Medicaid Managed Care Back Porch Chat
Key Updates: Children and Families Specialty Plan (CFSP) Launch, HOP
Thursday, July 31 | noon-1p.m.
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NC Medicaid published the 2025 NC Medicaid Standard Plan Performance Comparison Tool and accompanying Technical Guide. The new tool allows Medicaid beneficiaries to compare the performance of the five NC Medicaid Standard Plans.
The tool enables beneficiaries to make informed decisions about which Standard Plan works best for them. It provides easy-to-read comparisons of how the Standard Plans perform across different domains of health care, including: getting care, care experience, experience with providers, reproductive and sexual health, and children’s health. The complementary technical guide provides details on how NC Medicaid conducted the comparison, and where the data came from.
Here's one excerpt from the tool:
A Full Star means the health plan performed better than the average of all the Standard Plans
A Half-Filled Star means the health plan performed within the average of all the Standard Plans
An Empty Star means the health plan performed worse than the average of all the Standard Plans
Sources:
NC Medicaid Standard Plan Performance Comparison Tool 2025
NC Medicaid 2025 Standard Plan Performance Comparison Tool Technical Guide
NEW WEBINAR SERIES
NC Medicaid Provider Enrollment
NCDHHS-DHB Credentialing Committee Initiative Stakeholder Engagement Session#3
Please join NC AHEC and the North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (DHB), for the third stakeholder teleconference on June 25 from 2-3 p.m. to continue the discussion of a new initiative led in tandem with General Dynamics Information Technology (GDIT). This initiative will establish a Credentialing Committee aimed at maintaining a high-quality, ethical, and competent provider network to support NC Medicaid beneficiaries.
This third forum will offer stakeholders:
- A collaborative forum to discuss the committee’s future role in the provider enrollment and credentialing process to determine compliance of regulatory requirements by NC Medicaid provider applicants.
- A deeper dive into the roles of committee members.
- Status of committee bylaws.
- Review of frequently asked questions and answers pertaining to the development of this project.
These stakeholder engagement sessions will occur monthly, as follows, until the project implementation and are intended to be interactive as the Department values input from partnering stakeholders:
- June 25, 2025
- July 30, 2025
- August 27, 2025
- September 24, 2025
You are encouraged to submit your related questions and comments for targeted open discussion at the meetings to Medicaid.credcommittee.stakeholders@dhhs.nc.gov. We look forward to connecting with you!
Some private and commercial insurers already require these codes, so providers should check with their billing team to review relevant protocol. These F codes are required by NC Medicaid’s clinical policy and apply to all delivery claims (not just those that are globally billed).
NC Medicaid urges providers to begin using the new codes as soon as possible. After July 1, 2025, Medicaid claims for delivery will deny if 0500F is not in the patient's history. This change will apply to both NC Medicaid Managed Care and NC Medicaid Direct claims.
Details and Source: New F Codes: Capturing Prenatal and Postpartum Care Services
NEW WEBINAR SERIES
MEDICAID MANAGED CARE
Disaster Preparedness for Members with Chronic Conditions
June 12, July 15 and August 19
NOON - 1 p.m.
Please join us for a new webinar series focused on disaster preparedness for members with chronic conditions. This series will cover topics such as:
- Overview of Disaster Preparedness in North Carolina
- Understanding At-Risk Medicaid Populations
- General Preparedness for High-Risk Members
- Condition-Specific Considerations
- Sheltering in Place vs. Evacuation
- Special Considerations for Populations with Disabilities
- Behavioral Health and Substance Use Disorder Preparedness
- Building Resiliency and Promoting Equity
The first webinar will take place on June 12, 2025, followed by July 15 and August 19. Register for this series by clicking on the button below. We look forward to connecting with you!
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!
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.
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!
The most recent 'NC Medicaid/NC AHEC Office Hours' highlighted several important tidbits regarding NCTracks. If you were not able to attend, don't worry!
- The User Login process is changing in 2025, and will require multi-factor authentication. This will occur in phases and email notifications will be sent.
You do not have to wait for your e-mail notification---you can go ahead and update your user login now.
Learn more about Multi-Factor Authentication (MFA) for NC Tracks users.
- Change of Ownership notification required at least 30 days prior to the change taking place.
Learn more about Change of Ownership guidelines and FAQ's
- Why does it matter if Provider Records in NCTracks are not up to date?
Additional topics were covered during this call. You can review a pdf of the slides from today's office hours here.
