Please note this bulletin was updated on June 17, 2021, to add the new phone number for the Provider Ombudsman.
Effective July 1, 2021, NC Medicaid will increase fee-for-service rates and establish rate floors for facility-based crisis and mobile crisis management services that will mandate minimum reimbursement rates to aid in contracting between providers and health plans, including Local Management Entitles/Managed Care Organizations (LME-MCOs) and Prepaid Health Plans (PHPs).
Updating the rates and imposing a rate floor on LME-MCOs and PHPs will help to:
- Stabilize the behavioral health crisis system during the transition to NC Medicaid Managed Care; and
- Support behavioral health crisis providers in the contracting process with PHPs.
The following changes will be effective July 1, 2021:
- Fee schedules for procedure code S9484 will be set at $30 per unit;
- Fee schedules for procedure code H2011 will be set at $90 per unit; and
- LME-MCO and PHP contracts will be updated to include the rate floor.
These new rate floors may create additional capacity and opportunities for enhanced performance by behavioral health crisis service providers, especially those serving geographies that allow for higher utilization of staffing resources. In light of the Department’s commitment to sustainable rates for facility-based crisis and mobile crisis management services, the Department encourages health plans and providers to be innovative in effectively meeting the behavioral health crisis response and de-escalation needs of the communities they serve.
No other changes to the behavioral health fee schedule or managed care reimbursement requirements are anticipated for an effective date of July 1, 2021, other than COVID-19 actions. NC Medicaid will continue to evaluate how to support rates for walk-in clinic crisis services.
In partnership with the health plans, the Department remains committed to support and maintain the crisis system through the implementation of Medicaid Managed Care in July 1, 2021 to ensure there are no "wrong doors" for people in crisis. The PHPs continue to build their providers networks in advance of July 1, 2021, inclusive of behavioral health providers. If there are concerns or questions about the contracting process with PHPs, please reach out through the Provider Ombudsman at Medicaid.ProviderOmbudsman@dhhs.nc.gov or through the Provider Ombudsman line at 866-304-7062.
Contact
NCTracks Contact Center: 800-688-6696