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.

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.

 

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. 

In response to provider concerns about ongoing member assignment and panel management issues for Advanced Medical Homes (AMHs), North Carolina Medicaid is working with the Standard plans to analyze errors and create easier pathways for providers to resolve panel issues.

NCCARE360 helps providers electronically connect those with identified needs to community resources and allow for feedback and follow up. This solution ensures accountability for services delivered, provides a “no wrong door” approach, closes the loop on every referral made, and reports outcomes of that connection. NCCARE360 is available in all 100 counties across North Carolina.

The Advanced Medical Home webinar series provides Medicaid primary care practice staff and clinicians with more information on North Carolina’s AMH model and how to function at the highest AMH Tier possible when Medicaid Managed Care goes live in July 2021. This webinar, the last in this series, will provide a review of the Advanced Medical Home requirements, update on the glide path payments and more.

 

THURSDAY, MAY 13 | 5:30–6:30 PM
Advanced Medical Home Refresher

REGISTER NOW

NCDHHS has produced a Direct/Manged Care PCP enrollee report to assist with identifying North Carolina Medicaid and NC Health Choice beneficiaries currently assigned under the Community Care of North Carolina/Carolina ACCESS (CCNC/CA) program. NCDHHS generated the new Advanced Medical Home (AMH) NC Medicaid Direct/NC Medicaid Managed Care Primary Care Provider (PCP) Enrollee Report for distribution to CCNC/CA participating providers. 

The report, initially made available on March 15, 2021, is delivered each month to the NCTracks Secure Provider Portal Message Inbox the Monday before the second checkwrite to coincide with the receipt of CCNC/CA management fees.  

The AMH Medicaid Direct/Managed Care PCP Enrollee Report contains a list of all NC Medicaid beneficiaries who have been assigned to the identified NPI in the past 12 months and contains:

• NPI/Atypical ID
• Provider name
• Service location address (to which the beneficiary is assigned)
• Medicaid Identification Number
• Recipient name
• Date of birth
• Active (Y or N) (currently enrolled in Medicaid and assigned to you)
• Assignment program (i.e. Med-Dir for NC Medicaid Direct)
• Effective date (of assignment)
• End date (of assignment)
• Last office visit (based on paid claims from the billing NPI)
• Total visits (based on paid claims for the past 12 months)

To effectively use the report, add filters or sort the report based on an Active status of “Y.” In this way, the provider can narrow the results to display only those currently enrolled in NC Medicaid and assigned to the identified NPI. 

In addition to the Active status, the End Date of assignment will display the current eligibility span for the beneficiary which includes the provider assignment.

It is imperative to understand that this is not verification of eligibility or PCP assignment through that End Date.

NC Medicaid beneficiary benefits or PCP assignment may terminate at the end of any given month. Providers must verify eligibility through the NCTracks Recipient Eligibility Verification function each month to ensure coverage and inform the beneficiary of any changing prior to rendering services.

The most unique feature of the AMH Medicaid Direct/Managed Care PCP Enrollee Report is the identification of the most recent office visit and total number of office visits paid to the identified NPI. This information is offered on the report so providers may confirm whether an active relationship exists with the beneficiary. The dates and number of visits is based on paid claims when the identified NPI in the report is used as the Billing NPI on a paid claim within the past 12 months.

Primary Care Providers (PCPs) actively caring for beneficiaries not showing as assigned to their practice may help update their practice assignment by encouraging beneficiaries to contact their local Department of Social Services (DSS) caseworker to request reassignment. As an alternative, provider staff may complete the Community Care of North Carolina/Carolina ACCESS Enrollment Form for Medicaid Recipient, ask the beneficiary to confirm the change with their signature on the form and fax the form to the local DSS office. Fax numbers and other contact information are available on the Local DSS Directory.

Only the beneficiary may request PCP reassignment. In instances where issues persist or escalation is needed, providers may encourage beneficiaries to contact the Medicaid Contact Center at 888-245-0179 for assistance.

Based on feedback from providers regarding the AMH Medicaid Direct/Managed Care PCP Enrollee Report, and to better assist providers, NC Medicaid is in process of updating functionality to include health plan members and the name of the health plan to which each is assigned. Although the timeline for the addition is yet to be determined, the report will display the health plan name beginning in July 2021 when managed care assignments become effective.

Contact
NCTracks Call Center: 800-688-6696

Advanced Medical Homes Tier 3 “Glidepath” Payments Update   

In February, NC Medicaid announced that effective April 1, 2021, NC Medicaid will offer time-limited payments to practices that have attested as an AMH Tier 3 provider as part of the transition to Medicaid Managed Care. 

The NC Department of Health and Human Services recently released the Advanced Medical Home (AMH) Provider Manual 2.0. This version reflects program expectations as well as recent program modifications and changes that impact provider contracts. It replaces the prior version issued on Dec. 12, 2019.  
 

Advanced Medical Home, a Medicaid Managed Care Webinar Series