Effective April 16, 2020, NC Medicaid, in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services, is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability Clinical Coverage Policies to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic.
Topics Related to Behavioral Health Providers
Effective March 10, 2020, through the conclusion of the North Carolina declared state of emergency related to the COVID-19 crisis, NC Medicaid is temporarily increasing the number of therapeutic leave days for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs) from 60 days to 90 days and waiving the requirement of approval needed more than 15 consecutive days per Clinical Coverage Policy 8E.
NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver. Medicaid is hosting two webinars to further discuss the flexibilities.
NOTE: The Centers for Medicare & Medicaid Services (CMS) have approved Appendix K flexibilities mentioned below. - April 9, 2020
NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries may access and receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver. NC Medicaid has created an emergency planning document called Appendix K to seek approval to modify the scope, frequency, amount and setting of how waiver services are used and approved.
The Centers for Medicare & Medicaid Services has granted NC Medicaid the authority to move forward with Home and Community-Based (HCBS) waiver flexibilities requested March 13, 2020.
The Foundation for Health Leadership and Innovation's Center of Excellence for Integrated Care, in partnership with UNC-Chapel Hill School of Nursing, is conducting a short survey.
The Medicaid State Plan Amendment was approved by the Centers for Medicare & Medicaid Services with an effective date of Oct. 1, 2019. The clinical coverage policy was posted on Oct. 10, 2019 for an additional 15-day public comment period. Following the 15-day public comment period, the final Community Support Team policy will be posted with an effective date of Nov. 1, 2019.
The NC Medicaid State Plan Amendment for Peer Support Services was approved by the Centers for Medicare & Medicaid Services on Oct. 23, 2019, with an effective date of July 1, 2019. The clinical coverage policy will be posted with an effective date of Nov. 1, 2019.
The Secretary of the N.C. Department of Health and Human Services (DHHS) has approved the disengagement of Rutherford County from the VAYA Health Local Management Entity-Managed Care Organization (LME-MCO) and their alignment with Partners Behavioral Health Management LME-MCO.
NC Medicaid has adopted the American Medical Association's new Current Procedural Terminology® (CPT) Category I codes for Research Based Behavioral Health Treatment, effective for dates of service on or after Jan. 1, 2019.