In addition, we are also pleased to extend these contracts to you knowing negotiations with the state and Tailored Plans resulted in contracts more favorable to your practice, including a significant increase in the state PMPM payments for Tailored Plan members from $5 PMPM to $20 PMPM. The NC DHHS Bulletin detailing this change can be found here.

Earlier today, your practice’s CCPN primary contact received an email containing links to these Tailored Plan contracts and contract overview documents. If you did not receive the email with the contract links, we strongly encourage you to reach out to your practice’s CCPN primary contact to request this email so you can review the Vaya Health and Sandhills Center (AmeriHealth) Tailored Plan contracts and contract summaries.

Negotiations with Eastpointe (WellCare) for the remaining Tailored Plan contract are still under way. We will update you on the status of these negotiations as they continue. 

As stated in the CCPN Participation Agreement, you have 40 days from the date of this email to opt-out of these agreements. You are required to submit a Contract Participation Decision form for each Tailored Plan contract, and these were sent with the contracts to your practice’s CCPN Primary Contact. We strongly encourage your practice to submit your Contract Participation Decision forms as soon as possible, but no later than September 12, 2022, so your practice’s information can be submitted to Vaya Health and Sandhills Center (AmeriHealth) for inclusion in their Practice Participation Directories before the Tailored Plan Auto-Assignment period begins.  

Submitting your Contract Decision Forms to CCPN after September 12, 2022, means your practice will not be an option for Tailored Plan patients during the initial auto-assignment period.

Again, while we encourage you to make your contract participation decisions and submit your Contract Participation Decision forms as soon as possible, we must receive your Contract Participation Decision forms by Tuesday, October 11, 2022.

Important points to remember:

• Similar to the Medicaid Prepaid Health Plan (PHP) contracts, each contract contains a fee schedule and a value-based overlay. By contracting through CCPN, your practice will receive data analytics, care coordination, and quality improvement support to help you meet the value-based metrics that are part of these agreements. 

• AMHs who have Medicaid members from multiple counties may need to consider contracting with multiple Tailored Plans. Each Tailored Plan has a unique county catchment coverage area.

• Tailored Plan members who do not choose a provider during the Member Choice period will be auto-assigned to either their current AMH if the AMH is contracted with the matching Tailored Plan or a nearby AMH if their current AMH chooses to not participate.

If you have any questions about CCPN’s Tailored Plan contracts, please contact your CCPN Provider Relations Representative or CCPNSupport@communitycarenc.org.

Note: All Medicaid PHP contracts and related materials are confidential, proprietary information of CCPN, which may not be disclosed unauthorized third party, except in certain, limited circumstances. CCPN and CCPN Participating Clinicians and Practices shall comply with all applicable state and federal laws, and applicable contract provisions, respecting the confidentiality of these and any other related materials, which are not otherwise public information. Except as permitted by law or contract provision, neither CCPN nor Participating Clinicians and Practices may disclose any confidential and proprietary information collected or exchanged at any time during this initial contract review process, or at any time afterward.