The 1115 Waiver seeks to transition Medicaid services in North Carolina from fee-for-service to managed care. Services will be offered through two distinct products: Standard Plans and Behavioral Health and 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.
BH 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.
Both Standard Plans and BH IDD Tailored Plans will integrate physical health, behavioral health, and pharmacy services to best serve individual needs. Trillium will continue to serve members with complex needs (significant behavioral health disorders, intellectual and developmental disabilities, substance use disorders, and traumatic brain injury once the Standard Plans go live in July 2021. Tailored Plans will not launch until July 2022.
Providers are invited to ask questions from Trillium related to Medicaid Transformation. Our goal is to help providers find answers and resources to help during this transition. Once we have started receiving questions, we will post a “Frequently Asked Questions” in this page.
INFORMATION FOR PROVIDERS FROM NC DHHS
NC Medicaid launched a “Provider Playbook,” an online resource for those who deliver health care services to Medicaid beneficiaries, including independent providers and practices, local health departments, federally qualified health centers and clinics, health care systems, and our many other community partners.
The Provider Playbook shares the following information:
NC Medicaid also posted their NC Medicaid Help Center. The NC Medicaid Help Center is an online source of information about Managed Care, COVID-19 and Medicaid and behavioral health services, and is also used to view answers to questions from the NC Medicaid Help Center mailbox, webinars and other sources. Formerly referenced as the “SWAT Command Center,” the NC Medicaid Help Center also includes resource documents such as standard and COVID-19 Medicaid Bulletins. To use this new tool:
- Go to NC Medicaid Help Center
- Type a topic or keywords into the search bar; or,
- Select a topic from the available list of Categories
Key Dates for Transitioning to Medicaid Managed Care
- March 15, 2021 – Open Enrollment begins (Standard Plans only)
- May 15, 2021 – Auto Enrollment for beneficiaries who have not selected a health plan
- May 22, 2021 (approximate) – Transition of Care information is sent to each health plan for beneficiaries assigned to that health plan
- July 1, 2021 – Medicaid Managed Care launch (*Standard Plans only; Tailored Plans will launch in July 2022)
PROVIDER CONTRACTING REMINDERS
Although providers may contract with health plans at any time, the NC Department of Health and Human Services (DHHS) published two specific deadlines to increase the likelihood of inclusion in the Medicaid and NC Health Choice Provider and Health Plan Look-up Tool, as well as the Health Plan provider directories by certain milestone dates. The first deadline to ensure inclusion during open enrollment (begins March 15, 2021) has passed, but it should not deter uncontracted providers from quickly beginning that process to meet the next deadline and be included in the provider directories as soon as possible.
In order for a provider’s information to be used in auto-enrollment (May 15, 2021), contracts should be executed with Health Plans by April 12, 2021. This allows sufficient time for signed contracts to be returned and for the Health Plan to process those contracts. Typically, Health Plan processing time is two to three weeks but may take longer. Providers need to contract with health plans in a timely fashion to avoid losing patients when health plans assign beneficiaries to in-network providers. More information about Provider and Health Plan Contract Deadlines.
Trillium will work with DHHS 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.
Another training opportunity
- Thursday, May 6, 2021 | Hot Topics in Medicaid Transformation
- Thursday, Jun 3, 2021 | Hot Topics in Medicaid Transformation
Register with Medicaid Care Webinar Series for Providers sponsored by NCDHHS Division of Health Benefits. Here is the full schedule for these trainings.
Past 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 and Slides (
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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