N.C. Health Information Exchange Authority and the Rural Health Transformation Program: Support for Rural Providers

The Rural Health Transformation Program (RHTP) is a federal initiative authorized in July 2025 that provides five years of funding to states to strengthen health care in rural communities. In North Carolina, part of this work will focus on improving health information technology infrastructure and helping rural health care providers connect to and effectively use NC HealthConnex.

How NC HIEA Is Supporting Rural Health Transformation

The N.C. Health Information Exchange Authority (NC HIEA) is partnering with the N.C. Department of Health and Human Services (NCDHHS) to strengthen health information technology infrastructure across rural North Carolina.

As part of this effort, NC HIEA plans to support more than 170 rural provider Electronic Health Record (EHR) integrations with NC HealthConnex, North Carolina's statewide health information exchange, during the first two years of the program.

Who May Be Eligible for Support?

Funding is available to eligible rural NC HealthConnex participant providers to help offset one-time costs associated with NC HealthConnex integration and adoption after successful connection within the funding period.

Rural provider integrations will be prioritized based on factors such as:

• Potential population health impact
• Rural populations served
• Demonstrated engagement
• The provider's place in the NC HIEA connection queue

What Costs Can the Funding Help Cover?

RHTP funding may help offset EHR vendor fees and other expenses associated with connecting to NC HealthConnex once a participating organization successfully completes onboarding and meets applicable program requirements.

The amount of support will vary by participant based on the type of interface or service needed and the anticipated work involved. Funding is intended to assist with one-time technical and workflow-related expenses associated with establishing the NC HealthConnex connection.

Why Does Connecting to NC HealthConnex Matter?

NC HealthConnex allows participating health care providers to securely access and share important patient health information.

Effective use of the health information exchange can help providers:

• Make more informed care decisions
• Reduce unnecessary duplication of services
• Improve transitions of care
• Coordinate services across care settings
• Support value-based care efforts

How Rural Providers Can Get Started

Rural providers interested in participating should contact the NC HIEA Rural Health Transformation Program team at RHTP.HIEA@nc.gov.

After receiving your information, the program team can review your organization's circumstances and follow up about next steps. This may include confirming eligibility, reviewing your current NC HealthConnex connection status, discussing EHR readiness, identifying potential support needs, and outlining the steps required to move forward.

NC AHEC Practice Support Can Help

Rural practices do not have to navigate this process alone.

If you are a rural primary care practice, Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or local health department, NC AHEC Practice Support can assist with the process.

Practice Support Coaches can help rural organizations:

• Navigate and facilitate the NC HIEA application and onboarding process
• Understand NC HealthConnex requirements and next steps
• Prepare for successful implementation
• Address training needs
• Integrate NC HealthConnex into practice workflows

To get assistance, contact your local NC AHEC Practice Support Coach or email practicesupport@ncahec.net.

Take the Next Step

If your rural practice is considering connecting to NC HealthConnex or is already in the onboarding process, now is a good time to explore whether Rural Health Transformation Program support may be available.

For RHTP and NC HealthConnex questions: RHTP.HIEA@nc.gov
For practice support, training, and workflow assistance: practicesupport@ncahec.net

NC Medicaid Quarterly Virtual Office Hours: Provider Updates and Reminders

NC Medicaid will host its next Quarterly Virtual Office Hours on Thursday, November 5, 2026, from noon to 1 p.m. The session will provide important program updates and reminders for Medicaid providers.

Topics will include:

• Newly implemented unannounced provider site visits
• Drug Enforcement Agency certification requirements
• End-of-year license renewals
• Categorical risk level adjustments
• 251S taxonomy enrollment deadline
• Reverification application reminders
• An update on H.R. 1 and federally mandated changes coming to NC Medicaid

Providers and other interested organizations are encouraged to attend and share the opportunity with colleagues who may benefit from these updates.

When: Thursday, November 5, 2026
Time: Noon to 1 p.m.
Format: Virtual

Register

Atrium Health has announced a new Affordability Protection Program for eligible North Carolina State Health Plan members who receive care through Atrium Health. The program is scheduled to take effect January 1, 2027.

The program is designed to reduce out-of-pocket costs for eligible State Health Plan members receiving care at Atrium Health under the Plan’s new provider tier structure. According to Atrium Health, the organization will cover certain deductibles, coinsurance, and other cost differences so that eligible members pay less for qualifying care.

The program does not change State Health Plan benefits or the amount the Plan pays for care.

