The Autism Society of North Carolina (ASNC) is now a provider of Tailored Care Management (TCM), a Medicaid program that officially launched across the State of North Carolina in December of 2022.
What is Tailored Care Management?
Tailored Care Management (TCM) is a new Medicaid service that seeks to support whole-person care for individuals covered by the Medicaid Tailored Plan. With Tailored Care Management, a single person (a Care Manager) is assigned to each Medicaid recipient. Care Managers help lead the care team to make sure each Medicaid recipient can access all available services, support, resources, and information to best meet all their needs.
Tailored Care Management aims to help coordinate whole-person care. Through this model, the full care team should also include all doctors, specialists, or therapists who provide care. This might include a pediatrician or primary care doctor, a psychiatrist, a psychologist, a pharmacist or pharmacy office, a social worker or therapist, speech/occupational/physical therapists, ABA therapy teams, direct care staff, medical specialists like neurologists and gastroenterologists, teachers, faith communities, and anyone else the individual or family feels is important to their health and well-being.
For those who have received case management or care coordination in the past, the service may feel similar, but it’s important to know Care Management is intended to be broader to ensure that all a person’s needs (social, psychiatric, emotional, developmental, medical, educational, occupational, etc.) are acknowledged and supported.
For many families, this may be the first time someone has been assigned to help their family. As providers within the publicly funded healthcare space, we are so excited this day has come, and we hope it means more and more people and families across North Carolina will get the support and assistance they need!
Who is the ASNC Care Management Team?
- Kerri Erb – Chief Program Officer
- Cheri Howell – Project Manager
- Jenna Flynn – Integrated Care Professional / TCM Clinical Supervisor
- Nicole Sevigny – Care Manager
- Trista Palmer – Care Manager
You can connect with the team at CareManagementContact@autismsociety-nc.org
How is ASNC’s model of Care Management different than others?
ASNC follows all required elements of Tailored Care Management as required by the North Carolina Department of Health and Human Services. However, there are some key things to know about the ASNC Care Management program.
- Children Only: At the time of this writing, ASNC’s Tailored Care Management program is being piloted with children (under age 22) who are not receiving Innovations and who have a diagnosis of autism.
- Limited Locations: ASNC’s Tailored Care Management program is being piloted in Durham, Orange, and Wake counties in the Alliance LME/MCO Tailored Plan.
- Partnership with Duke Health: ASNC Care Management has partnered with Duke Health to ensure clients’ needs are met, as they pertain to any higher medical or psychiatric needs and understand medication management. This partnership helps ASNC ensure high-quality care management is provided to all families assigned to our program and provides consultation around the high medical and/or psychiatric needs our clients and families may have.
What should you expect from Tailored Care Management?
Whether your Tailored Care Management is provided by ASNC or another partner, there are steps and outcomes you can expect.
Once you, your child, or another person in your family is assigned to the Medicaid Tailored Plan, you will be assigned to a Tailored Care Management (TCM) agency and may receive a letter from the Tailored Plan or agency you’re assigned notifying you of this assignment.
The assigned agency will contact you by phone to tell you about Care Management and ensure it is something you are interested in. They may also contact you via text, email, or by traveling to the home address on file.
You can decline the service for any reason. To decline, you need to speak to someone at the assigned agency or call the Tailored Plan to indicate you want to “opt-out” of the program.
If you say “yes” to Care Management, your provider agency will help you identify where you need support and how to best be supported. Examples include providing information about activities to do in the community, providing support during meetings with teachers or school staff, completing referrals for therapeutic programs (ABA, counseling, speech therapy, occupational therapy, etc.), locating community resources to help pay for housing and utility costs, helping you understand diagnoses and behavior, and helping you communicate with medical providers about questions and concerns.
Last but certainly not least, the goal of Care Management is to put clients and families at the center of the work being done – families and individuals can decide how frequently they’d like to talk with their Care Manager, through what method they’d like to talk with their Care Manager (phone, text, email, telehealth platform), and what goals or objectives their Care Manager helps them works toward.
Within the first three months, Care Managers must work with you to complete an assessment that helps summarize what you need. The assessment is used to create a Plan of Care that helps the care team know which team members are responsible for completing which tasks or goals, and when they will be completed. If your needs change or a crisis occurs, your Care Manager is responsible for changing the plan and supporting you.
If you have not heard from your Care Manager within three months, call the Tailored Plan assigned to manage care for the county you live in and say “I’m calling to find out who my assigned Tailored Care Management agency is.” They should be able to help get you connected as soon as possible.
The last important piece to expect is that if you are interested in receiving Medicaid 1915(i) services, a Care Manager is required to complete an assessment with you to detail your needs – this is required to determine if you are eligible for the 1915(i) services. Your Care Manager will oversee the assessment, plan, and eventual services. If you have opted out of Tailored Care Management, a Care Coordinator assigned by the Tailored Plan will complete this for you.
What are your rights in Tailored Care Management?
As a recipient of Tailored Care Management, you have the right to:
- Ask questions about Tailored Care Management and the specific agency you are assigned to before providing verbal consent.
- Change your provider of Tailored Care Management. To change your provider, contact the Tailored Plan that manages the county in which you live and tell them, “I want to change my Tailored Care Management provider.” They should assist you via phone and confirm for you that the change was submitted to the system. There can be a limit to the number of times you can change your Care Management provider, but the Tailored Plan can help you understand your options.
- Opt out of the Tailored Care Management program. This service is offered to you but is not mandatory. If you do not feel it is something your family would benefit from, you have the right to “opt-out” of the program.
- Voice what you prefer when it comes to meetings. Who would you like to invite to them? Do you want them to be done in person at your home, in the community, via a telehealth platform, or by phone?
- Voice what you prefer when it comes to frequency of contact. While the State has outlined recommendations for how frequently your Care Management should contact you both via phone and in person, they have stressed that families should be able to voice preferences.
- Have copies of all assessments and plans created for you by your Care Manager.
Please email the Care Management team with questions.