This article applies to NC Medicaid Direct and NC Medicaid Managed Care. The following Medicaid clinical coverage policies (CCP) were scheduled to promulgate on May 1, 2024, but have been delayed allowing health plans and service providers to align with coverage requirements and applicable licensure rule waivers issued by the NC Division of Health Service Regulation.
- CCP 8A- 7, Ambulatory Withdrawal Management (WM)Without Extended On-Site Monitoring (ambulatory detox), 1-WM
- CCP 8A -8, Ambulatory Withdrawal Management with Extended On-Site Monitoring, 2-WM
- CCP 8A-10, Clinically Managed Residential Withdrawal Management (Social setting Detox), 3.2-WM
- CCP 8A-11, Medically Monitored Inpatient Withdrawal Management (non-hospital medical detox), 3.7-WM
- CCP 8A-12, Substance Abuse Intensive Outpatient Program (SAIOP) CP 8A-13, Substance Abuse Comprehensive Outpatient Treatment (SACOT)
- CCP 8A-13, Substance Abuse Comprehensive Outpatient Treatment (SACOT)
Health Plans and service providers shall provide the following services as outlined in the NC Medicaid State Plan Amendments.
- CCP 8A -8, Ambulatory Withdrawal Management with Extended On-Site Monitoring, 2-WM
- CCP 8A-10, Clinically Managed Residential Withdrawal Management (Social setting Detox), 3.2-WM
Coverage for the following services will continue as outlined in Clinical Coverage Policy 8A – Enhanced Mental Health and Substance Abuse Services and billing guide. Standard Plans will continue to align policies for these services to CCP 8A to ensure that their policies for these services are no more restrictive in amount, duration, and scope than CCP 8A.
- Ambulatory withdrawal management without extended on-site monitoring (ambulatory detox), 1-WM
- Medically monitored inpatient withdrawal management (non-hospital medical detox), 3.7-WM
- Substance Abuse Intensive Outpatient Program (SAIOP) CP 8A-13, Substance Abuse Comprehensive Outpatient Treatment (SACOT)
- Substance Abuse Comprehensive Outpatient Treatment (SACOT)
NC Medicaid will continue to collaborate with the health plans, service providers and stakeholders to align Medicaid clinical coverage polices with the American Society of Addiction Medicine (ASAM) Criteria, Third Edition, 2013.
Contact
Provider Ombudsman: 866-304-7062 or Medicaid.ProviderOmbudsman@dhhs.nc.gov