Service Definitions

Service Definitions describe the services that providers can be paid for in the state's public system of Division of Mental health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS).

State-Funded Enhanced Mental Health and Substance Abuse Services 2014 effective 8/1/14

The revised State-Funded Enhanced MH/SA Services document contains technical revisions based on DSM-5, ASAM, NC TRACKS and Benefit Plan language changes. Technical revisions include the following: 

  • DSM-IV to DSM-5 including “or any subsequent editions of this reference material” to be inclusive of future changes (e.g. all entrance criteria changed as there are no axes in DSM-5)
  • ASAM PPC-2-R to The ASAM Criteria language (e.g. ASAM changed from Roman numeral to numerical, some titles changes for the different levels of care e.g. detoxification to withdrawal management)
  • IPRS to NC TRACKS language
  • Target population to Benefit Plan language
  • Revised “substance abuse” language to better reflect DSM-5 language when possible.  Changed substance abuse to substance use when it pertained to a disorder, diagnosis, symptom, condition, intervention, treatment, etc.  The substance abuse language stayed in place if it pertained to a provider, professional, service, etc. due to licensure rules, general statutes, DMA SPA, etc.
  • Some format changes

State-Funded MH/DD/SAS Service Definitions 2003-2014 effective 8/1/14

The 2003 MH/DD/SA Service Definitions package has been revised based on DSM-5, ASAM, NC TRACKS and APSM language and other technical changes.

Technical revisions to the document include the following:

  • DSM-IV to DSM-5 including "or any subsequent editions of this reference material" to be inclusive of future changes.
  • ASAM PPC-2-R to The ASAM Criteria language (e.g. ASAM changed from Roman numeral to numerical)
  • IPRS and Pioneer to NC TRACKS language.
  • Revised "substance abuse" language to better reflect DSM-5 language when possible. Changed substance abuse to substance use when it pertained to a disorder, diagnosis, symptom, condition, intervention, treatment, etc. The substance abuse language stayed in place if it pertained to a provider, professional, service, etc. due to licensure rules, general statutes, DMA SPA, etc.
  • Updated developmental disabilities language to IDD as appropriate.
  • Included the Supports Intensity Scale under Medical Necessity as appropriate.
  • Eliminated service definitions that have been end dated (e.g. assertive outreach, case support, case management, etc.) See Quick Reference Guide, Appendix A for more details.
  • Eliminated service definitions when the definition utilized for billing purposes are found in other service definition or policy documents (e.g. SAIOP is in the State-Funded Enhanced MH/SA Service Definition package and child residential services are in DMA Clinical Coverage Policy 8-D-2)See Quick Reference Guide, Appendix A for more details.
  • The only clinically revised service definition in the package was Outpatient Services. DMH/DD/SAS currently follows the Division of Medical Assistance's 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers for outpatient services provided by licensed (CPT codes) or associate level professionals (for H-Codes) with the exception of the "Incident to" criteria. However, DMH/DD/SAS also has a set of YP codes specifically for "Designated Non-Licensed Substance Abuse Counseling Professionals". As a result, the Outpatient Services (SA YP Codes) definition in this package is now specifically for the SA-specific YP codes.

    Additionally, a Quick Reference Guide: Revisions to 2003 State Service Definitions Package is included at the end of the document in Addendum A. This guide serves as a reference tool to determine which services are still in the package, services that are no longer in the package and where they can be found and services that were eliminated due to end dating.

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