Family and Children's Medicaid MA-3435 COMMUNITY CARE OF NORTH CAROLINA/CAROLINA ACCESS

IV. COUNTY DSS RESPONSIBILITIES

A. Designate a county CCNC/CA contact and back-up person or a managed care representative.

B. Maintain a current and accurate county CCNC/CA Primary Care Provider Directory.

C. Explain CCNC/CA at each application and redetermination to all mandatory and optional Medicaid a/rs and NCHC recipients and offer enrollment. Give Medicaid a/rs a copy of the CCNC/CA Member Handbook.

D. Give a copy of the DMA-9016 (Medicaid) or the DMA-9017 (NCHC), CCNC/CA: The Benefits of Being a Member handout to all mandatory and optional a/rs at each application and redetermination.

REVISED 12/01/11-CHANGE NO. 19-11

(IV.)

E. Assist the a/r in choosing a medical home/PCP based on location of the recipient, medical history, or physical needs. Assist the a/r in locating medical providers, e.g., dentists.

F. Auto enroll all mandatory a/rs in CCNC/CA. Auto enroll all optional a/rs unless they opt out. Please refer to VII for enrollment rules.

G. At application or redetermination (when necessary), complete the CCNC/CA Enrollment Form, DMA- 9006 to link recipients with a medical home/PCP or to exempt recipients from participation, using the exempt policy to determine the appropriate exempt code. Make timely changes for a medical home/PCP as requested by the recipient. Enter the appropriate change reason code if applicable.

H. Key the CCNC/CA PCP provider number or exempt code in EIS.

I. Educate enrollees on CCNC/CA policies found in IX, Recipient Education, below.

J. Providers may begin the enrollment process for CCNC/CA by having the recipient complete a CCNC/CA Enrollment Form while at the provider’s office. This form is sent to the local DSS for keying into EIS. Providers are responsible for the initial education and providing explanation of CCNC/CA benefits to the recipient. At the next redetermination or client contact, the IMC is responsible for continuing the CCNC/CA education process.

K. Refer CCNC/CA enrollees or providers with questions or concerns outside the scope of CCNC/CA enrollment and education to the appropriate individual or agency.