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

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

I. Background

In 1991, Carolina ACCESS (CA) was implemented on a county by county basis and became statewide in 1998. The purpose is to improve access to primary care, improve quality of care and utilization of services, and provide a more cost effective system of care. This is accomplished by linking recipients to a medical home where there is a primary care provider (PCP) to deliver and coordinate health care.

In 1996, Medicaid began using the existing CA infrastructure to build an enhanced -managed care plan, Community Care of North Carolina (CCNC). CCNC was formerly known as ACCESS II & III. CCNC developed networks of CA providers in order to deliver community directed care. Each network has an administrative entity to plan and administer the local and state wide managed care initiatives. Each network brings together key players in the community who provide services to Medicaid and North Carolina Health Choice (NCHC) recipients. Depending on community resources these players include primary care providers, DSS agencies, health departments, and others. In November 2009, these two programs were given one name, Community Care of North Carolina/Carolina ACCESS, CCNC/CA.

Even with the addition of CCNC, some recipients continue to know the program as Carolina ACCESS. Efforts are being made to assist recipients to identify with CCNC, in addition to Carolina ACCESS (CA). Not all primary care providers choose to join with a network. There will continue to be PCPs who are Carolina ACCESS providers only.

Every PCP, participating in CA or CCNC, must first be enrolled in Carolina ACCESS and must complete a Carolina ACCESS provider contract and agreement before becoming a PCP. A provider cannot move into a network unless he has first been approved as a CA provider. For the purpose of this section, Medicaid managed care will be identified as CCNC/CA.

In 2005, the General Assembly passed legislation requiring NCHC children ages 6-18 to be linked to a CCNC/CA provider unless exempt. All Medicaid recipients who fail to choose a CCNC/CA provider will be auto enrolled, unless they qualify for an exemption.

The Recipient and Provider Services Section of DMA works with the managed care section to provide training and policy implementation of CCNC/CA with the local DSS agencies. The Managed Care Section continues to be responsible for policy development.

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

(I.)

The Managed Care Section works closely with the provider community and the local network administrative entities. Regional managed care consultants (MCC) develop and coordinate community involvement in the CCNC/CA program.