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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Critical Access Behavioral Health Agencies

DMA Clinical Policy and Programs
Phone Number 919-855-4290
Fax 919-715-9451

The Department of Health and Human Services (DHHS) has approved a new category of provider agency, a Critical Access Behavioral Health Agency (CABHA) for mental health and substance abuse services.

A CABHA must meet all statutory, rule, and policy requirements for Medicaid mental health and substance abuse service provision and monitoring; be determined to be in good standing with the Department; and have a three year (or longer) accreditation from an accrediting body recognized by the Secretary of the Department of Health and Human Services.

State statutory requirements regulating the provision of mental health and substance abuse services are documented in N.C. General Statute, Chapter 122C and clinical policy requirements are specified in Medicaid clinical coverage policies.

Medicaid and enrollment policy require compliance with federal Medicaid policy relating to confidentiality, record retention, fraud and abuse reporting and education, documentation, staff qualifications, and compliance with clinical standards for each service.

Required staff for a CABHA includes a Medical Director, a Clinical Director, and a Quality Management/Training Director.

The goals in developing the CABHA designation are to:

  1. Ensure that critical services are delivered by a clinically competent organization with appropriate medical oversight and the ability to deliver a robust array of services.
  2. Move the public system over time to a more coherent service delivery model that reduces clinical fragmentation at the local level and begins to prepare the provider community for the changes that will be required in a waiver environment.
  3. Ensure that consumer care is based upon a comprehensive clinical assessment and an appropriate array of services for the population to be served. 

Effective December 31, 2010, as approved by CMS, CABHAs will be the only type of provider eligible to provide

  • Community Support Team
  • Intensive In-Home Services
  • Day Treatment

More information on CABHA from DMH/DD/SAS.

CABHA Transitions Workgroup

The CABHA Transitions Workgoup will develop a feasible plan for the transition of consumers receiving the services listed above from Community Intervention Services Agencies to Critical Access Behavioral Health Agencies. More on the CABHA Transitions Workgroup

Frequently Asked Questions

 

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Enrollment

How do I enroll to be a CABHA?
Once you have received your certification letter from the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS) go to NCTracks to download the application. We will inform you when the online application has been made available.

What application do I download and what do I select to enroll as a CABHA?
You will select the Organization In-State/Border Application. On page 2, select Critical Access Behavioral Health Agency (CABHA). On page 4, check the three core services that make up your CABHA agency:

  • Comprehensive Clinical Assessment,
  • Medication Management, and
  • Outpatient Therapy.  

Check your organization’s two Enhanced and/or Residential services that help to create your agency’s continuum from the list provided.  If you will be providing Mental Health/Substance Abuse Targeted Case Management, check that box as well.

What does “attending provider” mean?
The term “attending providers” refers to directly-enrolled individuals (i.e., the doctor providing Medication Management, Outpatient Therapy, etc.), Enhanced Services sites, and Residential Service sites.  Each attending provider (person or service site) should have its own Medicaid Provider Number (MPN).

How do I indicate the services/providers that make up my CABHA organization on the application?
Starting with page 5 of the application, list all the direct-enrolled individuals and the Enhanced and/or Residential services that make up your CABHA organization.  You will list the name of the provider, the Medicaid Provider Number (MPN), and the NPI.  Also, please identify the service(s) that the attending provider will be responsible for (i.e., Medication Management, Outpatient Therapy, etc.).  If you have more than five attending providers, please make copies of this page to accommodate all the attending providers associated with your organization.

Do I have to list my medical and clinical director on the application?  Do I have to list the individuals that make up my Enhanced Service teams (i.e., Community Support Team)?  What about provisionally licensed staff?
Only list individuals who will be providing billable services.  In most cases, that will exclude your medical and clinical director. 

For the Enhanced Services, you only need to list the site-specific service Medicaid Provider Number (MPN) (with alpha suffix). You do not need to list the individuals providing the Enhanced Services.

If your provisionally licensed staff are billing ‘Incident To’ a physician, list the physician’s MPN and NPI.  If they are billing through the local management entity (LME), list the LME’s MPN and NPI. 

