From NC Medicaid:

Children & Families Specialty Plan

The Primary Care Provider (PCP) contracting deadline for Beneficiary Choice Period is September 1, 2025.

The Children and Families Specialty Plan (CFSP) is a single, statewide NC Medicaid Managed Care health plan designed to support children, youth and young adults currently and formerly served by the child welfare system. Sept. 1, 2025, is the last day for PCPs to have fully executed contracts with the CFSP for inclusion at the start of the Beneficiary Choice Period.  Go Live Date is 12/1/25. 

Providers who wish to participate in CFSP should contact Health Blue Care Together to discuss the contracting process and requirements.

For inquiries, please use the following contacts:

Email:

• Contracting Inquiries: NC_Contracting@healthybluenc.com
• General Questions and Comments: NC_Provider@healthybluenc.com

Phone:

1-844-594-5072

For more details on the CFSP, including eligibility, covered services and updates, please visit our Children and Families Specialty Plan website. You can also find more information by reviewing the What Providers Need to Know fact sheet.

Date: August 26, 2025

Time: 12:00 - 1 p.m.

The Statewide Health Information Exchange Act was passed in 2015 by the North Carolina General Assembly.  This legislation paved the way for a statewide health information exchange (HIE), now known as NC HealthConnex.

NC HealthConnex is a valuable tool to support care improvement efforts.  In the context of value-based care, providers need access to timely, accurate clinical data to track outcomes and coordinate care effectively.  By its very definition, value-based care requires visibility into a patient's full journey across the care continuum.

Real-time, reliable clinical data is a critical tool for delivering appropriate care and closing information gaps. NC HealthConnex supports this by offering services that allow providers to:

• Query patients,

• Receive Admission, Discharge and Transfer notifications, and

• Send encrypted messages to other providers involved in a patient’s care.

NC Medicaid’s transition to NC Medicaid Managed Care, the launch of Tailored Care Management, and Medicaid Expansion make NC HealthConnex services an increasingly valuable follow-up tool for providers. The North Carolina Health Information Exchange Authority (NC HIEA), the state  agency that oversees NC HealthConnex, and NC Medicaid have built a strong partnership, collaborating through NC Medicaid Managed Care launch and the COVID-19 pandemic. Today, they are working together on a series of use cases that leverage NC HealthConnex to support NC Medicaid’s quality and population health goals.

In this session, speakers will explain how NC HealthConnex works, review available services, and provide a live demonstration of the NC HealthConnex Clinical Portal. They will also highlight current innovations stemming from the collaboration between NC Medicaid and the NC HIEA. Attendees will leave with an understanding of how NC HealthConnex and its services can serve as valuable tools to support high-quality, coordinated patient care.

At this time, there’s been no indication that the Clear Pricing Project (CPP) will be extended or replaced for primary care. The only new program announced so far is the Behavioral Health Access Program (BHAP), which does not apply to primary care providers.

That said, here are a few proactive steps you can take:

• Review your current contracts with Aetna to understand how your reimbursement rates may change once CPP ends.
• Consider renegotiating your contract. Many practices are already doing this to secure more sustainable terms.
• Ensure you’re part of Aetna’s Choice POS II network, which the NC State Health Plan will use exclusively starting January 1, 2025.
  
  👉 Join the Aetna Network
  👉Behavioral Health Access Program(BHAP)

MEDICAID MANAGED CARE

Disaster Preparedness for Members with Chronic Conditions

August 19 | NOON - 1 p.m.

Please join us for the last webinar in this series focused on disaster preparedness for members with chronic conditions.  This webinar will cover the following:

• Long term recovery considerations
• Behavioral Health impacts
• Finding resources
• Crisis Services
• Hope 4 NC
• Understanding Resilience
• Building Resilience

Register by clicking the button below. We look forward to connecting with you!

A new toolkit from NCDHHS offers a variety of resources to support healthcare providers with giving vaccines. The information and tools address the challenges involved in providing vaccines, including conversation guides, communication tools, and population-specific guidance.

Save the Date!

Fifth Annual Virtual Statewide Quality Forum

October 8, 2025 | noon - 1 p.m.

