MEDICAID MANAGED CARE BACK PORCH CHAT

Key NC Medicaid Updates

Thursday, May 15 | noon-1 p.m.

Please join this month's Back Porch Chat on Thursday, May 15 from 12-1 p.m. This webinar will be hosted by Dr. Janelle White, Chief Medical Officer of NC Medicaid, and will cover important federal updates and NC Medicaid budget priorities.

Additional topics include:

• Clinical Coverage Request Process and Policy Revision Request Process
• 2024 Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Results
• Credentialing Committee Updates
• Justice-Involved Reentry Work

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

As the seasons change, so do opportunities to expand your knowledge and professional skills! Northwest Area Health Education Center (Northwest AHEC) and the Office of Continuing Medical Education at Wake Forest University School of Medicine are offering a variety of engaging and informative programs this spring, summer, and fall.

Today we share with you a recent communication from North Carolina Medicaid. Your feedback can help shape the 2026 Standardized AMH Performance Incentive Program.

MEMORANDUM

The Advanced Medical Home (AMH) is NC Medicaid’s cornerstone primary care program, serving more than 2 million Medicaid members across the state. Innovative primary care payment is critical to supporting practice improvements that lead to the outcomes that matter to Medicaid enrollees and their families. 

Prepaid health plans (PHPs) are currently required to offer performance incentive payment arrangements to AMH practices based on a defined set of AMH quality measures; however, provider feedback and formal PHP reporting indicate that approach to these arrangements varies widely among PHPs. This variability makes it difficult for AMH practices to consistently participate in incentive arrangements across plans and to focus and align their quality improvement efforts for Medicaid members.   

To address these challenges, NC Medicaid plans to implement the AMH Standardized Performance Incentive program in 2026. Additional details can be found in the draft AMH Standardized Performance Incentive Program Policy Guide, which is being shared for community partner input. 

Standard Plans and Tailored Plans would be required to offer this program to all AMHs. Participation in the program is optional for AMH practices, and PHPs and AMHs may agree to other Value-Based Payment models in addition to or in lieu of this program, if desired. 

The AMH Standardized Performance Incentive program was developed as a feature of North Carolina’s participation in the Centers for Medicare & Medicaid Services (CMS) Making Care Primary (MCP) model. CMS recently announced the MCP model will be ending early by Dec. 31, 2025, nine years earlier than planned. While the Medicare MCP model will not be continuing, the Department’s proposed AMH Standardized Performance Incentive program remains an important step to advance NC Medicaid’s goals of reducing provider burden and improving health outcomes.

NC Medicaid is seeking additional feedback from community partners on the design of the AMH Standardized Performance Incentive Program and will continue to meet and collaborate with community partners and CMS in the consideration and design of this proposal. 

Community partners are encouraged to provide feedback on the draft AMH Standardized Performance Incentive Program Policy Guide by emailing Medicaid.NCEngagement@dhhs.nc.gov (subject line “AMH Standardized Performance Incentive Program Feedback”) by April 21, 2025.

ADL News for Blog Post

Each April, we come together to celebrate National Public Health Week (NPHW) — a time to recognize the powerful role public health plays in our lives and to honor those working tirelessly to improve the health and well-being of our communities.

On March 20, CMS released an update of the Medicare Benefit Policy Manual that revises and clarifies payment policy information for Rural Health Clinics and Federally Qualified Health Centers.

Some Key Updates Include:

• Starting January 1, 2025, RHCs and FQHCs must include costs for hepatitis B vaccines on their annual cost reports.
• CMS no longer requires RHC productivity standards starting with cost reporting periods ending after December 31, 2024.
• RHCs and FQHCs can continue to bill for non-behavioral health telehealth services by reporting HCPCS code G2025, including services you provide using audio-only technology, through December 31, 2025.
• CMS includes Principal Illness Navigation Peer-Support and Advanced Primary Care Management in RHC's and FQHC's care coordination services.

There are several additional important updates that RHCs and FQHCs should be aware of.

Make sure your billing staff knows about the 2025 updates to the Medicare Benefit Policy Manual, Chapter 13. 

Source:

Medicare Learning Network, MLN Matters 13946

The Northwest AHEC Practice Support Team supports social, physical, and economic environments which promote attaining the full potential of health and well-being for all. This blog segment highlights impactful publications which promote improved health outcomes through Social Determinants of Health (SDOH) each month.

Our featured report this month discusses reducing disparities in health care.

Reducing disparities in health care. American Medical Association. https://www.ama-assn.org/delivering-care/patient-support-advocacy/reducing-disparities-health-care. October 23, 2023. Accessed November 12, 2024

In this article, the AMA aims to enhance health outcomes and reduce inequities across all patient populations. They also agreed to raise awareness of health imbalances and the importance of understanding culturally competent health care and health literacy by working with state medical societies, medical schools, medical students and policymakers. 

Today we bring you important news from NC Division of Health Benefits:

The Advanced Medical Home (AMH) is NC Medicaid’s cornerstone primary care program, serving more than 2 million Medicaid members across the state. Innovative primary care payment is critical to supporting practice improvements that lead to the outcomes that matter to Medicaid enrollees and their families. 

