Issued: November 25, 2019
Revised Provider Operations Manual
Partners has updated its Provider Operations Manual, located at https://providers.partnersbhm.org/orientation-packet-provider-operations-manual/. This manual outlines the requirements and responsibilities of those in Partners’ Provider Network. All providers should review and be familiar with this manual.
Revised Manual Service Authorization Request Form
Partners has revised the Manual Service Authorization Request form and Instructions for Use. This form can be located on the Partners Provider Website, https://providers.partnersbhm.org/utilization-management/. This form is intended to be used when providers do not have access to the electronic system.
Revised Community Support Team Benefit Limits
Effective November 26, 2019, the benefit limits for Community Support Team (CST) have been revised to reflect the new CST Clinical Coverage Policy (CCP) 8A-6. These benefit limits apply to both State and Medicaid-funded members.
| Service Description |
Benefit Limit |
Level of Care |
Source |
Documentation Requirements |
| Community Support Team:
H2015HT (DJ)
|
Initial: Pass-through of 36 units for 30 days only once per treatment episode, once per fiscal year.
1st Concurrent: Up to 128 units per 60 days.
2nd Concurrent: Up to 192 units per 90 days. |
LOCUS: 2-4
ASAM: 1-2.5 |
8A-6 | Notification SAR is Required for Pass-through on Initial Service Authorization Request (SAR)
1st Concurrent: CCA, PCP, and Comprehensive Crisis Plan. Service Order is also required and is due on or before the first date of service.
2nd Concurrent: Updated PCP. New CCA or CCA Addendum needed if request exceeds 6 months per calendar year. |
Clinical Coverage Policy 8A-6 and Partners Benefit Plan indicate that:
- A pass-through of 36 units for 30 days will be allowed only once per treatment episode, once per fiscal year. A Notification SAR is required for pass-through on initial Service Authorization Request (SAR). No clinical documentation is required for Notification SARs. Providers will need to indicate that they are submitting for the pass-through period within the SAR.
- The CCA/CCA Addendum for CST requests exceeding six months will no longer need to be completed by an independent practitioner. Any licensed clinician on the team may complete the CCA/CCA Addendum (they must sign, credential, and date to validate the document).
- If medically necessary, providers may now submit a SAR for State-funded members beyond six months of service with the appropriate clinical documentation to justify the need for continuation of services.
As providers are selected and contracted for NC Medicaid Community Support Team-Permanent Supportive Housing services, the benefit grid will be updated with the new CST service codes and benefit limits for housing services. Utilization Management will send out an alert with more details at a later date.
If you have any additional questions, please contact the Mental Health/Substance Use (MHSU) UM Workgroup at 704-842-6436.