Recent Posts
From the North Carolina Office of Rural Health:
The Office of Rural Health (ORH) offers qualifying physicians, with educational (student) loan debt, incentive payments to repay their loans tax-free through the Primary Care Physicians Initiative (NC PCPI). With the passage of Session Law 2023-134, incentive payments are awarded to eligible physicians in exchange for providing comprehensive primary care services in outpatient settings at eligible sites serving those with highest need located within Tier 1 and Tier 2 of the North Carolina's County Distress Rankings (Tiers).
Funding is limited and the awards will be based on a first-come, first-served basis for eligible and complete applications. ORH anticipates up to 16 awards in each of the six Medicaid Regions. The application portal will not accept more than 20 applications per Medicaid Region.
Applicants are strongly encouraged to review the guidelines carefully and gather necessary documentation so that they are prepared to complete the online application in its entirety via the application portal.
MEDICAID MANAGED CARE BACK PORCH CHAT
Key NC Medicaid Updates
Thursday, May 15 | noon-1 p.m.
Please join this month's Back Porch Chat on Thursday, May 15 from 12-1 p.m. This webinar will be hosted by Dr. Janelle White, Chief Medical Officer of NC Medicaid, and will cover important federal updates and NC Medicaid budget priorities.
Additional topics include:
- Clinical Coverage Request Process and Policy Revision Request Process
- 2024 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Results
- Credentialing Committee Updates
- Justice-Involved Reentry Work
Register by clicking the blue button below. We look forward to connecting with you!
Today we share with you a recent communication from North Carolina Medicaid. Your feedback can help shape the 2026 Standardized AMH Performance Incentive Program.
MEMORANDUM
The Advanced Medical Home (AMH) is NC Medicaid’s cornerstone primary care program, serving more than 2 million Medicaid members across the state. Innovative primary care payment is critical to supporting practice improvements that lead to the outcomes that matter to Medicaid enrollees and their families.
Prepaid health plans (PHPs) are currently required to offer performance incentive payment arrangements to AMH practices based on a defined set of AMH quality measures; however, provider feedback and formal PHP reporting indicate that approach to these arrangements varies widely among PHPs. This variability makes it difficult for AMH practices to consistently participate in incentive arrangements across plans and to focus and align their quality improvement efforts for Medicaid members.
To address these challenges, NC Medicaid plans to implement the AMH Standardized Performance Incentive program in 2026. Additional details can be found in the draft AMH Standardized Performance Incentive Program Policy Guide, which is being shared for community partner input.
Standard Plans and Tailored Plans would be required to offer this program to all AMHs. Participation in the program is optional for AMH practices, and PHPs and AMHs may agree to other Value-Based Payment models in addition to or in lieu of this program, if desired.
The AMH Standardized Performance Incentive program was developed as a feature of North Carolina’s participation in the Centers for Medicare & Medicaid Services (CMS) Making Care Primary (MCP) model. CMS recently announced the MCP model will be ending early by Dec. 31, 2025, nine years earlier than planned. While the Medicare MCP model will not be continuing, the Department’s proposed AMH Standardized Performance Incentive program remains an important step to advance NC Medicaid’s goals of reducing provider burden and improving health outcomes.
NC Medicaid is seeking additional feedback from community partners on the design of the AMH Standardized Performance Incentive Program and will continue to meet and collaborate with community partners and CMS in the consideration and design of this proposal.
Community partners are encouraged to provide feedback on the draft AMH Standardized Performance Incentive Program Policy Guide by emailing Medicaid.NCEngagement@dhhs.nc.gov (subject line “AMH Standardized Performance Incentive Program Feedback”) by April 21, 2025.
On March 20, CMS released an update of the Medicare Benefit Policy Manual that revises and clarifies payment policy information for Rural Health Clinics and Federally Qualified Health Centers.
Some Key Updates Include:
- Starting January 1, 2025, RHCs and FQHCs must include costs for hepatitis B vaccines on their annual cost reports.
- CMS no longer requires RHC productivity standards starting with cost reporting periods ending after December 31, 2024.
