Today, the North Carolina Department of Health and Human Services issued a Request for Applications for Behavioral Health and Intellectual/Developmental Disability (I/DD) Tailored Plans as part of North Carolina’s transition to Medicaid Managed Care.
As directed by the North Carolina General Assembly, only Local Management Entity - Managed Care Organizations (LME/MCOs) are eligible for the first contract term and allowed to respond to the RFA to serve as Behavioral Health and I/DD Tailored Plans. The first Behavioral Health and I/DD Tailored Plan contract term will last four years. NCDHHS will award no more than seven and no fewer than five regional Behavioral Health and I/DD Tailed Plan contracts and will not award any statewide tailored plan contracts.
Behavioral Health and I/DD Tailored Plans will provide physical health, behavioral health, long-term care and pharmacy services, and will address unmet health-related resource needs for qualifying North Carolinians under one plan. These plans will provide the same services as NC Medicaid Standard Plans with additional specialized services to serve individuals with significant behavioral health conditions, including those utilizing 1915(c) Home and Community-Based Services waivers and those utilizing State Funded Services.
Under Medicaid Managed Care, Standard Plans and the Eastern Band of Cherokee Indians (EBCI) Tribal Option will launch on July 1, 2021, followed by Behavioral Health and I/DD Tailored Plans on July 1, 2022. NCDHHS expects to award Behavioral Health and I/DD Tailored Plan contracts by early summer 2021.
Individuals who need certain services to address an intellectual/developmental disability, traumatic brain injury, serious mental illness, serious emotional disturbance or severe substance use disorder may be eligible to enroll in a Behavioral Health and I/DD Tailored Plan. People who do not get Medicaid through Standard Plans when they launch in 2021 will continue to get the same Medicaid services they receive now through “NC Medicaid Direct” and their current LME/MCO.
Behavioral Health and I/DD Tailored Plans will offer robust care management - called Tailored Care Management. Tailored Care Management will be:
- Available to nearly everyone who is enrolled in a Behavioral Health and I/DD Tailored Plan;
- Community-based, with requirements for frequent in-person contacts between enrollees and care managers;
- Focused on the whole person, incorporating physical health, behavioral health, I/DD, and pharmacy services, and addressing unmet health-related resource needs; and
- In place to support the member through their entire enrollment in the Behavioral Health and I/DD Tailored Plan; care management will not be episodic.
NCDHHS will accept applications from LME/MCOs until February 2, 2021. Both NCDHHS and the federal Centers for Medicare & Medicaid Services must approve the contract awards, which are anticipated to be announced in early summer 2021.
This is an official procurement. Send all procurement inquiries to Medicaid.Procurement@dhhs.nc.gov.
For specific Tailored Plans information, please visit the Behavioral Health I/DD Tailored Plans landing page.
For more information about Medicaid managed care, visit the Medicaid Transformation website at https://www.ncdhhs.gov/medicaid-transformation.