What State Health Plan Members Should Know

Key details include:

• The program is scheduled to begin January 1, 2027.
• Eligible members do not need to enroll, opt in, or complete additional paperwork. The affordability protections will be applied automatically to eligible care.
• The program is available to eligible active State Health Plan members, enrolled spouses and dependents, and retirees younger than age 65 who are enrolled in the State Health Plan.
• Individuals with Medicare, Medicaid, Medicare Advantage, managed Medicaid, TRICARE, or another similar federally supported plan are not eligible, whether that coverage is primary or secondary.
• The program applies across Atrium Health facilities and practices in North Carolina, including Atrium Health Wake Forest Baptist facilities.
• The program is funded by Atrium Health and is not affiliated with, authorized by, or endorsed by the NC State Treasurer, NC State Health Plan, or State of North Carolina.

Atrium Health also advises State Health Plan members to review their open enrollment materials carefully and consider the coverage options that best meet their healthcare needs.

Learn More

NC State Health Plan members and healthcare practices can review program details, eligibility information, cost examples, and frequently asked questions on Atrium Health’s State Health Plan Education Center.

About This Update

Northwest AHEC shares information that may be relevant to healthcare professionals and practices across our region. Questions about eligibility, benefits, or individual coverage should be directed to the appropriate health plan or healthcare organization.

Rural communities in North Carolina are expected to see expanded access to mental health, substance use disorder, crisis response, and maternal behavioral health services through more than $17 million in federal funding announced on October 7, 2026.

The funding is part of the Rural Health Transformation Program and is intended to support new behavioral health clinics, opioid treatment access, mobile crisis response, early intervention, and perinatal behavioral health care in rural communities.

Where the Funding Will Go

The announced investments include:

• $4 million for three new mental health clinics
• $3 million to expand access to medications for opioid use disorder through stationary medication units in five counties
• $4 million to expand mobile crisis teams to six additional counties, providing in-home support to children and families experiencing a crisis for up to eight weeks
• $6.7 million for additional behavioral health efforts, including early support for young people experiencing serious mental health symptoms, regional partnerships intended to strengthen crisis response, and expanded mental health care for new and expecting mothers in underserved areas

Expanding Behavioral Health Care Closer to Home

A significant focus of the funding is making services available closer to where rural residents live.

The planned expansion of mobile crisis teams is intended to bring support directly to children and families in their homes. According to the federal announcement, these teams can provide assistance for up to eight weeks, with the goal of helping children remain with their families and reducing the need for hospital or residential placement.

Another component will expand access to medications for opioid use disorder through stationary medication units in five counties. The overall investment also includes support for early intervention for young people beginning to experience serious mental health symptoms.

Supporting Maternal Behavioral Health

The funding also addresses behavioral health needs among new and expecting mothers in underserved areas. This work is included within the $6.7 million investment that also supports early mental health intervention and regional crisis-response partnerships.

Part of North Carolina’s Broader Rural Health Transformation Work

The behavioral health announcement represents one component of a larger federal investment in North Carolina through the Rural Health Transformation Program. The broader program includes initiatives related to rural health workforce development, healthcare facilities and access, new care and payment models, community-based and preventive care, and healthcare technology.

These areas include recruitment, training and retention of rural healthcare professionals; partnerships and operational improvements intended to help rural providers maintain services; approaches to healthcare delivery and financing; school-based and mobile services; and remote-care and data tools.

For organizations working in rural health, behavioral health, primary care, maternal health, substance use treatment, and community-based care across North Carolina, the announcement provides additional detail about how portions of the state’s Rural Health Transformation funding are being directed toward specific services and populations.

Learn More

Read the full federal announcement:

https://www.cms.gov/newsroom/press-releases/trump-administration-announces-more-17-million-new-mental-health-clinics-mobile-crisis-teams

Additional information about the Rural Health Transformation Program is available at:

https://www.medicaid.gov/resources-for-states/rural-health

Rural healthcare organizations often face significant challenges when it comes to adopting and expanding technology solutions. Limited resources, infrastructure barriers, and funding constraints can make it difficult to implement tools that improve patient care, strengthen operations, and support long-term sustainability.

The North Carolina Rural Health Innovation Fund (RHIF) was created to help address these challenges by providing financial support for technology-driven projects that improve healthcare delivery in rural communities. For eligible organizations, this funding opportunity may help accelerate initiatives that enhance access to care, improve patient outcomes, and strengthen healthcare operations.

What Is the Rural Health Innovation Fund?

The Rural Health Innovation Fund is a North Carolina initiative designed to support rural healthcare providers and organizations in implementing innovative technology solutions. Funding is available for projects that demonstrate the potential to improve healthcare delivery and strengthen care in rural communities.

Organizations interested in applying should carefully review eligibility requirements, application instructions, and program guidance available on the Rural Health Innovation Fund website.

