State Funded Service Definitions

The State-Funded Comprehensive Case Management Service clinical policy has an effective date of January 1, 2025. This new service is for adults with: a primary mental health (MH) or primary substance use (SU) disorder, or co-occurring MH or SU disorder and IDD or TBI diagnosis, or other designated eligibility criteria as outlined in the policy that would benefit from time-limited case management assistance to access necessary behavioral health, physical health, health-related, and social services.

The State-Funded Community Engagement Options (NCSWTCIE/SPARK Pilot) service definition and State-Funded Job Retention Services (NCSWTCIE/SPARK Pilot) have been posted. Community Engagement Options is a range of community-based and comprehensive services that enable a recipient 18 years of age and older with a developmental disability as defined in G.S. 122-C-3(12a) who is enrolled in Adult Developmental Vocational Program (ADVP), Sheltered Workshop settings or considering enrollment to an ADVP or Sheltered Workshop settings earning sub-minimum wage to achieve competitive integrated employment (CIE). Job Retention is an individualized wraparound support service that enables a recipient 18 years of age and older with a developmental disability as defined in G.S. 122-C-3(12a) who is enrolled in Adult Developmental Vocational Program (ADVP), Sheltered Workshop settings or considering enrollment to an ADVP or Sheltered Workshop settings earning sub-minimum wage to achieve competitive integrated employment (CIE). Recipients must be enrolled in the NC Subminimum Wage to Competitive Integrated Employment/Strength, Positivity, Access, Respect and Knowledge (NCSWTCIE/SPARK) Pilot.

The State-Funded Supported Employment Service Definition has been amended to change required training requirements to recommended training requirements.

The following new and revised withdrawal management (WM) standalone service definition policies with an effective date of 10/1/24 have been posted: State-Funded Ambulatory WM Without Extended On-site Monitoring Service (formerly State-Funded Ambulatory Detoxification), State-Funded Ambulatory WM With Extended On-site Monitoring Service (New Service) and State-Funded Medically Monitored Inpatient Withdrawal Management Service (formerly State-Funded Non-Hospital Medical Detoxification). The 2024 State-Funded Enhanced Mental Health and Substance Use Services- Effective 10/1/24 document was amended to remove the following services and all related references to these policies: State-Funded Ambulatory Detoxification and State-Funded Non-Hospital Medical Detoxification. Please see Section 8.0 page 17 for additional information.

The implementation of the following state funded services has been postponed to allow the LME/MCOs and service providers the opportunity to align with new and amended policies and applicable licensure rule waivers: State-Funded Enhanced Mental Health & Substance Use Services 2024 (5/1/24 version), State-Funded Ambulatory Withdrawal Management without Extended Onsite Monitoring Services (Ambulatory Detoxification), State-Funded Ambulatory Withdrawal Management with Extended Onsite Monitoring Services, State-Funded Clinically Managed Residential Withdrawal Management Services (Social Setting Detoxification), State-Funded Medically Monitored Inpatient Withdrawal Management Services (Non-Hospital Medical Detoxification), State-Funded Substance Abuse Intensive Outpatient Program (SAIOP) and State-Funded Substance Abuse Comprehensive Outpatient Treatment (SACOT). Each of the existing state-funded services listed will continue to be available, with the exception of the State-Funded Ambulatory Withdrawal Management with Extended Onsite Monitoring Service, which is a new service. These service definitions can be found in the State-Funded Enhanced Mental Health & Substance Use Services 2024 3/01/24 document.

The following standalone service definition policies have been posted with an effective date of 5/1/24: State-Funded Substance Abuse Intensive Outpatient Program (SAIOP) and State-Funded Substance Abuse Comprehensive Outpatient Treatment (SACOT). The 2024 State-Funded Enhanced Mental Health and Substance Use Services-Effective Date: 5/1/24 has been amended to remove State-funded SAIOP and State-Funded SACOT and all related references to these policies.

The amended 2024 Enhanced Mental Health and Substance Use Services-with an effective date of March 1, 2024 has been posted. This document includes amendments to the utilization management section of the State-Funded Professional Treatment Services in Facility-Based Crisis program policy.

The 2023 Enhanced Mental Health and Substance Use Services-10/15/23 document has been re-posted and includes the following services and all related references to these policies: Ambulatory Detoxification, Social Setting Detoxification, and Non-Hospital Medical Detoxification. These services will remain effective until 4/30/24. The following standalone service definition policies have been re-posted with an effective date of 5/1/24: State-Funded Ambulatory WM Without Extended Onsite Monitoring Service, State-Funded Ambulatory WM With Extended Onsite Monitoring Service, State-Funded Clinically Managed Residential Withdrawal Management Service and State-Funded Medically Monitored Inpatient Withdrawal Management Service. The 2024 State-Funded Enhanced Mental Health and Substance Use Services has been amended to remove the following services and all related references to these policies with an effective date of 5/1/24: Ambulatory Detoxification, Social Setting Detoxification, and Non-Hospital Medical Detoxification.

The following standalone service definition policies have been posted: State-Funded Ambulatory WM Without Extended Onsite Monitoring Service, State-Funded Ambulatory WM With Extended Onsite Monitoring Service, State-Funded Clinically Managed Residential Withdrawal Management Service and State-Funded Medically Monitored Inpatient Withdrawal Management Service. The 2024 State-Funded Enhanced Mental Health and Substance Use Services has been amended to remove the following services and all related references to these policies: Ambulatory Detoxification, Social Setting Detoxification, and Non-Hospital Medical Detoxification.