I have a lot of providers. Do they all have to be listed, and do they all have to sign the ECS Agreement?
Yes, all of the individual providers and Enhanced and/or Residential services sites must be listed for your claims to adjudicate properly. If they are not listed, this may cause denial in billing for their services or cause your claims to not pay properly.

Yes, all the individual providers have to sign the ECS Agreement to be included as a provider with your CABHA organization. Each Enhanced and Residential services site must also be listed on the Group ECS agreement and the authorized agent must sign in the signature section for each services site.

What Medicaid Provider Number do I use on page 1 where it indicates that if I have previously been enrolled I should enter the Medicaid Provider Number? I have several Medicaid Provider numbers.
This question is designed for re-enrolling a terminated MPN and can be left blank since this is your first time enrolling as a CABHA agency.

Authorizations

Do I use my CABHA Medicaid Provider Number to request authorizations?
No.  Authorizations for Enhanced Services and Residential Child Care Services (Level II-Program Type, III, and IV) are entered to the site-specific MPN listed as the "Facility ID" on the ITR.

Therapeutic Foster Care (Level II-Family Type) authorizations are entered to the local management entity's (LME) MPN. 

Outpatient authorizations are entered to the attending provider MPN on the "Attending Provider" line of the ORF 2.  This attending MPN is the individual that will be providing the outpatient therapy service.  In the case of provisionally licensed professionals, the MPN of the physician (for incident-to) or the LME (for LME billing) would be listed as the attending MPN. 

Once I become a CABHA, do I have to request a new authorization for recipients already receiving services?
No.

For Outpatient Therapy, do I request authorization using my group Medicaid Provider Number?
No.  All Outpatient Therapy authorization requests should be made using the attending MPN.  This attending MPN is the individual that will be providing the outpatient therapy service.  In the case of provisionally-licensed professionals, the MPN of the physician (for incident to) or the local management entity (LME) (for LME billing) will be listed as the attending MPN.

Can more than one Attending Medicaid Provider Number be included on the ORF2 form?
Yes.  If clinically appropriate, up to three MPNs may be included on the Attending Provider line to allow for “reserve” therapists.  These MPNs can be a combination of direct-enrolled MPNs, local management entity (LME) MPNs (for provisionally licensed individuals billing through the LME) or a physician MPN (for provisionally licensed individuals billing “incident to” a physician).

Q: How do I request authorization for Mental Health/Substance Abuse Targeted Case Management?
A: CABHAs may submit a MH/SA TCM Attestation Letter for recipients seen under a Community Support (CS) authorization, if clinically appropriate. They must submit an Attestation Letter for each recipient that will be transferred from CS to MH/SA TCM.  Upon receipt of the Attestation Letter, ValueOptions will end-date the CS authorization under the Community Intervention Services Agency's Medicid Provider Number (MPN) and begin the MH/SA TCM authorization under the new MH/SA TCM MPN. 

To submit MH/SA TCM requests for recipients who are not currently receiving the case management portion of CS services, CABHAs must submit the ITR, PCP, and signed service order.  The CABHA should request prior authorization using the MH/SA TCM MPN on the ITR in the “Facility ID” field.  Authorizations will be made to the MH/SA TCM MPN and not to the CABHA MPN.

Billing

What is my billing NPI?
Upon successful enrollment, CABHAs will be issued one statewide CABHA Medicaid Provider Number (MPN).  Although a CABHA could obtain a subpart NPI for each of their service sites, Medicaid can only have one NPI associated with an MPN.  Therefore, CABHAs will need to identify one NPI to associate with the CABHA MPN and use that NPI when submitting claims.  

CABHAs do NOT need to associate all Enhanced and Residential service sites with this NPI.  Providers may keep the same NPI that is currently associated with all their Enhanced and Residential service sites. All claims for core and enhanced services must be submitted with the NPI associated with the CABHA MPN as the “Billing Provider” and the NPI associated with the direct-enrolled provider or Enhanced Services site as the “Attending Provider” on the professional claim format (CMS-1500/837P).

