Medicaid services in North Carolina are changing from fee-for-service to managed care. Services will be offered through two distinct products: Standard Plans and Behavioral Health Intellectual/Developmental Disabilities (I/DD) Tailored Plans. Standard Plans will serve most Medicaid and NC Health Choice members, including all adults and children and those with mild to moderate behavioral health needs.
Behavioral Health I/DD Tailored Plans are specifically designed to serve the complex needs of individuals with significant behavioral health disorders, intellectual and developmental disabilities, and traumatic brain injury — populations Trillium and all other LME/MCOs have long served. The Tailored Plans will also serve uninsured individuals currently receiving state-funded services, regardless of their diagnosis.
The Trillium Tailored Plan will launch on December 1, 2022.
INFORMATION FOR PROVIDERS
Key Dates for Tailored Plan launch
- June 15, 2022 – Tailored Plan marketing can begin; Enrollment Broker to start updating provider directory to include Tailored Plan providers
- August 15, 2022 - October 15, 2022 – Tailored Plan Auto Enrollment and Choice period begins; members can select primary care physicians
- October 15, 2022 – Trillium to start sending welcome packets to members and recipients
- November 1, 2022 – Behavioral Health Crisis Line and Nurse Line go live
- December 1, 2022 – Tailored Plans will launch
PROVIDER CONTRACTING REMINDERS
Trillium will start sharing information soon with providers about changes to come in the contracts, both the services included and processes such as credentialing.
TAILORED PLAN PROVIDER CONTRACT
In anticipation of Tailored Plan launch expected to occur on December 1, 2022, and to ensure Trillium will meet the Network Adequacy requirements, Trillium will begin issuing the NCDHHS approved Tailored Plan Procurement Contract (“TP Provider Contract”) to its fully contracted providers in June 2022. The effective date of the TP Provider Contract will be December 1, 2022, and providers will continue serving Trillium members under the terms and conditions of their current procurement contract until that time.
Per NCDHHS, there is a 90-day Opt-Out period from when you receive the new Tailored Plan contract. However, a quicker response is desired and will assist Trillium to ensure network adequacy.
Rejecting participation in any program shall not have any impact upon the provider’s ability to continue participation under other programs, and any questions can be submitted to Provider Contracting Questions and Feedback
In an effort to aid in the review of the terms and conditions that will be changing, we created a Quick Reference Guide. While this guide does not capture every edit, it does highlight changes that have the potential to increase provider issues for meeting contracting requirements, service delivery, claims, and reimbursement.
Please forward any questions regarding the TP Provider Contract or the contracting process to TP Provider Contracting Questions and Feedback or call the Provider Support Services Line at 1-855-250-1539.
Note: The contract template is subject to change as the Department issues additional guidance. Trillium will communicate such changes in a Trillium Network Communication Bulletin and incorporate the changes, when applicable, in an addendum. Additionally, while some of the language can be negotiated, most of the revised language is required by the Department to be verbatim.
|General Terms and Conditions||Appendix F||Hospital Addendum|
|Appendix A||Federal Assurances Certification Regarding Environmental Tobacco Smoke||Appendix G||Business Associate Addendum|
|Appendix B||Federal Assurances Certification Regarding lobbying||Attachment A||Contracted Services and Approved Sites|
|Appendix C||Federal Assurances Certification Regarding Drug-free Workplace Requirements||Attachment B||Deficit Reduction Act|
|Appendix D||Federal Assurances Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions||Attachment C||Advanced Medical Home Program Policy for Medicaid and NC Health Choice Members|
|Appendix E||Outcomes and Reporting Requirements||Attachment D||Pregnancy Management Program Policy for Medicaid and NC Health Choice Members|
|Appendix F||Agency Addendum||Attachment E||Care Management for High-Risk Pregnancy Policy for Medicaid and NC Health Choice Members|
|Appendix F||Practitioner/Group Addendum||Attachment F||Care Management for At-Risk Children Policy for Medicaid and NC Health Choice Members|
|Appendix F||ICF Addendum||Attachment G||Indian Health Care Providers|
Trillium aims to develop a robust integrated network of providers and maintains an open network for all physical health providers. To join the Trillium network, for physical health services, please contact NetworkServicesSupport@TrilliumNC.org.
During the beneficiary choice period (Aug. 15, 2022, through Oct. 14, 2022) for Tailored Plan Launch, beneficiaries can choose a primary care provider (PCP) and Tailored Care Management provider by contacting their Tailored Plan. Beneficiaries who do not make a choice will be automatically assigned (auto-assignment commences on Oct. 15, 2022, and runs for six days) a Tailored Care Management provider and a PCP.
Provider contracts must be signed and mailed to the Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans by:
- July 16, 2022, for inclusion in the initial beneficiary choice period.
- Sept. 15, 2022, for PCP inclusion in auto-assignment.
- Sept. 30, 2022, for Tailored Care Management inclusion in auto-assignment.
Trillium maintains a closed network for BH/IDD services. To request to join the Trillium network for BH/IDD services, please visit our Provider Recruitment or Vendor Opportunities webpage for current network openings OR email NetworkServicesSupport@TrilliumNC.org.
Trillium will work with NCDHHS to develop a training plan for providers; we will share details and registration information with providers when modules have been scheduled. Previous and future trainings can be found on the Provider.MyLearningCampus.org site.
Current trainings available include:
- Standard Plan/Tailored Plan Care Management
- Performance Measures
- Whole Person Care
- Value-Based Purchasing
- Network Capacity and Competencies
Members will be able to “raise their hand” and request transition if they have been placed on the Standard Plan and feel they would be better served by the Tailored Plan. Members who use certain services for their developmental disability, mental illness, traumatic brain injury, or substance use disorder (for example, need access to State-funded or B3 services, are on Innovations Waiver, OR are on the Innovations waiting list) may choose to follow the directions in the letter and ask to be served through the Tailored Plan. Providers will be instructed on forms to use to help a member transition from a Standard Plan to a Tailored Plan.
After the Tailored Plans launch, providers will change all information to be reflected in directories using NCTracks. Please visit the NCDHHS page below for details on trainings regarding these changes.
NC DHHS past webinar recordings slides and transcripts:
- October 1, 2020 | Better with Time:
Recording, Slides, and Transcript, and Q&A
- November 5, 2020 | Advanced Medical Home:
Recording, Slides, and Transcript
- December 3, 2020 | Beneficiary Attribution:
Recording, Slides, and Transcript and Q&A
- January 7, 2021 | Behavioral Health (standard plans):
Recording, Slides, and Transcript, and Q&A
- February 4, 2021 | Quality, Tracking quality performance, outcomes and expectations: Recording, Slides, Transcript and Q&A
- March, 4, 2021 | Medicaid Hot Topics:
Recording, Slides and Transcript, and Q&A
- April 1, 2021 | Hot Topics in Medicaid Transformation:
Recording, Slides, Transcript, and Q&A
- May 6, 2021 | Behavioral Health:
Recording, Slides, Transcript and Q&A
- June 3, 2021 | Transitions of Care:
Recording, Slides, Transcript and Q&A
The NC Medicaid Enrollment Broker webpage is now live. This new information will help members in selecting a health plan if they are placed on the Standard Plan.
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