Prepaid health plans (PHPs) are currently required to offer performance incentive payment arrangements to AMH practices based on a defined set of AMH quality measures; however, provider feedback and formal PHP reporting indicate that approach to these arrangements varies widely among PHPs. This variability makes it difficult for AMH practices to consistently participate in incentive arrangements across plans and to focus and align their quality improvement efforts for Medicaid members.   

To address these challenges, NC Medicaid plans to implement the AMH Standardized Performance Incentive program in 2026. Additional details can be found in the draft AMH Standardized Performance Incentive Program Policy Guide, which is being shared for community partner input. 

Standard Plans and Tailored Plans would be required to offer this program to all AMHs. Participation in the program is optional for AMH practices, and PHPs and AMHs may agree to other Value-Based Payment models in addition to or in lieu of this program, if desired. 

The AMH Standardized Performance Incentive program was developed as a feature of North Carolina’s participation in the Centers for Medicare & Medicaid Services (CMS) Making Care Primary (MCP) model. CMS recently announced the MCP model will be ending early by Dec. 31, 2025, nine years earlier than planned. While the Medicare MCP model will not be continuing, the Department’s proposed AMH Standardized Performance Incentive program remains an important step to advance NC Medicaid’s goals of reducing provider burden and improving health outcomes.

NC Medicaid is seeking additional feedback from community partners on the design of the AMH Standardized Performance Incentive Program and will continue to meet and collaborate with community partners and CMS in the consideration and design of this proposal. 

Community partners are encouraged to provide feedback on the draft AMH Standardized Performance Incentive Program Policy Guide by emailing Medicaid.NCEngagement@dhhs.nc.gov (subject line “AMH Standardized Performance Incentive Program Feedback”) by April 21, 2025.

Collaborative Care Management (CoCM) Capacity Building Fund

APPLICATIONS OPEN APRIL 1 FOR PHASE 2

Applications remain open for Phase 1

The first-of-its-kind Children and Families Specialty Plan will go live on December 1, 2025. This is a single, statewide NC Medicaid Managed Care plan that will wrap Medicaid-enrolled children, youth and their families in the child welfare system with seamless, integrated and coordinated health care. 

NCDHHS and Blue Cross NC’s highest priority is to deliver a plan that meets the needs of the children and families of North Carolina. We are committed to building the systems and processes needed to ensure the Plan works for families and the counties that serve them. Since the contract was awarded in August 2024, we have been working together to and carefully planning to ensure the launch of the new plan goes smoothly and is ready to serve beneficiaries on day one.  

Over the next year, we will be working quickly and collaboratively to ensure that we are ready to support children and families by providing coordinated and comprehensive health care, including mental health care, that follows the person and works across multiple systems. 

We will also support providers in preparing to best serve this population under the new plan including extensive training and working with providers to address unmet health-related resource needs, including housing, food, transportation, and interpersonal violence. And, of course, we will collaborate with county leaders, DSS staff, community partners and stakeholders while preparing to support children and families in this new way of accessing care.  

What is the Children and Families Specialty Plan? 

• The Children and Families Specialty Plan is a new single, statewide Medicaid Managed Care plan that will wrap Medicaid-enrolled children, youth, and their families currently and formerly served by the child welfare system with seamless, integrated and coordinated health care. 
• The Plan will operate statewide, ensuring members can access the health care services they need, including mental health care, and continue to work with their doctors as placements may move them across the state.  
• The Plan is part of North Carolina’s commitment to improving the long-term health and well-being of children experiencing the child welfare system and to strengthen and support families. 
• To implement the Plan, NCDHHS will work with Blue Cross and Blue Shield of North Carolina (Blue Cross NC), who will manage it under the name Healthy Blue Care Together.  

• One, single statewide plan: The Plan will operate statewide as the single entity accountable for the health care of its members, simplifying processes and providing caregivers, providers, case workers and families with the information to provide the right care at the right time.  
• Informed by local needs: The Plan will collaborate with County DSS, local stakeholders and families to understand and respond to needs in each community. Care managers will be located within the community to support this work. 
• Prevention focused: The Plan will take a family-focused approach to care delivery to strengthen and preserve families, reduce entry and re-entry into foster care, and support reunification and other permanency plan options. 
• Comprehensive care: The Plan will increase timely access to a broad range of physical health, behavioral health, pharmacy, long-term services and supports (LTSS) and I/DD services, as well as unmet health-related resource needs for all members. 
• Coordinated care: The Plan will provide care management to all members to support integrated, whole-person care and facilitate coordination among service providers. It will also facilitate seamless transitions for members who experience changes in treatment settings, child welfare placements, transitions to adulthood and/or loss of Medicaid eligibility.  

• We will continue to share regular updates and also hold meetings with key stakeholders and organizations. 

Stay Connected and Get Involved with the work happening at DMH/DD/SUS!

Visit the DMH/DD/SUS Website