Effective Dec. 1, 2022, through June 30, 2023, Advanced Medical Homes (AMHs) 1, 2 and 3 that are serving as the assigned primary care provider for NC Medicaid beneficiaries eligible for Tailored Care Management will receive an enhanced medical home payment of $20 per member per month.
This payment will be made for all Tailored Plan members assigned to the practice, as well as for NC Medicaid Direct members assigned to the practice who are eligible for Tailored Care Management. Continuation of the enhanced payment after June 30, 2023, is anticipated, but is dependent on available funding. In the future the enhanced fee may be tied to additional performance expectations for primary care engagement.
As a reminder, AMH 3 providers will not provide care management services for members in Tailored Plans or members eligible for Tailored Care Management in NC Medical Direct. Only Advanced Medical Home + (AMH+) practices are eligible to provide Tailored Care Management. More information on Tailored Care Management can be found in the Tailored Care Management Provider Manual.
This enhanced medical home payment is meant to provide additional reimbursement to primary care providers as they are providing primary care and coordinating care with new Tailored Care Management providers for assigned members in the transition to Tailored Plans.
As a reminder, medical home fees are paid to support AMH practices that include:
- Provide primary care and patient care coordination services to each Member
- Provide or arrange for primary care coverage for services, consultation or referral, and treatment for emergency medical conditions, 24 hours per day, seven days per week
- Provide direct patient care a minimum of 30 office hours per week
- Provide preventive services
- Promptly arrange referrals for medically necessary health care services that are not provided directly and document referrals for specialty care in the medical record
- Provide primary care and patient care coordination services to each Member
The full set of practice requirements for AMHs can be found in the Advanced Medical Home Manual.
Link to DHHS posting
