Issued: March 31, 2023

What is happening:

The Centers for Medicare & Medicaid Services (CMS) has approved an amendment to the NC Innovations Waiver to add additional waiver slots to transition the 1915 (b)(3) Deinstitutionalization services (NC Innovations-look alike services) into the NC Innovations Waiver effective April 1, 2023.

How is this impacting members?

  • Members currently authorized and receiving 1915 (b)(3) Deinstitutionalization services, also known as (b)(3)DI, will transition to NC Innovations Waiver services effective April 1, 2023.
  • Members will continue to receive their currently authorized services. There will be no disruption in service.
  • Tailored Care Managers will update Individual Supports Plans (ISPs) to reflect the transition to NC Innovations Waiver Services at the member’s next annual planning meeting.

How is this impacting Providers?

  • Utilization management (UM) will transition current (b)(3) DI authorizations to Innovations with an April 1 start date with prorated units through the end of the member’s plan year. No additional documentation is needed from the provider or member at this time.
  • Providers will begin submitting service claims using the NC Innovations Waiver Service Codes for services provided on April 1. You can access the service code crosswalk here.
  • Some cases may require a point in time eligibility review for Innovations criteria. The state will let Partners and the provider know if either’s involvement is required.

Who should I contact with questions?