Claims for Therapeutic Foster Care (Level II-Family Type) must continue to be submitted through the local management entity (LME) for processing.

Claims for Residential Services (Levels II-Program Type, III, and IV) should continue to be billed using the institutional claim (UB-04/837I) format.  In these instances, providers must continue to submit claims with the current billing NPI associated with Level II-Program Type, III, or IV.  If providers submit Residentail claims under the CABHA’s NPI, the claim will be denied.

After enrolling with CSC and receiving my Medicaid Provider Number what are my next steps?
Once you have received your CABHA MPN, you must complete and submit the

What claim format should be used for submission?

  • Claims for core and Enhanced Services should be billed on the professional claim format (CMS-1500/837P). 
  • Claims for Therapeutic Foster Care (Level II-Family Type) must continue to be submitted through the local management entiry (LME). 
  • Claims for Residential Services (Levels II-Program Type, III, and IV) should continue to be billed on the institutional claim (UB-04/837I) format. 

The N.C. Medicaid Program requires all providers to file claims electronically.  There are some situations in which a claim must be submitted on paper. Only claims that comply with the exceptions listed on DMA’s ECS Exceptions web page may be submitted on paper.

What should be entered in the Service Facility Location field?
Submit the zip code for the service facility location associated with the attending provider where the service was rendered. 

How can I reconcile payments efficiently using the Remittance and Status Report?
To determine the site where the service was performed, you can include site identifying information within the Patient Account Number you submit on the claim. If billing on the 837P, the Patient Account Number is located within Loop 2300 Segment CLM01.  If billing on the NCECSWeb Tool, this information is entered in the field titled Patient Account Number.  The Patient Account Number cannot exceed 20 characters.

Contact Information

Who should I contact if I have additional question?

  • For enrollment, contact CSC at 1-800-688-6696 and ask to speak to a representative about CABHA enrollment.
  • For authorizations:
Contractor Services Contact Information
Crossroads Behavioral Healthcare Prior Authorization of CAP/MR-DD Services for Buncombe, Davie, Forsyth, Henderson, Iredell, Madison, Mitchell, Polk, Rockingham, Rutherford, Stokes, Surry, Transylvania, Yadkin, and Yancey counties
Durham Center Prior Authorization of Behavioral Health Services for Durham County
Durham Center Prior Authorization of CAP/MR-DD Services for Alamance, Anson, Caswell, Chatham, Durham, Franklin, Granville, Guilford, Halifax, Harnett, Hoke, Lee, Montgomery, Moore, Orange, Person, Randolph, Richmond, Vance, Wake, and Warren counties
Eastpointe LME Prior Authorization of Behavioral Health Services for Duplin, Lenoir, Sampson, and Wayne counties
Eastpointe LME Prior Authorization of CAP/MR-DD Services for Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Cumberland, Currituck, Dare, Duplin, Edgecombe, Gates, Greene, Hertford, Hyde, Johnston, Jones, Lenoir, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Robeson, Sampson, Scotland, Tyrrell, Washington, Wayne, and Wilson counties
Partners Behavioral Health Management LME Prior Authorization of CAP/MR-DD Services for Alexander, Alleghany, Ashe, Avery, Burke, Caldwell, Catawba, Cherokee, Clay, Cleveland, Gaston, Graham, Haywood, Jackson, Lincoln, Macon, McDowell, Mecklenburg, Swain, Watauga, and Wilkes counties
ValueOptions Prior Authorization of Behavioral Health Services (for all counties except Durham, Duplin, Lenoir, Sampson, and Wayne)
  • 1-888-510-1150
  • Fax Numbers
    • For Mental Health/Substance Abuse Services, 1-877-339-8753
    • For Intellectual and Developmental Disability Services, 1-877-339-8754
    • For Inpatient Services and Psychiatric Residentail Treatment Facility Services, 1-877-339-8760
    • For N.C. Health Choice, 1-877-339-8758
  • ValueOptions Website External link

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

Behavioral Health Services Forms

To see forms that apply to all providers, please visit our Provider Forms page.