Policy Papers

Final Policy Guidance

NC Medicaid Final Policy Guidance documents outline the final policies that will govern certain NC Medicaid Managed Care features or programs. The Department appreciates previous stakeholder input, which helped shape final policies. The Department reserves the right to amend or update policies as needed. Questions about the final policies are welcome. Please send an email to Medicaid.Transformation@dhhs.nc.gov.

Behavioral Health and Intellectual and Developmental Disability Tailored Plans Eligibility and Enrollment - Released March 18, 2019.

Policy Papers

DHHS Medicaid Managed Care policy papers focus on NC Medicaid Managed Care program features. Policy papers typically include a public comment period. Although these technical papers are primarily written for providers and health plans that want to participate in Medicaid Managed Care, all comments are welcome and encouraged. Send an email to Medicaid.Transformation@dhhs.nc.gov.

Clinically Integrated Networks and Other Partners Support of Advanced Medical Homes Care Management Data Needs - Released March 5, 2019.

Healthy Opportunities Pilots: A Review of Proposed Design for Interested Stakeholders - Released Feb. 15 as a companion to the Healthy Opportunities Pilots Request for Information.

North Carolina Medicaid Managed Care Updates - Released July 23, 2018. Comments are due Aug. 24, 2018.

Data Strategy to Support the Advanced Medical Home Program in North Carolina - Released July 22, 2018. Comments are due Aug. 20, 2018.

Supporting Provider Transition to Medicaid Managed Care - Released May 18, 2018. Comment period is closed.

Prepaid Health Plans in NC Medicaid Managed Care - Released May 16, 2018. Comment period is closed.

Using Standardized Social Determinants of Health Screening Questions to Identify and Assist Patients with Unmet Health-related Resource Needs in North Carolina - Released April 5, 2018. Comment period is closed.

Updated Standardized Screening Questions for Health-related Resource Needs - July 9, 2018. Please use with "Using Standardized Social Determinants of Health Screening Questions..." paper released April 5, 2018, above.

North Carolina's Vision for Long-term Services and Supports under Managed Care - Released April 5, 2018. Comment period is closed.

Draft: North Carolina's Medicaid Managed Care Quality Strategy - Released March 20, 2018. Comment period is closed. Please also use as a companion document to the PHP Quality Performance and Accountability concept paper.

Centralized Credentialing and Provider Enrollment - Released March 20, 2018. Comment period is closed.

Provider Health Plan Quality Performance and Accountability - Released March 20, 2018. Comment period is closed.

North Carolina's Care Management Strategy under Managed Care - Released March 9, 2018. Comment period is closed.

Beneficiaries in Medicaid Managed Care - Released March 9, 2018. Comment period is closed.

Managed Care Benefits and Clinical Coverage Policies - Released March 2, 2018. Comment period is closed.

Prepaid Health Plan Network Adequacy and Accessibility Standards - Released Feb. 15, 2018. Comment period is closed.

Addressing Hospital Supplemental Payments in the Transition to Managed Care - Released Nov. 20, 2017. Comment period is closed.

Behavioral Health and I/DD Tailored Plan Concept Paper - Released Nov. 9, 2017. Comment period is closed.

Population Profiles - Released Nov. 9 as a companion document to the Behavioral Health I/DD Tailored Plan Concept Paper.