- RHCs and FQHCs can continue to bill for non-behavioral health telehealth services by reporting HCPCS code G2025, including services you provide using audio-only technology, through December 31, 2025.
- CMS includes Principal Illness Navigation Peer-Support and Advanced Primary Care Management in RHC's and FQHC's care coordination services.
There are several additional important updates that RHCs and FQHCs should be aware of.
Make sure your billing staff knows about the 2025 updates to the Medicare Benefit Policy Manual, Chapter 13.
Source:
Medicare Learning Network, MLN Matters 13946
Today we bring you important news from NC Division of Health Benefits:
The Advanced Medical Home (AMH) is NC Medicaid’s cornerstone primary care program, serving more than 2 million Medicaid members across the state. Innovative primary care payment is critical to supporting practice improvements that lead to the outcomes that matter to Medicaid enrollees and their families.
Prepaid health plans (PHPs) are currently required to offer performance incentive payment arrangements to AMH practices based on a defined set of AMH quality measures; however, provider feedback and formal PHP reporting indicate that approach to these arrangements varies widely among PHPs. This variability makes it difficult for AMH practices to consistently participate in incentive arrangements across plans and to focus and align their quality improvement efforts for Medicaid members.
To address these challenges, NC Medicaid plans to implement the AMH Standardized Performance Incentive program in 2026. Additional details can be found in the draft AMH Standardized Performance Incentive Program Policy Guide, which is being shared for community partner input.
Standard Plans and Tailored Plans would be required to offer this program to all AMHs. Participation in the program is optional for AMH practices, and PHPs and AMHs may agree to other Value-Based Payment models in addition to or in lieu of this program, if desired.
The AMH Standardized Performance Incentive program was developed as a feature of North Carolina’s participation in the Centers for Medicare & Medicaid Services (CMS) Making Care Primary (MCP) model. CMS recently announced the MCP model will be ending early by Dec. 31, 2025, nine years earlier than planned. While the Medicare MCP model will not be continuing, the Department’s proposed AMH Standardized Performance Incentive program remains an important step to advance NC Medicaid’s goals of reducing provider burden and improving health outcomes.
NC Medicaid is seeking additional feedback from community partners on the design of the AMH Standardized Performance Incentive Program and will continue to meet and collaborate with community partners and CMS in the consideration and design of this proposal.
Community partners are encouraged to provide feedback on the draft AMH Standardized Performance Incentive Program Policy Guide by emailing Medicaid.NCEngagement@dhhs.nc.gov (subject line “AMH Standardized Performance Incentive Program Feedback”) by April 21, 2025.
Collaborative Care Management (CoCM) Capacity Building Fund
APPLICATIONS OPEN APRIL 1 FOR PHASE 2
Applications remain open for Phase 1
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The NC General Assembly has earmarked $5 million for capacity building for Medicaid-enrolled primary care practices across the state to adopt Collaborative Care Management (CoCM). The NCDHHS Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS) is contracting with Community Care of North Carolina (CCNC) to manage the program in partnership with North Carolina Area Health Education Centers Practice Support coaching. CoCM is an evidence-based behavioral health integration model designed to support primary care clinicians in assessing and treating patients with mild to moderate behavioral health conditions. An evidence-based model shown to be more effective than usual care, CoCM improves patient outcomes, increases satisfaction for both patients and providers, and reduces healthcare costs and the stigma related to mental health and substance use disorders. A primary care practice entity applying on behalf of multiple primary care practice sites may receive a maximum of three awards per entity. Phase 1: Each clinic site may be eligible to receive awards of $50,000 to begin a CoCM model in-house. Phase 2: Additionally, $30,000 is available for practices to expand an existing in-house CoCM model and $20,000 is available to practice sites meeting Phase 1 eligibility, but planning to outsource staffing to a third-party, turn-key CoCM company. Phase 2 application process will open on April 1, 2025 and Phase 1 will remain open. For more information about this program, visit CCNC's webpage on CoCM capacity building fund. And, to see past recordings and slides on CoCM Capacity Building Fund webinars, click here.
