Issued: October 27, 2022
What is happening?
North Carolina’s six Local Management Entities/Managed Care Organizations (LME/MCOs) launched the NC Child and Family Improvement Initiative on May 1, 2022, to improve care for children, youth and families served by the child welfare system. The LME/MCOs are working together to create a statewide system that ensures seamless access to quality care for youth in foster care, regardless of where they live in North Carolina.
One of the NC Child and Family Improvement Initiative’s primary goals is to enhance statewide capacity for child behavioral health services. The LME/MCOs understand that increasing provider reimbursement rates will support this goal and improve the ability of providers to deliver the necessary treatment and supports to serve youth with very complex needs.
All the LME/MCOs are making a significant investment to pay above the current minimum rate established by NCDHHS for several types of child residential services (including Levels I-IV group or family settings) by Nov. 1, 2022.
Please note that Partners increased reimbursement rates for behavioral health Long-Term Residential Services (LTRS) on Oct. 1, 2022 and will increase these rates again on Nov. 1, 2022.
When will the change take effect?
The majority of the rates providers receive for child residential services will increase on Nov. 1, 2022.
Partners increased reimbursement rates for behavioral health Long-Term Residential Services (LTRS) on Oct. 1, 2022 and will increase these rates again on Nov. 1, 2022.
Claims that have already been submitted for October 2022 dates of service with the pre-October rates will need to be submitted as replacement claims to receive the higher rates.
How does the change affect providers?
| Service | HCPCS | Pre-PHE Base Rate* | Current PHE Rate 10/1/2022 | Rate as of 11/1/2022 |
| HRI Residential Level I | H0046 | $ 77.55 | $ 77.55 | $ 86.25 |
| HRI Residential Level II – Group Setting | H2020 | $ 140.13 | $ 146.45 | $ 146.45 |
| HRI Residential Level II – Family Setting | S5145 | $ 97.22 | $ 101.65 | $ 175.00 |
| HRI Residential Level III – 4 Beds or Less | H0019 HQ | $ 253.62 | $ 265.26 | $ 267.81 |
| HRI Residential Level III – 4 Beds or More | H0019 TJ | $ 210.49 | $ 219.98 | $ 219.98 |
| HRI Residential Level IV – 4 Beds or More | H0019 UR | $ 341.63 | $ 357.42 | $ 357.42 |
Who should providers contact with questions?
If you have questions, please contact, please contact claimsdepartment@partnersbhm.org
What is the NC Child and Family Improvement Initiative?
North Carolina’s six LME/MCOs launched the NC Child and Family Improvement Initiative on May 1, 2022, to create a statewide solution to the current pressing challenges of the service delivery system for children and youth in foster care. The goal of the Initiative is to implement a statewide model to ensure seamless access to quality care for youth and families served by the child welfare system regardless of where they live in North Carolina.
To learn more about the NC Child and Family Improvement Initiative, click here.