The Medicaid Managed Care webinars on the 1st and 3rd Thursday of the month are dedicated to bringing you late breaking information and guidance on NC Medicaid’s transition to Managed Care. Topics will vary, but each session will include an open question and answer period.  

On May 27, 2021, Governor Roy Cooper signed into law House Bill 395 (now NCSL 2021-26) allowing additional time for providers to connect to the state-designated health information exchange NC HealthConnex.  The bill extends the deadline for connecting from October 1, 2021 to January 1, 2023.    

On May 26, 2021, The North Carolina Department of Health and Human Services (NCDHHS) announced that all Medicaid beneficiaries currently eligible to transition to managed care have selected or been assigned a health plan with 97% enrolled in a plan that includes their current primary care provider (PCP) in network.   

Applications are now open for the MIPS Promoting Interoperability Performance Category Hardship Exception and Extreme and Uncontrollable Circumstances Exception for the 2021 Performance Year.  

Application Deadline: Those interested must submit their applications to CMS by December 31, 2021.   

NCDHHS recently released a fact sheet on Panel Management.  We pulled some highlights from the fact sheet for you on the blog today. 

The Merit-based Incentive Payment System (MIPS) cost performance category weight is 15% of the final score for the 2020 performance period/2022 MIPS payment year. CMS announced the reweighting the cost performance category from 15% to 0% for the 2020 performance period.  

Advocates and partner agencies can learn more about next steps in the NC Medicaid Managed Care rollout, with a focus on what people with Medicaid should expect next and how the Ombudsman can help. 

Tuesday, May 25, 2021 

12 – 1 p.m. 

HOW CAN I SEE WHICH BENEFICIARIES ARE ASSIGNED TO ME?  

Once the beneficiary has been assigned to the PCP/AMH, a provider can see these assignments by:  

• Working with your contracted health plan  
• Accessing information through the NCTracks Provider Portal  
• Using the Recipient Eligibility function in NCTracks to verify this information for a single beneficiary.  
• Using the NCTracks batch eligibility verification function.  
• If you are an AMH, you can review the beneficiary assignment file you will receive from the health plan.  

Providers cannot currently view their assigned beneficiaries as a list in NCTracks. DHHS will announce new functionality prior to the launch of NC Medicaid Managed Care, where providers will receive a monthly report to view the beneficiaries assigned to them. 

NCDHHS Extends Open Enrollment for Medicaid Managed Care through May 21, 2021.  Read about it in this announcement. 

In NC Medicaid Managed Care, most beneficiaries choose their health plan and primary care provider (PCP) or Advanced Medical Home (AMH), which is a type of primary care provider. During open enrollment from March 15 through May 21, 2021, beneficiaries will enroll in a health plan and select their PCP/AMH.  If a beneficiary does not select a health plan, they will be automatically enrolled in one by the NC Department of Health and Human Services (DHHS).  If a beneficiary does not select a PCP/AMH, then the health plan will assign one to them.  First, DHHS will auto-enroll the beneficiary in a health plan. Once the health plan receives the beneficiary information, the health plan will auto-assign a PCP/AMH to the beneficiary. 

On Monday May 10, 2021, the FDA amended the December 11, 2020 emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 Vaccine authorized for use in adolescents 16 or older to include adolescents 12 -15 years of age.   The FDA has determined that Pfizer-BioNTech COVID-19 Vaccine has met the statutory criteria to amend the EUA, and that the known and potential benefits of this vaccine in individuals 12 years of age and older outweigh the known and potential risks, supporting the vaccine’s use in this population.