North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services
Providers of MH/DD/SA Services
Service Definitions
Division of Medical Assistance Clinical Coverage Policy No:8A Enhanced Mental Health and Substance Abuse Services (Revised date: February 1,2008; Effective March 1,2008)
2007 Community Support Post Payment Review Instruments
Proposed Medicaid Clinical Coverage Policies (9/1/2006)
Final
Approved
Medicaid Enhanced Benefit Service Definitions
(updated 3/27/06)
CAP-MR/DD Manual (1-18-06)
Service Definition Benefit Package
(11-30-04)
MH/DD/SA Service Definitions
(1-1-03, revised 1/15/03)
New service definitions have been approved, and are effective on March 20, 2006. These service definitions will be integrated with the current Service Definition Manual that became effective January 2003.
***
Proposed Medicaid MH/DD/SA Service Rates
Service Definitions describe the services that providers can be paid for in the state's public system of mh/dd/sa services. The definitions include descriptions of:
- Required components
- Provider requirements
- Staffing requirements, including experience, training, education
- Service types/settings
- Program requirements
- Utilization management
- Entrance criteria
- Continued stay criteria
- Discharge criteria
- Expected outcomes
- Service exclusions
However,
even
when
the
service
definitions
are
approved,
not
all
of
the
changes
will
go
into
effect
at
once.
The
Division
will
notify
everyone
as
timetables
for
change
are
set.
Not all service definitions are new or being changed. Some are new, some are staying the same, some are being revised and some are being eliminated.
Overall,
though,
it
is
important
for
providers
to
know
that
many
services
are
being
bundled
together
into
service
definitions.
This
means
that
anyone
wanting
to
bill
for
providing
a
service
definition
has
to
be
able
to
provide
all
the
services
in
that
definition
or
bundle.
Individual
professionals
or
paraprofessionals
will
need
to
work
for
or
with
an
agency
that
can
provide
all
the
services
described
in
a
service
definition.
Questions and Answers
(most recent documents are posted first)
Please see new questions and answers that were added to this Implementation Issues and Answers document on 7/13/07. Please see new questions and answers that were added to this
Implementation Issues and Answers document on 6/28/07, 7/13/07, & 7/16/07. The new
questions and answers are categorized and numbered as follows:
- CAP-MR/DD (#61)
- Child/Adolescent Day Treatment (#83-84)
- Community Support (#106 - 112)
- Intensive In-Home (#189 - 194)
- Medicare (#204)
Please note that the information in "Implementation Issues and Answers" supersedes any previous answers.
Residential Services Questions and Answers 8/16/06
Questions
Received
Through
E-mail: 4/3/06 |
(3/15/06)
Recent
DMA
and
DMH/DD/SAS
Service
Definitions
Training
Questions
and
Answers
(updated
3/28/06)
Questions
and
Answers
(updated
3/13/06)
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