This bulletin provides additional clarification to Clinical Coverage Policy (CCP) 8C: Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers, to Standard Plans, LME-MCOs, and direct enrolled providers about the Nurse Practitioner (NP) credentialing requirements located in Section 6.1, when working in a substance use disorder treatment setting.
The following requirements are applicable only to NPs providing services to beneficiaries diagnosed with a primary substance use disorder that are not certified as a Psychiatric Mental Health Nurse Practitioner (PMHNP):
Nurse Practitioners not certified as PMHNP may be eligible to provide substance use disorder treatment services to Medicaid beneficiaries diagnosed with a substance use disorder if they meet all the requirements listed below, as demonstrated to the credentialing body of the Standard Plan or Prepaid Inpatient Health Plan (PIHP):
a. A Collaborative Practice Agreement with a North Carolina Licensed Physician with experience working in the field of substance use disorders, that covers prescribing activities; and
b. Have their DATA 2000 certification; and
c. At least one (1) year experience providing substance use disorder treatment in any setting; and
d. Continuing education requirements, going forward, which include 20 hours each year focused on addiction medicine, diagnosis, medication assisted treatment, and psychopharmacology relevant to their current field of practice. (21 NCAC 36.0807.)
This clarification is to ensure that NPs are entering into Collaborative Practice Agreements with physicians that have training and experience with the beneficiary group, and ensure NPs are receiving supervision, collaboration and consultation that supports their practice.
Waiver of the requirement for one year of supervised substance use disorder experience for an NP not yet certified as a PMHNP must be based on access needs of the Standard Plan or PIHP, documented in the records of the credentialing body, approved by the Standard Plan or PIHP Medical Director, and reassessed on an annual basis. Other details in items a., b., and d. shall not be waived.
NC Medicaid, in partnership with the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS) will begin revisions to CCP 8C in 2021, with an anticipated go-live date of July 1, 2022. The revisions will include the above in the new, revised policy.
Contact
NC Medicaid Contact Center 888-245-0179