This article applies to NC Medicaid Direct and NC Medicaid Managed Care.
Revised Mental Health and Substance Use Disorder Policies Promulgate
NC Medicaid has revised its mental health and substance use disorder clinical coverage policies (CCP) to comply with the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Code of Federal Regulations Title 42 Chapter IV Subchapter C Part 438 Subpart K, § 438.900.
The revisions include the removal of:
- Utilization management language
- Units, hours, days and visit limits [quantitative treatment limitations (QTLs)
- Prior authorization, concurrent review and reauthorization requirements [non-quantitative treatment limitations (NQTLs)].
Service specific revisions are documented in Section 8.0 - Policy Implementation and History for each CCP. The following revised CCPs were promulgated on Dec. 20, 2024, with an effective date of Jan. 1, 2025, and can be accessed on the NC Medicaid Program Specific Clinical Coverage Policies web page.
- 8A Enhanced Mental Health and Substance Abuse Services
- Mobile Crisis Management Services
- Intensive In-Home Services
- Multisystemic Therapy (MST)
- Psychosocial Rehabilitation
- Child and Adolescent Day Treatment (removal of QTLS only)
- Partial Hospitalization
- Professional Treatment Services in Facility-Based Crisis Program
- Substance Abuse Intensive Outpatient Program (SAIOP)
- Substance Abuse Comprehensive Outpatient Program (SACOT)
- Substance Abuse Non-Medical Community Residential Treatment
- Substance Abuse Medically Monitored Community Residential Treatment
- 8A-1 Assertive Community Treatment (ACT) Program
- 8A-2, Facility-Based Crisis Service for Children and Adolescents
- 8A-5, Diagnostic Assessment
- 8A-6, Community Support Team (CST)
- 8A-7, Ambulatory Withdrawal Management (WM) without Extended On-Site Monitoring
- 8A-8, Ambulatory Withdrawal Management with Extended On-Site Monitoring
- 8A-9, Opioid Treatment Program Service
- 8A-11, Medically Monitored Inpatient Withdrawal Management Service
- 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers
- 8D-1, Psychiatric Residential Treatment Facilities (removal of QTLs only)
- 8D-2, Residential Treatment Services (removal of QTLs only)
- 8G, Peer Support Services
- 8H-2, 1915(i) Individual Placement & Support (IPS) for Mental Health & Substance Use
- 8H-3, 1915(i) Individual and Transitional Support (ITS)
- 8I, Psychological Services in Health Departments and School-Based Health Centers Sponsored by Health Departments to the under-21 Population
- 8J, Children's Developmental Service Agencies (CDSAs)
- 8L, Mental Health/Substance Abuse Targeted Case Management
Termination of the Medically Supervised or Alcohol and Drug Abuse Treatment Centers Detoxification Crisis Stabilization
As outlined in the Substance Use Disorder Demonstration Implementation Plan approved April 25, 2019, by the Centers for Medicare & Medicaid Services (CMS), the Medically Supervised or Alcohol and Drug Abuse Treatment Centers (ADATC) Detoxification Crisis Stabilization service has been terminated.
This change follows the implementation of Medically Managed Intensive Inpatient Withdrawal Management (WM)(ASAM Level 4-WM), now incorporated into CCP 8B, Inpatient Behavioral Health Services. This service was removed from CCP 8A, Enhanced Mental Health and Substance Abuse Services and the Medicaid State Plan, effective Jan. 1, 2025.
Opioid Treatment Program Place of Service Update
CCP 8A-9, Opioid Treatment Program (OTP) service has been revised to include medication and mobile units as an approved place of service. This update aligns with Session Law 2023-65 (House Bill 190), PART X. ALLOW OPIOID TREATMENT PROGRAM MEDICATION UNITS AND MOBILE UNITS.
An OTP facility, associated medication unit and mobile unit must be licensed by the NC Division of Health Service Regulation (DHSR) Mental Health Licensure and Certification Section under 10A NCAC 27G .3600 Outpatient Opioid Treatment emergency rules. The CCP was promulgated on Dec. 20, 2024, with an effective date of Jan. 1, 2025.
The full revised policies can be accessed on the NC Medicaid Program Specific Clinical Coverage Policies web page.
Contact
Phone: Provider Ombudsman: 866-304-7062
Email: Medicaid.ProviderOmbudsman@dhhs.nc.gov