North Carolina Medicaid Division of Health Benefits (DHB) has announced that Tailored Plans (the health plans for qualifying members with mental health needs, substance use disorders, intellectual/developmental disabilities or traumatic brain injuries) will start on July 1, 2024.
What do you need to do?
- Be aware of which of the Local Management Entities / Managed Care Organizations (LME/MCOs) serve your region. Keep in mind your patients may live in a neighboring county that is served by a different entity.
- Contract with these entities. Keep in mind that credentialing may take some time.
- Consider that given the recent LME/MCO consolidation, much has changed. You may need to make new connections.
If you do not have a contract for the Tailored Plan network, you will be considered 'out-of-network' and subject to reduced reimbursement rates for physical services.
Have questions?
Sources:
LME/MCO Directory
NC DHHS LME/MCO Fact Sheet
Tailored Plan Services page