Why Technology Readiness Matters

Before investing in new technology, healthcare organizations need to understand their current capabilities and readiness for adoption. Technology readiness assessments can help organizations identify strengths, gaps, and areas that may require additional planning before implementation.

As part of the application process, organizations are encouraged to review the Technology Readiness Assessment Questions before completing the online submission form. Reviewing these questions in advance can help practices gather the information needed and prepare a stronger application.

Technology Readiness Assessment Questions

Preparing Your Application

Organizations considering an application should begin by assembling key stakeholders, evaluating current technology infrastructure, and identifying projects that align with organizational priorities and community needs.

Potential areas of focus may include:

• Telehealth and virtual care expansion
• Digital health tools that improve patient engagement
• Technology that enhances care coordination
• Infrastructure improvements that support healthcare delivery
• Innovative approaches to addressing healthcare access challenges in rural communities

Applicants should also review the program guidance and frequently asked questions to better understand the application process and funding requirements.

Complete the Online Readiness Assessment

After reviewing the readiness assessment questions, organizations can complete the online assessment form.

Online Readiness Assessment Form

Completing the assessment can help organizations determine their preparedness for technology implementation and identify opportunities for future growth.

Frequently Asked Questions

Additional information about the Rural Health Innovation Fund, including answers to common questions, is available in the program FAQ document.

Rural Health Innovation Fund FAQ

Take the Next Step

Technology continues to play an increasingly important role in expanding access to care, improving patient experiences, and supporting healthcare teams. The Rural Health Innovation Fund offers an opportunity for eligible rural healthcare organizations to explore innovative solutions and strengthen their capacity to serve patients and communities.

Organizations interested in learning more should review the program materials, complete the readiness assessment, and determine whether this funding opportunity aligns with their strategic goals.

Resources

Rural Health Innovation Fund

Technology Readiness Assessment Questions

Online Readiness Assessment Form

Rural Health Innovation Fund FAQ

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has announced a new Office and Other Outpatient Evaluation and Management (E&M) Leveling Program and updates to its E&M reimbursement policy. Beginning August 15, 2026, select providers may be subject to additional review of office and outpatient E&M claims to help ensure coding aligns with national industry standards.

For physicians, advanced practice providers, practice managers, coding professionals, and billing teams, now is a good time to review E&M documentation and coding practices to understand how this change may affect claims processing and reimbursement.

What Is the E&M Leveling Program?

The new E&M Leveling Program is designed to support accurate and consistent coding and reimbursement. Blue Cross NC will identify providers whose E&M coding patterns are consistently higher than those of their peers and evaluate whether submitted E&M services are supported by the services and conditions documented in the claim.

The review process uses analytics supported by human and clinical review. If Blue Cross NC determines that the billed E&M level is higher than what is supported by the documentation and services submitted, the claim may be denied or reimbursed at a different E&M level. Providers may use the standard claims dispute process to request a review of any determination.

Who Will Be Affected?

The updated reimbursement policy does not automatically apply to all providers.

Only providers identified for participation in the E&M Leveling Program will be subject to the additional review process. Blue Cross NC has indicated that providers selected for the program will receive advance notification. If your practice does not receive a notification letter, no further action is required regarding program participation.

The policy applies to:

• Blue Cross NC Commercial plans
• Blue Cross NC Medicare Advantage plans

The policy does not apply to:

• Federal Employee Program (FEP)
• Inter-Plan Program (IPP) Host
• Inter-Plan Program (IPP) Home

What Should Practices Do Now?

Even if your organization has not received a notification letter, this announcement serves as a reminder of the importance of accurate E&M coding and thorough clinical documentation.

Practices may want to review:

• Current E&M coding processes
• Documentation supporting medical decision-making and time-based coding
• Internal coding education and auditing activities
• Opportunities for provider and staff training related to E&M guidelines

Practices that receive notification of program participation may also wish to work closely with coding, compliance, and revenue cycle teams to monitor adjudication outcomes and address reimbursement questions.

Why This Matters

E&M services account for a substantial portion of outpatient reimbursement. Changes in payer review processes can affect reimbursement, claim adjudication, and administrative workload. Maintaining strong documentation practices and ensuring coding accuracy can help practices prepare for reviews and support appropriate reimbursement.

As payers continue to focus on coding accuracy and documentation standards, ongoing provider and staff education remains an important component of practice operations.

Learn More

Blue Cross NC has published additional information about the program and related reimbursement policies:

• New E&M Leveling Program and Updated E&M Reimbursement Policy 
• Blue Cross NC Provider Policies, Guidelines, and Codes 
• Provider Policy Notifications

NC AHEC Practice Support Takeaway

While the E&M Leveling Program will only apply to selected providers, all practices can benefit from regularly reviewing coding and documentation processes. Ensuring that E&M services are fully supported by clinical documentation can help reduce claim denials, support appropriate reimbursement, and prepare practices for evolving payer review programs.

