Important Announcements for NC Medicaid Providers

NC Medicaid is sharing two announcements for Medicaid Providers.

Temporary Clinical Policy Modifications: Payment for Healthy Opportunities Screening and Referral

Effective Jan. 1, 2021, NC Medicaid and NC Health Choice are temporarily covering Healthy Opportunities screenings to encourage providers to gain capacity for screening Medicaid beneficiaries for unmet health-related resource needs and referring them to appropriate community-based resources prior to the launch of Medicaid managed care.

• Reimbursement is limited to Carolina Access II providers and is a time limited opportunity through June 30, 2021.
• Coverage of this code after Medicaid Managed Care launch will be at the discretion of the health plans.

Carolina Access II providers may temporarily receive reimbursement for positive Healthy Opportunities screenings conducted using the North Carolina Department of Health and Human Services (DHHS) standard screening questions or an equivalent instrument with similar questions covering beneficiary needs related to DHHS’s 4 priority domains (food, housing/utilities, transportation and interpersonal safety). For providers who have not already adopted a tool, we strongly encourage the use of the DHHS standard questions.

For more information, please see Temporary Clinical Policy Modifications: Payment for Healthy Opportunities Screening and Referral.

Advanced Medical Home Tier 3 “Glidepath” Payments

Effective April 1, 2021, as part of the transition to Medicaid Managed Care, NC Medicaid will offer a time-limited payment opportunity to practices that have attested into Advanced Medical Home (AMH) Tier 3 if they can demonstrate successful readiness for AMH Tier 3 responsibilities as set out below.

• The payments, called “AMH Tier 3 Glidepath Payments,” will be $8.51 per member, per month (PMPM), paid by NC Medicaid in addition to eligible practices’ existing Carolina Access II PMPM payments.
• AMH Tier 3 Glidepath Payments are intended to provide an incentive for managed care launch readiness as well as provide funding to offset some of practices’ Tier 3 implementation costs.
• Payments will be available for the months of April, May and June, 2021, only.