The North Carolina Department of Health and Human Services Division of Health Benefits and North Carolina AHEC, in conjunction with the five Medicaid managed care standard plans, will host the Fifth Annual Virtual Statewide Quality Forum on October 8 from noon-1 p.m. Topics will include:

• Simplification Updates
• Key Developments on NC Division of Health Benefits
• Key Developments on 2026 Advanced Medical Home Measures and Benchmarking Approach
• Key Developments on NC HealthConnex Updates
• Screen Early, Optimize Health: Proven Strategies for Success

The forum is designed to help providers, practice managers, and quality managers succeed with Medicaid Managed Care quality initiatives. Look for additional details, including how to register, soon.

We hope you can join us!

Today we bring you updates from the latest CMS QPP Newsletter for Small Practices:

CMS Proposes Policy Changes for Quality Payment Program

The Centers for Medicare & Medicaid Services (CMS) has issued its Calendar Year (CY) 2026 Medicare Physician Fee Schedule (PFS) Proposed Rule, which includes proposed policies for the Quality Payment Program (QPP).

The Notice of Proposed Rulemaking (NPRM) includes proposals for the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), as well as several Requests for Information (RFIs).

Specifically, we’re proposing policies that:

• Continue the transformation of MIPS through MIPS Value Pathways (MVPs).
• Are responsive to feedback and concerns raised by interested parties.
• Maintain stability within the MIPS program through the established performance threshold.

2026 Policy Proposal Highlights

Key QPP policies that we are proposing in the CY 2026 PFS Proposed Rule include:

• Introducing 6 new MVPs for the 2026 performance year that are related to diagnostic radiology, interventional radiology, neuropsychology, pathology, podiatry, and vascular surgery.
• Introducing a 2-year informational-only feedback period for new cost measures, allowing clinicians to receive feedback on their score(s) and find opportunities to improve performance before a new cost measure affects their MIPS final score.
• Maintaining the current performance threshold policies, leaving the performance threshold set at 75 points through the 2028 performance year.
• Introducing Qualifying APM Participant (QP) determinations at the individual level, in addition to existing determinations at the APM entity level.

Overview of RFIs

We are also seeking feedback on RFIs about the following topics:

• Establishing Core Elements for MVPs, to require reporting on key quality measures within each MVP.
• Establishing a process to assign clinicians to an MVP, to facilitate the most relevant reporting for their scope of care.
• Transitioning to FHIR-based electronic clinical quality measure (eCQM) reporting in quality reporting programs.
• Understanding the current environment, including challenges, with collecting and exchanging high-quality healthcare data.
• Changing requirements for the Query of Prescription Drug Monitoring Program (PDMP) Measure and Performance-Based Measures in the Public Health and Clinical Data Exchange Objective.
  

Medicaid Managed Care Back Porch Chat

Key Updates: Children and Families Specialty Plan (CFSP) Launch, HOP

Thursday, July 31 | noon-1p.m.

NC Medicaid published the 2025 NC Medicaid Standard Plan Performance Comparison Tool and accompanying Technical Guide. The new tool allows Medicaid beneficiaries to compare the performance of the five NC Medicaid Standard Plans.  

The tool enables beneficiaries to make informed decisions about which Standard Plan works best for them. It provides easy-to-read comparisons of how the Standard Plans perform across different domains of health care, including: getting care, care experience, experience with providers, reproductive and sexual health, and children’s health. The complementary technical guide provides details on how NC Medicaid conducted the comparison, and where the data came from.  

Here's one excerpt from the tool:

A Full Star means the health plan performed better than the average of all the Standard Plans

A Half-Filled Star means the health plan performed within the average of all the Standard Plans

An Empty Star means the health plan performed worse than the average of all the Standard Plans

Sources:

NC Medicaid Standard Plan Performance Comparison Tool 2025

NC Medicaid 2025 Standard Plan Performance Comparison Tool Technical Guide

NC Medicaid Quality Management and Improvement webpage

The AHEC Standardized Onboarding and Credentialing program aims to improve the process of placing health science students in clinical placements through partnerships as well as onboarding and credentialing tools.

These tools help reduce the time and resources needed to onboard and credential students to clinical rotations. These tools, as well as support and guidance from AHEC and other partners, can make it easier for small practices to host students, helping to increase opportunities for training, and ultimately increasing clinical capacity. To get started or for more information, please contact Aubrey Delaney, Associate Director Onboarding and Credentialing at Audelaney@wakeahec.org. 

Learn more: Standardized Student Onboarding and Credentialing.