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The first-of-its-kind Children and Families Specialty Plan will go live on December 1, 2025. This is a single, statewide NC Medicaid Managed Care plan that will wrap Medicaid-enrolled children, youth and their families in the child welfare system with seamless, integrated and coordinated health care.
NCDHHS and Blue Cross NC’s highest priority is to deliver a plan that meets the needs of the children and families of North Carolina. We are committed to building the systems and processes needed to ensure the Plan works for families and the counties that serve them. Since the contract was awarded in August 2024, we have been working together to and carefully planning to ensure the launch of the new plan goes smoothly and is ready to serve beneficiaries on day one.
Over the next year, we will be working quickly and collaboratively to ensure that we are ready to support children and families by providing coordinated and comprehensive health care, including mental health care, that follows the person and works across multiple systems.
We will also support providers in preparing to best serve this population under the new plan including extensive training and working with providers to address unmet health-related resource needs, including housing, food, transportation, and interpersonal violence. And, of course, we will collaborate with county leaders, DSS staff, community partners and stakeholders while preparing to support children and families in this new way of accessing care.
What is the Children and Families Specialty Plan?
- The Children and Families Specialty Plan is a new single, statewide Medicaid Managed Care plan that will wrap Medicaid-enrolled children, youth, and their families currently and formerly served by the child welfare system with seamless, integrated and coordinated health care.
- The Plan will operate statewide, ensuring members can access the health care services they need, including mental health care, and continue to work with their doctors as placements may move them across the state.
- The Plan is part of North Carolina’s commitment to improving the long-term health and well-being of children experiencing the child welfare system and to strengthen and support families.
- To implement the Plan, NCDHHS will work with Blue Cross and Blue Shield of North Carolina (Blue Cross NC), who will manage it under the name Healthy Blue Care Together.
- One, single statewide plan: The Plan will operate statewide as the single entity accountable for the health care of its members, simplifying processes and providing caregivers, providers, case workers and families with the information to provide the right care at the right time.
- Informed by local needs: The Plan will collaborate with County DSS, local stakeholders and families to understand and respond to needs in each community. Care managers will be located within the community to support this work.
- Prevention focused: The Plan will take a family-focused approach to care delivery to strengthen and preserve families, reduce entry and re-entry into foster care, and support reunification and other permanency plan options.
- Comprehensive care: The Plan will increase timely access to a broad range of physical health, behavioral health, pharmacy, long-term services and supports (LTSS) and I/DD services, as well as unmet health-related resource needs for all members.
- Coordinated care: The Plan will provide care management to all members to support integrated, whole-person care and facilitate coordination among service providers. It will also facilitate seamless transitions for members who experience changes in treatment settings, child welfare placements, transitions to adulthood and/or loss of Medicaid eligibility.
- We will continue to share regular updates and also hold meetings with key stakeholders and organizations.
Stay Connected and Get Involved with the work happening at DMH/DD/SUS!
Our colleagues at Wake AHEC in Raleigh, NC are offering a one-day, in-person workshop to provide updates on HIPAA Compliance issues for local health departments.
Date and Time:
June 26, 9:00 AM - 4:00 PM
Core topics of the workshop include:
- Hybrid entity designations
- Breach response
- Business associate relationships
- Sharing information with local Departments of Social Services
Faculty:
Jill D. Moore, JD, MPH, Associate Professor of Public Law and Government
Kirsten Leloudis, JD, MPH, Assistant Professor of Public Law and Government
The most recent 'NC Medicaid/NC AHEC Office Hours' highlighted several important tidbits regarding NCTracks. If you were not able to attend, don't worry!
- The User Login process is changing in 2025, and will require multi-factor authentication. This will occur in phases and email notifications will be sent.
You do not have to wait for your e-mail notification---you can go ahead and update your user login now.
Learn more about Multi-Factor Authentication (MFA) for NC Tracks users.
- Change of Ownership notification required at least 30 days prior to the change taking place.
Learn more about Change of Ownership guidelines and FAQ's
- Why does it matter if Provider Records in NCTracks are not up to date?
Additional topics were covered during this call. You can review a pdf of the slides from today's office hours here.
