer added services. Some people will be automatically enrolled in a Tailored Plan based on their needs. More information on Medicaid Managed Care can be found on the NC Medicaid website at medicaid.ncdhhs.gov/transformation. To learn more, use theNC Medicaid Tribal informational handout. In June, beneficiaries were mailed welcome packets with information from their health plan and new Medicaid ID cards. "July 1 marks a significant milestone with the official launch of Medicaid Managed Care in North Carolina," said North Carolina Department of Health and Human Services Secretary Mandy K. Cohen, M.D. 1 0 obj the beneficiary must sign the provider form. 2 0 obj North Carolina's Value-Based Payment Strategy for Standard Plans and Providers in Medicaid Managed Care. The LME/MCOs (PIHP) will become Tailored Plan (PHP), effective 10/1/2023 and will operate the Innovation Waiver under the 1115 authority and under the 1915(b) for tribal members. As of July 1, 2021, RHA will accept three North Carolina Medicaid Standard Health Plans: RHA will not accept (is not in network with) the following NC Medicaid Standard Health Plans: If you have a North Carolina Medicaid Standard Health Plan that RHA accepts and have questions about your plan or coverage, use the information below to contact your plan directly. For 24/7/365 help in a crisis situation, please call 1-833-207-4240. Please be sure to note the request is for the EBCI PCCMe contract. Alliance Health is the only Tailored Plan that currently offers TBI Waiver services. 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. 2501 Mail Service Center Raleigh, NC 27699-2501 . Below are the answers to frequently asked questions about Tailored Plans. If you are in danger or need immediate medical attention, call 9-1-1. 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. Call 1-877-201-3750 or visit ncmedicaidombudsman.org. Summary of changes included in the 10/1 TBI Waiver draft amendment: Submit your comment via email to Medicaid.WaiverComment@dhhs.nc.gov. Some services may require a copay. These levers include quality, culture, financial performance, opportunity for growth, geography, payor mix, and access to human capital. NC Department of Health and Human Services Words to know. Tailored Plans will provide NEMT for all Medicaid-covered services, including carved out services. Real-time, two-way interactive audio and video telehealth for the following services: Increase the Innovations Waiver cap to 157,000. Most people in NC Medicaid must enroll in a Standard Plan in the NC Medicaid Managed Care program. Meetings and events: To find meetings and events near where you live, go to Meetings and events. But health care options depend on the person's specific situation. View health plans with thisHealth Care Option Guide. It manages the primary care needs of federally recognized tribal members and others eligible for services through the Indian Health Service (IHS). Some will be able to opt-in to a Tailored Plan. 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). 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. To learn more, go to, Certified pediatric and family nurse practitioner services, Dietary evaluation and counseling and medical lactation services, Early and periodic screening, diagnostic and treatment services (EPSDT), Federally qualified health center services, Freestanding birth center services (when licensed or otherwise recognized by the North Carolina Department of Health and Human Services), Inpatient psychiatric services for individuals under age 21, Limited inpatient and outpatient behavioral health services, Prescription drugs and medication management, Speech, hearing and language disorder services, Tobacco cessation counseling for pregnant women, Early and periodic screening, diagnostic and treatment services (EPSDT) for members under age 21, Facility-based crisis services for children and adolescents, Medically supervised alcohol and drug abuse treatment center detoxification crisis stabilization, Non-hospital medical detoxification services, Outpatient behavioral health emergency room services, Outpatient behavioral health services provided by direct-enrolled providers, Professional treatment services in a facility-based crisis program, Research-based intensive behavioral health treatment for autism spectrum disorder, Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) services, Traumatic Brain Injury (TBI) Waiver services, Transitions to Community Living (TCL) program services, Services provided by Childrens Developmental Services Agencies (CDSAs) or providers contracted with CDSAs that are included in your childs Individualized Family Service Plan (IFSP), Services provided before NC Medicaid eligibility determination. * Children and youth in foster care, except for those beneficiaries receiving the Innovations Waiver or TBI Waiver. Approved In Lieu of Services, Carolina Complete Health Attachment M.10. What if I move outside of my Tailored Plans service area? The public comment period is from June 22, 2023 through July 21, 2023. In both cases, beneficiaries will receive a notice from the NC Medicaid Enrollment Broker letting them know about Tailored Plans. On October 1, 2023, Tailored Plan members will begin to receive health services from their Tailored Plan. Tell us about your experience with this website, and how we could make it better. To see the full list of NC Medicaid covered services provided by the health plans, go to ncmedicaidplans.gov. To learn more, view our full privacy policy. Visit the New Provider Data Management and Credentialing Verification Organization page for information on a new solution to align North Carolinas credentialing process with the National Committee for Quality Assurance Standards. Contract #30-190029 Prepaid Health Plan Services and Draft Rate Book To learn more, go to Tailored Plan services. During this process, we set up live meetings with employees to give them an overview of RHA, explain our employee benefits and payroll process, as well as answer any transitional questions employees may have. Learn more about Copays. Or use the chat tool to chat with us online. What is the Traumatic Brain Injury (TBI) Waiver? Contact Information. Use the Request to Move to NC Medicaid Direct (Fee for Service) and LME-MCO: Provider form. We can structure an approach either where we purchase the real estate or in which the seller keeps real estate and leases it to us. State Government websites value user privacy. 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. 10 Things to Know About Medicaid Robin Rudowitz , Alice Burns , Elizabeth Hinton , and Maiss Mohamed Published: Jun 30, 2023 Medicaid is the primary program providing comprehensive coverage of. 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. 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. The call is toll free. In managed care, people enroll in a health plan that is run by an insurance company. Waive requirement for beneficiary to attend the Day Supports provider once per week. stream NC Medicaid changed the start date for Tailored Plans. Until October 1, 2023, you will keep getting services the way you do now. 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. Online account. November 18, 2021. Only use it for. Learn more about, Non-emergency medical transportation (NEMT) to medical appointments, To learn more about your prescription drug benefits under NC Medicaid, use the. To choose a PCP or Tailored Care Management provider with the Tailored Plan, contact your Tailored Plan directly. 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.
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nc medicaid standard plans
