On Friday, Nov. 13, 2020, NCDHHS issued a Request for Applications for Behavioral Health I/DD Tailored Plans as part of North Carolina’s transition to Medicaid Managed Care.
As directed by the North Carolina General Assembly, for the first contract term, only LME/MCOs are eligible to respond to the RFA to serve as Behavioral Health I/DD Tailored Plans. The first Behavioral Health 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, pharmacy services and unmet health related resource needs to qualifying North Carolinians under one plan. These plans will provide the same services as Standard Plans but will also provide additional specialized services that serve individuals with significant behavioral health conditions, I/DDs and traumatic brain injuries (TBI).
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:
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.
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.
More information about Tailored Plans is available at https://medicaid.ncdhhs.gov/providers/programs-and-services/behavioral-health-idd/behavioral-health-idd-tailored-plan