The Importance of Becoming An Advanced Medical Home

The NC Department of Health and Human Services (NCDHHS) introduced their Advanced Medical Home (AMH) program earlier this summer as the “primary vehicle for care management delivery” for Medicaid managed care in North Carolina.  The AMH program is built on the foundation of the existing Medicaid care management program, Carolina ACCESS, but structured to incorporate more options and opportunities to support North Carolina clinicians in providing high-value, low cost quality health care to Medicaid beneficiaries.

Read our one-page overview of the AMH Program.

For practices considering AMH Tier 3, we offer the following guidance:

  • Practices that want to be certified as an AMH Tier 3 practice must attest by Jan. 31, 2019. This is important because when the state awards contracts to the Medicaid managed care health plans (PHP), the PHP will be required to contract with 80 percent of AMH Tier 3 practices. The initial list of AMH Tier 3 certified practices will be based on the current attestation period that ends in January.
  • The NCMS has heard from several practices that the attestation process is quick and simple. The process is done online through the NCTracks portal and, when complete, a confirmation message will appear.  The next steps will be provided by the state at a future date.  The AMH Provider Manual offers more information on the requirements and attestation questions.
  • A key factor in becoming certified as an AMH Tier 3 practice is the ability to provide comprehensive care management. Most practices do not have the infrastructure to provide this on an independent level so they contract with a CIN (Clinically Integrated Network) or other partner.  A number of CIN options are available, however it is imperative that a practice is prepared and understands what is and is not included in the contract before signing on with a CIN.  To aide practices through this process, the NCMS partnered with The Physicians Foundation and Smith Anderson to create a Physician’s CIN and ACO Contracting Guide.  This guide is applicable for Medicare and Medicaid CIN/ACO purposes and NCMS encourages practices considering contracting with a CIN or other partner to read through it prior to any contracting discussions.  A few key areas to highlight:
    • Part I, Section F (pg. 12): Due Diligence BEFORE You Negotiate Contract Terms. This section will outline specific attributes a CIN should have in place and what questions a practice should be asking.
    • Part II (pg. 16): The Physician’s CIN Participation Agreement Negotiation Roadmap. This entire segment of the guide is extremely important and helpful in navigating the negotiating discussion of a participation agreement. Section D: Parts of Agreement, provides guidance on specific provisions to look for or include as well as sample language that may be used to incorporate these provisions adequately.
  • Practices should consider more than one option and check references in order to comparison shop.
  • Finally, please be advised that neither the State nor PHPs are responsible for the oversight of the CIN, therefore, it is crucial that the practice fully understands the responsibilities of the CIN and holds it accountable to the expectations set forth in the participation agreement.

NC DHHS is continuing to offer AMH trainings and has archived the previously presented trainings for easy accessibility on their AMH Training Webpage.  NCMS will continue to provide informational posts and training updates in future Bulletins.  For additional questions, please contact Kristen Spaduzzi at kspaduzzi@ncmedsoc.org

To get an overview of NC DHHS’ care management strategy for Medicaid, read this announcement released today.

 
 

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