The State-Funded Individual Placement and Support standalone service definition has been amended to align closely with the new Medicaid IPS clinical coverage policy under the 1915(i) authority. A summary of the changes can be found under Section 8.0 Policy Implementation (Page 16).

The State-Funded Opioid Treatment Program Service standalone service definition policy has been posted. Additionally, the 2023 State-Funded Enhanced Mental Health and Substance Use Services document has been amended to remove the Outpatient Opioid Treatment service definition and all related references to the policy. This document was also updated to change substance “abuse” to “use”, where possible, in accordance with legislative changes. Please note: There are still instances where “abuse” has not been changed, in rule or otherwise, that require it to remain at this time.

The State-Funded Mental Health and Substance Abuse Services 2023 document was revised effective September 15, 2023 to include technical changes to the following: 1) Intensive In Home, 2) Psychosocial Rehabilitation, 3) Child and Adolescent Day Treatment and 4) Partial Hospitalization. A summary of the technical changes can be found under Section 8.0 Policy Implementation (Page 17).

As a part of NC’s 1115 SUD Waiver implementation, the State-Funded Inpatient Behavioral Health Services have been amended to align with The American Society of Addiction Medicine (ASAM) Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (Third Edition, 2013). Policy amendment includes: addition of an attachment for The ASAM Level 4, Medically Managed Intensive Inpatient Services and revision of the attachment for The ASAM Level 4-WM, Medically Managed Intensive Inpatient Withdrawal Management Services. Please Section 8 of the policy for additional changes.

On Feb. 15, 2023, NC Medicaid and DMH/DD/SUS issued a bulletin that outlined new requirements for Mobile Crisis Management for both Medicaid Clinical Coverage Policy 8A and State Funded Policy to be effective Feb. 15, 2023.

Due to workforce shortages, we are delaying the implementation of these new requirements. The previous policies have been posted to our clinical coverage/service definition pages and the previous requirements will continue effective Feb. 15, 2023, while we develop a path forward.

The State-Funded Diagnostic Assessment service definition clinical policy has been revised to include the following: 1) technical, non-substantive language changes, 2) to add Federally recognized tribal or Indian Health Service provider language, and 3) to add ASAM level of care requirement for diagnostic assessment, ASAM training clarification with required learning objectives and minimum training hours.

The State-Funded Enhanced Mental Health and Substance Use Services document was revised to include the following: 1) technical, non-substantive language changes throughout the policy and 2) substantive policy changes to the Mobile Crisis Management service definition clinical policy (see Section 8 pages 17-18 for a list of amendments).

The State-Funded Peer Support Services policy was revised to remove the following from Section 3.2.1 Letter b.: “the Level of Care criteria for Locus Level 1”.

The State-Funded Enhanced MH/SU Services 2022 document revision deleted the following from Section 8: Attachment D, Medically Supervised or ADATC Detoxification Crisis Stabilization Deleted “30” and replaced with “45” in the Service Exclusions section.

The State-Funded Facility-Based Crisis- Child service definition clinical policy was amended as follows: Subsection 5.3 a.: Added “or Licensed Practical Nurse under the supervision of a registered nurse” and Subsection 6.2 c. & b.1.: Removed “on-site”.

The State-Funded Enhanced Mental Health and Substance Use Services 2022 document has several amendments, including but not limited to, the following: adding a Telehealth Services section (Section 3.1.1); updating the State-Funded Service Summary chart; replacing “face-to-face” with “in-person” language throughout the document; adding language regarding licensed and certified professionals in compliance with NCGA Session Law 2019-240 Senate Bill 537; revising length of stay in several service definition policies; and revising the Outpatient Opioid Treatment Payment Unit Section. Please see Section 8 Policy Implementation for a detailed list of amendments.

The State-Funded Enhanced Mental Health and Substance Use Services 2021 was amended to remove Diagnostic Assessment which is now a stand alone service definition policy, remove limit on billable units in a 24-hour period in MST and provide a clarification in the Outpatient Opioid treatment service definition policy. The State-Funded FBC-Child service definition policy was amended to include telehealth language, increase number of days the service can be provided in a 12-month period and amend supervision requirements. Additionally, the new standalone State-Funded Diagnostic Assessment service definition policy was published including telehealth clarification and ASAM language.

Published the State-Funded Telehealth and Virtual Communications Services policy intended to provide definitions and overarching guidance related to the delivery of services via telehealth and virtual communications that are not otherwise included in a state-funded service definition specific policy. Also, posted amended State-Funded Peer Support Service which includes updated telehealth and telephonic language.

All state-funded services were amended to include a statement that the Division of MH/DD/SUS will not reimburse for conversion therapy per Executive Order # 97. Additionally, a statement providing guidance to providers utilizing Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5) manual was added to the State-Funded DMHDDSUS Service Definitions 2003-2019 document, State-Funded Inpatient Behavioral Health & State-Funded Developmental Therapy service definitions.

The State-Funded Enhanced MH/SU Services 2019 document, State-Funded ACT Service, State-Funded Facility-Based Crisis-Child and State-Funded Community Support Team were amended to include a statement that the Division of MH/DD/SUS will not reimburse for conversion therapy per Executive Order # 97. Additionally, a statement providing guidance to providers utilizing the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0–5) manual was added to the State-Funded Enhanced MH/SU Services 2019 document and State-Funded Facility-Based Crisis-Child service definition.

The State-Funded Enhanced MH/SU Services 2019 document revision removed the Community Support Team (CST) service definition from the document. Community Support Team is now a standalone service definition.