CoCM Capacity Building Fund Application Components

Applicants must attest to the following three prerequisites to be eligible for capacity building funding:

• Practice is referred by AHEC Practice Support coach (Y/N)
• A Practice leadership representative has watched the first three AHEC introduction modules to CoCM (Y/N)
• Practice Leadership (decision makers) have made the informed decision to implement CoCM (date and by whom)

Qualifying primary care practice entities may receive a maximum of one award per primary care practice site. Each award may be used across up to three primary care practice sites. A primary care practice entity applying on behalf of multiple primary care practice sites may receive a maximum of three awards per entity (covering a maximum of 9 sites).

 

Phase 1

$50K maximum awards for practices who have not yet implemented CoCM or have not provided CoCM services in the last 6 months and will implement the model in-house (i.e., without using an external vendor for staffing) and who meet one of the following criteria: (Practices meeting Phase 1 criteria who newly began billing for CoCM in-house after 7/8/24 can also apply in Phase 1). 

• Any Medicaid enrolled independent or hospital-owned primary care practice site or sites (up to 3 sites) located in Tier 1 or Tier 2 counties with at least 50* total assigned Medicaid beneficiaries. 

         OR

• Any Medicaid enrolled independent (non-hospital owned) primary care practice site or sites (up to 3 sites) located in Tier 3 counties with at least 50* total assigned Medicaid beneficiaries. 

         OR

• Any Medicaid enrolled hospital-owned primary care practice site or sites (up to 3 sites) located in Tier 3 counties with at least 100* total assigned Medicaid beneficiaries. 

* Number of Medicaid beneficiaries at-large

Note: Practices that do not meet the 50 assigned beneficiary threshold can collaborate with other practices to meet the requirement. One award will be shared between the practices listed in the application and the lead applicant is awarded. This is to allow access to smaller practices that may need to share staff to operationalize the model. 
 

Phase 2

Launch date to be announced

A: $30K maximum awards for primary care practice sites that have already adopted the CoCM model, have provided CoCM services during the last 6 months and who otherwise meet Phase 1 eligibility, and either have been unsuccessful in their implementation or have additional demand for the service that exceeds current CoCM staff capacity (No/few claims billed, claims issues, or want to expand services but require funds to do so).

B: $20K maximum awards for primary care practice sites that meet Phase 1 eligibility but will outsource staffing to a 3rd party turn-key company.

Note: County Tier refers to the County Distress Ranking per the NC Department of Commerce found here.

Family Medicine, Internal Medicine, Pediatrics, FQHCs, LHDs, and/or RHCs are eligible to apply. OB/GYN practices with attributed Advanced Medical Home patients are eligible to apply.

• Specialty practices
• OB/GYN practices without attributed Advanced Medical Home patients

Phase 1

Summary for $50k Award – Three Payments. Disburse 25% planning funds up front, 50% implementation funds and, 25% operational funds.

• Distribution Criteria: Planning Funds: 25% ($12,500)
  • Application reviewed and information validated by CCNC
  • Completion of contract agreement/forms required for fund distribution (e.g. W-9, EFT instructions)
  • Funds will be distributed 30 days following a signed participation agreement
• Distribution Criteria: Implementation Funds: 50% ($25,000)
  • Psychiatric Consultant has started employment (may be a contract)
    • Practice contact emails CCNC and copies new Psychiatric Consultant
  • BH Care Manger has started employment (may be a contract)
    • Practice contact emails CCNC and copies new BH CM
  • Confirmation via attestation on Jotform that staff and consultants are in place and active and meet NC DHHS criteria (link)
  • Funds will be distributed within 30 days after meeting criteria above
• Distribution Criteria: Operational funds: 25% ($12,500)
  • Established a panel of patients – with minimum caseload met (20)
  • Services are still in process and filed initial claims using CoCM codes
  • Monthly documented case load numbers reported through Jotform to CCNC – Submit every other month
  • Confirmation via attestation that staff and consultants are in place and active
  • Funds will be distributed within 30 days after meeting criteria above
     

Phase 2

Summary for both $30k (A: Already adopted CoCM) and $20k awards (B: Outsourcing to a Turn-key CoCM vendor) – Two Payments. Disburse 50% planning funds up front, 50% implementation funds.

• Distribution Criteria: Planning Funds: 50% (A: $15,000 B: $10,000)
  • Application reviewed and information validated by CCNC
  • Completion of contract agreement/forms required for fund distribution (e.g. W-9, EFT instructions)
  • Funds will be distributed 30 days following a signed participation agreement
• Distribution Criteria: Implementation Funds: 50% (A: $15,000 B: $10,000)
  • Psychiatric Consultant has started employment (may be a contract) or if outsourced, is now working with the practice
  • BH Care Manger has started employment (may be a contract) or if outsourced, is now working with the practice
  • Services are still in process and claims filed using CoCM codes
  • Already adopted CoCM: Increase caseload from award date by 20 patients
  • Outsourcing CoCM: 20 patients on active caseload
  • Practice contact emails CCNC and copies new BH CM
  • Confirmation via attestation on Jotform that staff and consultants are in place and active and meet NC DHHS criteria (link)
  • Documented monthly case load numbers reported through Jotform to CCNC – Submit every other month
  • Funds will be distributed within 30 days after meeting criteria above

This funding shall be used to support capacity building, infrastructure development, and other activities for start-up CoCM providers.

