Member Resources

NC Medicaid Transformation

NC Medicaid Managed Care Transformation efforts have been restarted. Standard Plans are scheduled to go live July 1, 2021, while Behavioral Health I/DD Tailored Plans are scheduled to launch July 1, 2022. Until that time, NC Medicaid will continue to operate under the current model.

Background:

In 2015, the NC General Assembly directed the transition of Medicaid to a privatized managed care structure. For the first time in NC Medicaid history, we will have an integration of behavioral health and physical health reimbursement dollars. In February 2019, NC DHHS announced the four entities who have received contracts to participate as Prepaid Health Plans (PHPs) in Medicaid Managed Care:

  1. AmeriHealth Caritas North Carolina, Inc.
  2. Blue Cross and Blue Shield of North Carolina
  3. UnitedHealthcare of North Carolina, Inc.
  4. WellCare of North Carolina, Inc.

A regional contract for Regions 3 and 5 was awarded to Carolina Complete Health, Inc.

Quicklinks to Plan Resources:

NC DHHS | AmeriHealth Caritas | Carolina Complete Health | Healthy Blue | United Healthcare | WellCare

Please note, this procurement is for the Standard Plans, in which 1.6 million Medicaid Managed Care beneficiaries will be enrolled. Tailored Plans, designed for certain populations with more specialized behavioral health needs, will be procured later. Psychiatrists can and should enroll with both the Standard Plans and Tailored Plans.

See Medicaid Transformation Resources>>
 

Integrated Care

Over the past decade, the integration of behavioral health and general medical services has been shown to improve patient outcomes, save money, and reduce stigma related to mental health. Significant research spanning three decades has identified one model – the Collaborative Care Model – in particular, as being effective and efficient in delivering integrated care.

See Integrated Care Resources>>
 

A Psychiatrist’s Toolkit: Supervising NPs and PAs

Nurse Practitioners and Physician Assistants (NP/PA) have long played an important role in the provision of healthcare in North Carolina. NP/PAs have worked with psychiatrists in every practice setting—private practice, institutions, and particularly community mental health agencies. The traditional multi-disciplinary team approach of psychiatric care has instilled an appreciation for and reliance upon all clinicians in the care of this complex patient population, making the field uniquely situated to embrace the evolving health care delivery system of team-based care, collaborative care, accountable care, and shared savings. To that end, psychiatry’s ability to work with other professionals, to assess skills, and to assist in their development will be even more crucial.

See Supervising NPs and PAs Toolkit>>
 

Medicare Resources

Medicare was created in 1965 as part of the Social Security Act. The program was divided into two parts. Part A is hospital insurance and helps to pay for care provided in a hospital, skilled nursing facility, nursing home, or hospice. It covers the room, board, and ancillary charges billed directly by the facility. The covered portion of expenses is based on the number of days the patient has received care. Part B covers the professional services of physicians and nonphysician healthcare providers and a variety of outpatient services including x-rays, laboratory work, and durable medical equipment. As a psychiatrist, you will almost always be working with Part B.

Medicare Resources>>
 

PDL and Prior Authorization

NCPA’s Executive Council convened a task force in 2015 on prior authorizations (PAs) and the Medicaid preferred drug list (PDL) in response to members’ concerns about the ever-increasing number of prior authorizations being required by insurers. We've compiled several resources to assist with PAs (including appeals) and have developed guidelines for responsible prescribing. 

See Prior Authorization Resources>>
 

Practice Management

We've compiled several resources to assist with your Practice Management needs. Should you have additional questions, the APA has a Practice Management Helpline that puts you in contact with staff in the APA’s Office of Healthcare Systems and Financing who will provide assistance with problems you are encountering in your practice. Call 800-343-4671.

See Practice Management Resources>>
 
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