Accurate coding, complete documentation, and ongoing education can help practices navigate payer policy changes while maintaining efficient revenue cycle operations.

For many organizations, preparation does not require launching entirely new programs. Instead, it presents an opportunity to strengthen existing workflows through focused quality improvement (QI) initiatives. Projects that improve patient outreach, data accuracy, care coordination, and eligibility support can help health centers build readiness well before implementation deadlines arrive.

Rather than waiting for final regulations, practice leaders can use the coming months to identify operational gaps and test process improvements that will benefit both patients and staff.

Start with Contact Information Accuracy

One of the most valuable quality improvement projects a health center can undertake is improving the accuracy of patient contact information.

Patients who do not receive Medicaid notices, renewal reminders, or requests for documentation may face avoidable coverage interruptions. A focused QI project could examine how often contact information is updated during patient encounters, identify breakdowns in current workflows, and establish standard procedures for verifying addresses, phone numbers, and email addresses at every visit.

Even small improvements in data accuracy can significantly improve patient outreach efforts when policy changes take effect.

Evaluate Your Patient Outreach Workflows

Many practices already conduct outreach related to preventive care, chronic disease management, and appointment reminders. The same infrastructure can often be leveraged to support Medicaid-related communications.

A quality improvement initiative focused on outreach workflows might evaluate how patients are contacted, which methods generate the highest response rates, and whether communication strategies effectively reach patients who face language, transportation, technology, or health literacy barriers.

By strengthening outreach processes now, practices can create systems that are ready to support future eligibility and renewal communications.

Assess Care Management Capacity

Care managers, patient navigators, and community health workers often play an important role when patients must navigate complex systems. Health centers may benefit from conducting a workflow assessment that examines current care management capacity and identifies opportunities for improvement.

Questions worth exploring include whether staff have sufficient time to support high-risk patients, whether referral pathways are clearly defined, and whether social needs screening processes connect patients to appropriate community resources.

Quality improvement efforts in this area can help organizations better support patients who may require additional assistance understanding and meeting future Medicaid requirements.

Strengthen Population Health Reporting

Many health centers already use population health tools to identify care gaps and track clinical measures. Similar approaches can support future Medicaid preparedness efforts.

Organizations may consider quality improvement projects that focus on improving patient registries, identifying populations that could be disproportionately affected by policy changes, and developing reporting processes that support proactive outreach.

Better data visibility can help practices allocate resources more effectively and prioritize support for vulnerable patient populations.

Reduce Barriers Through Team-Based Care

Successful implementation of any administrative change depends on clearly defined roles and responsibilities. Health centers may benefit from conducting process mapping exercises that document how eligibility concerns, patient questions, documentation requests, and care management referrals move through the organization.

A quality improvement project focused on team-based workflows can help eliminate duplication, clarify responsibilities, and improve coordination among front-desk staff, medical assistants, clinicians, care managers, and patient navigators.

These improvements often generate benefits long before policy changes take effect.

Partner with Community Organizations

Many of the factors that influence Medicaid enrollment and retention extend beyond the walls of a clinic. Workforce development agencies, educational institutions, social service organizations, transportation providers, and community-based organizations may all become important partners in supporting patients.

Health centers can use quality improvement methods to evaluate existing partnerships, identify gaps in referral networks, and strengthen connections that may help patients navigate future requirements.

Building these relationships now may improve patient outcomes while creating a stronger community support infrastructure.

Use the Changes as a Catalyst for Improvement

Federal policy changes can create uncertainty, but they can also provide an opportunity to strengthen systems that already support patient care. Health centers that approach H.R. 1 implementation through a quality improvement lens can focus on practical changes that improve operations regardless of future policy developments.

Projects that enhance data quality, patient outreach, care coordination, workflow efficiency, and community partnerships are likely to produce benefits well beyond January 1.

The question for health centers is not simply how to comply with future requirements. The larger opportunity is how to use the months ahead to build more resilient systems that help patients maintain access to care and support the long-term health of the communities they serve.

Learn More

For the latest federal and state guidance, visit:

• North Carolina Medicaid
• Centers for Medicare & Medicaid Services (CMS)
• National Association of Community Health Centers (NACHC)
• North Carolina Community Health Center Association (NCCHCA)
• Rural Health Information Hub

Northwest AHEC Practice Support supports primary care practices, health centers, and community-based organizations through quality improvement coaching, practice transformation support, and workforce development initiatives that strengthen care delivery across North Carolina.