Issued: May 6, 2024

On July 1, 2024, Partners Health Management will begin using a new state-wide Tailored Care Management monitoring tool. The tool was developed through a collaboration of the state’s four LME/MCOs (Alliance, Partners, Trillium and Vaya), the National Committee for Quality Assurance (NCQA) and the North Carolina Department of Health and Human Services (the Department). It was designed to ensure adherence to required TCM provider guidelines and help standardized monitoring of quality of services across the state.

Prior to the July 1 launch of the Tailored Plans, Partners and the other LME/MCOs will pilot the Tailored Care Management monitoring tool during June. This will identify initial barriers and will allow any edits to the tool if needed.

What is happening?

Partners will begin using a new Tailored Care Management monitoring tool at Tailored Plan launch on July 1, 2024. During the month of June, Partners will pilot the Tailored Care Management monitoring tool.

Prior to July 1:

  • Partners and the other three LME/MCOs will pilot the tool beginning in June.
    During the pilot, each LME/MCO will:

    • Review a large provider collectively for the pilot.
    • Identify a smaller, regionally specific provider for inclusion in the pilot. (Only one smaller provider will be selected per LME/MCO).

After July 1:

  • After the Tailored Plan launches on July 1, 2024, Partners will begin using the tool with all Tailored Care Management providers.
  • Initial monitoring reviews will be for technical assistance and will not have corrective action plans.
    • The initial monitoring review will be a sample of 10 members who are engaged in Tailored Care Management. Members will be pulled by population segment as evidenced by paid claims, with a cap of 30 total members per provider.
  • Providers will be notified 28 days in advance of the intended monitoring activities to allow time for providers to work with their care management platform vendors to establish user login access for the monitoring staff.
    • Providers will be notified of the time period under review when they are notified of their scheduled monitoring.

What do providers need to do?

Providers should download and review the Tailored Care Management Monitoring Tool:

https://providers.partnersbhm.org/wp-content/uploads/NC-Standardized-Care-Management-Monitoring-Tool-rev.-4.18.24.xlsx

Providers should submit any feedback or questions by the end of the day on Friday, May 10, 2024, to Medicaid.TailoredCareMgmt@dhhs.nc.gov or QMMS@PartnersBHM.org.

A Frequently Asked Questions document will be compiled by the Department and LME/MCOs.

Who can providers contact if they have questions?

Providers can contact Partners at QMMS@PartnersBHM.org or the Department at Medicaid.TailoredCareMgmt@dhhs.nc.gov.

Providers can also download the Tailored Care Management Provider Manual at: https://medicaid.ncdhhs.gov/documents/providers/playbook/tcm-provider-manual-20240209/download?attachment