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

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!

Visit the DMH/DD/SUS Website 

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

Learn more and register

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.

The role of Physician Assistant (PA) in North Carolina is integral to the healthcare system.  Physician Assistants are trained to provide high-quality care, often serving as primary care providers. 

Our colleagues from South Piedmont AHEC are offering a free lunchtime webinar to learn more about this important health care professional.

Overview of Physician Assistants in North Carolina -- Regulations, Scope of Practice, and Common Questions

April 30, 2025 | 12 PM - 1 PM

There is no registration fee for this webinar!

What is the lawsuit about?

In the class action In re: Blue Cross Blue Shield Antitrust Litigation, the Plaintiffs (Provider Class Representatives, or group of providers and facilities bringing the suit) claim that the Settling Defendants (Individual Blue Plans and the Blue Cross Blue Shield Association) violated antitrust laws by illegally dividing the United States into "Service Areas" and agreed not to compete in those areas.  They also claim that the Settling Defendants fixed prices for services provided.

Why is there a Settlement?

The Court did not decide in favor of the Plaintiffs or Settling Defendants.  Instead, both sides have agreed to the Settlement.

Who is included in the Settlement Classes?

The Settlement Class includes all Providers in the U.S. (except Excluded Providers) who currently provide or provided healthcare services, equipment or supplies to any patient who was insured by, or was a member of or a beneficiary of any plan administered by any settling individual Blue Plan from July 24, 2008 to October 4, 2024.

The bird flu (H5N1) is becoming a greater concern among people who track infectious diseases.

A recent article in Nature explains why changes in how the disease spreads could affect humans, and a new LibGuide from UNC Health Sciences Library collects key resources to help understand the current bird flu situation.

To learn more, check out the ADL's Highlighted Resources for February 15:
Will bird flu spark a human pandemic? Scientists say the risk is rising
Avian Influenza - "Bird Flu" (H5N1) Guide

With funding from NCDHHS, Project AWARE is able to offer SBIRT (Screening, Brief Intervention, and Referral to Treatment) training via Appalachian State University at no cost to the first 300 applicants!

SBIRT

• is brief
• is comprehensive
• decreases the severity of drug and alcohol use (early intervention with SBIRT saves lives and money and is consistent with overall support for patient/client wellness)
• reduces health care costs
• is used in various settings (by doctors, nurses, social workers, psychologists, counselors and other service providers)

Users of this technique employ a variety of tools including AUDIT (Alcohol Use Disorder Identification Test), DAST (Drug Abuse Screening Test) and CRAFFT (Adolescent Screening Tool). Motivational Interviewing is at the core of SBIRT training.

There are two components to this free training; online asynchronous modules and a synchronous workshop. 

You can also register here.

Today we bring you some important news from United Healthcare.

Don't lose access to the United Healthcare Provider Portal! Make sure your sign-in options include passkey, authenticator and/or a verified phone number by March 6th.

What's changing and when

A security update to the UnitedHealthcare Provider Portal is coming soon.  This will affect how you sign in to the portal and gain access if you're ever locked out.

Currently, many use email as a recovery and multifactor authentication option. On March 6, 2025, this option won't be available. Be prepared; review your options now.

UnitedHealthcare provider portal authentication webpage has all the details you need to ensure your access is maintained.

You can also review FAQs on the changes.