Connect with NC AHEC practice-based support coaches to receive training and technical assistance to of building and initiating CoCM services.

Practice application elements will consist of Jotform with the following attestation fields:

• Practice demographics (name, address, NPI, provider champion, point of contact, etc.)
• Eligibility tier: Identify practice tier on map (link)
• Medicaid enrollment attribution
• Attestation indicating completion of AHEC training minimums with dates (AHEC introduction modules)
  • Module 1: Collaborative Care Model (CoCM) Rationale and Evidence
  • Module 2: Laying the Foundation for Collaborative Care Through Practice Transformation
  • Module 3: Putting Collaborative Care Principles into Practice: Planning for Clinical Practice Change
• Shared email referral from AHEC with practice included
• Implementation plan provided
  • Description of staffing strategy and timeline (consultants, care managers, etc.)
• Practice will agree to submit reports every other month showing their activities on a monthly basis via a Jotform through month 18

Collaborative Care Management (CoCM) Capacity Building Fund

Implementation Plan for Practices Meeting Phase 1 Eligibility

 

Save File: MyClinicsName.ImplementationPlan

 

We’re pleased your practice is interested in providing CoCM to your patients. The Implementation Plan is an Integral part of the application and should include input from your team. Please note, incomplete or insufficient responses will result in a request for revisions.

 

Practice Name:

Practice Address:

Practice NPI/Loc:

 

Practice Decision to Implement CoCM

Provide a narrative description of:

• Date practice leadership met and approved implementation of Collaborative Care Management (CoCM) and the type of meeting where leadership approved plans to implement CoCM (examples: executive leadership, board, or staff meeting
• Timeline and any steps taken to make the decision to implement CoCM
• What does your practice team hope the CoCM program and related funding will accomplish for the practice?
• How does the practice implement new programming and quality initiatives?

 

CoCM Implementation Team

Provide a narrative description of:

• The Implementation Team, including names and roles: practice manager, provider champion, on-site provider-lead, BHCM, clinical staff members, EMR specialist, etc.
• How often will the CoCM Implementation Team meet and who will lead/facilitate?
• Outline ways the BHCM can connect for support between meetings
• Who will directly supervise the BHCM?

 

Staffing Strategy

Description of staffing strategy and timeline and plan if not already hired (if not already hired, include the plan to advertise, and the target employment/contract date).

• Behavioral Health Care Manager (BHCM)
  • Name of Behavioral Health Care Manager (BHCM): (may be TBD)
  • Licensure and/or degree of BHCM: (may be TBD)
  • Hire date of BHCM: (may be TBD)
  • Contracted/ing with a behavioral health agency for the BHCM? Y/N
    • If yes, date Business Associate Agreement (BAA) signed: (may be TBD)

 

• Psychiatric Consultant
  • Name of Psychiatric Consultant: (may be TBD)
  • Licensure and/or degree of Psychiatric Consultant: (may be TBD)
  • Hire date of Psychiatric Consultant: (may be TBD)
  • Contracted/ing with an agency for the Psychiatric Consultant? Y/N
    • If yes, date Business Associate Agreement (BAA) signed: (may be TBD)

 

Registry Strategy

The practice’s CoCM registry functions should be in place for the first day of the new service.

• Who reviewed the CoCM registry components (names/roles)
• Plan for CoCM registry functions:
  • Which registry option will be used? (EMR modification/module, AIMs Caseload Tracker, Other)
  • If using an EMR, share details on how you will use the EMR to gather the required common registry components and monthly reporting requirements for the CoCM activities for the capacity building funds

 

CoCM Service Implementation

Provide a narrative description of:

• The preliminary plans for providers and staff at the practice to receive education on CoCM
• The details of how you plan to train staff on the necessary changes related to
• Documentation,
• Billing, coding,
• Workflows for all practice staff roles including PCPs, BHCM, clinical staff, billing and scheduling

 

Resource Tools:

AIMS Implementation Guide

Implementation: Create a Shared Vision

Clinic Implementation Team Role Description

Practice Reporting to CCNC will submit reports every other month showing their activities on a monthly basis via a Jotform through month 18:

• Number of active cases each month
• Number of new cases each month
• Number of cases (cumulative) in remission (use scales. i.e., number of cases with a PHQ-9 score below 5)
• Number of cases (cumulative) with Improvement (use scales. i.e., 5 points or 50% reduction in PHQ-9 score)
• Number of terminated cases each month (prior to completion)
• Percent of current cases invoiced each month (across all payers)
• Confirmation of Staff and Consultation Engagement (checkbox)