​Medicaid Managed Care: Advanced Medical Home Tier 3 “Glidepath” Payments

Notice Date: Feb. 1, 2021 

Effective Date: April 1, 2021 

Notice applies to: AMH Tier 3 practices 

Following is a summary.  For more detailed information click on the Advanced Medical Home Tier 3 “Glidepath” Payments bulletin article.   

Overview 

Effective April 1, 2021, as part of the transition to Medicaid Managed Care, NC Medicaid will offer time-limited payment to practices that have attested into Advanced Medical Home (AMH) Tier 3 if they can demonstrate successful readiness for AMH Tier 3 responsibilities as set out below.   

• The payments, called “AMH Tier 3 Glidepath Payments,” will be $8.51 per member, per month (PMPM), paid by NC Medicaid in addition to eligible practices’ existing Carolina Access II PMPM payments.   

• AMH Tier 3 Glidepath Payments are intended to provide an incentive for managed care launch readiness as well as provide funding to offset some of practices’ Tier 3 implementation costs.   
• Payments will be available for the months of April, May and June, 2021, only.    

Guidance for Receiving AMH Tier 3 Glidepath Payments  

What are the eligibility requirements to qualify for Glidepath payments? 

AMH Tier 3 Practices must have met the following three criteria:  

1. Successfully completed NCTracks attestation as an AMH Tier 3.   
2. Completed contracting at a Tier 3 level with at least two health plans. 
3. Undergone successful data exchange with at least two health plans. 

What are the data exchange requirements? 

Practices must attest to meeting data exchange readiness milestones as part of their Tier 3 glidepath attestation. The AMH Tier 3 practice or its contracted Clinically Integrated Network (CIN)/other partner must have:  

• Completed necessary technology work required to ingest all required/mandatory AMH data interfaces per the published state technical specifications.   
• Completed at least one full round of testing with at least two (2) of its contracted health plans for all required AMH interfaces. One full round of testing includes demonstration of the ability to systematically ingest test AMH files for all required/mandatory interfaces and submission of test results to health plans.   
• Completed defect resolution from the full round of testing and be on target to complete additional testing as needed to operationalize required/mandatory AMH interfaces aligned with the Medicaid production schedule.  

What if I belong to a CIN or do business with a technology partner? 

While AMH Tier 3 practices will be responsible for attesting to completion of data exchange requirements, CINs/other partners may complete these data exchange testing requirements on behalf of contracted practices if the AMH and CIN have an active association and if that CIN will be performing data exchange on behalf of the AMH practice after managed care launch.    

What are the required mandatory data exchange requirements (end-to-end testing)? 

AMHs (or CINs/other partners) and health plans must test the following required/mandatory data exchanges: 

• Beneficiary Assignment Interface 
• Pharmacy Lock-in Interface 
• Medical Professional Claims Interface—includes separate header and line interfaces
• Medical Institutional Claims Interface—includes separate header and line interfaces 
• Pharmacy Claims Interface—includes separate header and line interfaces 
• Dental Claims Interfaces—includes separate header and line interfaces 

Health plans have selected a small number of CINs/AMH Tier 3 practices as testing partners to support AMH data interfaces testing as part of Medicaid’s end-to-end testing efforts to ensure all data exchange systems are working prior to managed care launch. Practices and their affiliated CINs/other partners who are participating in end-to-end testing are considered by NC Medicaid to have met the AMH Tier 3 Glidepath data exchange testing requirements as part of their participation in end-to-end testing. Those AMHs will still need to attest to meeting eligibility for Glidepath payments in NCTracks.  

How do I complete attestation for the Glidepath payments? 

In order to receive AMH Tier 3 Glidepath payments, each AMH Tier 3 practice must attest within NCTracks to meeting the eligibility, contracting and data exchange testing requirements outlined above. The Glidepath attestation page will be located under the NCTracks provider portal and will be available for use by March 2021. NC Medicaid will publish additional guidance on the NCTracks portal functionality in a later bulletin. 

What are the attestation deadlines for the Glidepath payments? 

Once the AMH Tier 3 Glidepath attestation page is available for use, practices may complete attestation at any time before June 1, 2021 to receive glidepath payments. Practices will only be required to complete the AMH Tier 3 Glidepath attestation once. NC Medicaid will validate practices prior to initiating payment for each month. To receive AMH Tier 3 Glidepath payments for each month, practices must complete attestation before the deadlines listed below: 

• For payment in April, May and June: complete attestation no later than March 30, 2021, at 5 p.m. ET 
• For payment in May and June only: complete attestation no later than April 27, 2021, at 5 p.m. ET 
• For payment in June only: complete attestation no later than May 26, 2021, at 5 p.m. ET 

How is my attestation information validated? 

Once an AMH Tier 3 practice has attested to meeting these milestones in NCTracks, NC Medicaid will validate that the practice is enrolled with NC Medicaid and attested as an AMH Tier 3 before initiating AMH Tier 3 Glidepath payments. NC Medicaid will also collect reports from health plans to validate that each Tier 3 practice has contracted at the Tier 3 level and has completed the required data exchange testing. 

More about glidepath payments 

Practices that complete attestation and are validated by NC Medicaid for the AMH Tier 3 Glidepath will receive $8.51 PMPM. This payment will be added onto existing Carolina Access Medical Home payments that the practice currently receives. Payments will be based on the Medicaid population currently enrolled with the practice, even if not all current Medicaid members will be assigned to the practice after managed care launch. 

Who do I contact if I have other questions? 

NCTracks Call Center, 800-688-6696 

Resources 

https://medicaid.ncdhhs.gov/transformation/advanced-medical-home 

Glidepath Payments Presentation Jan. 20, 2021