Psychological Testing

The following services have been added to the Partners’ service array for Psychological Testing/Assessment. Service code 96105 is available to adults and children with either Medicaid or State funding. Service code 96127 is available to adults and children with Medicaid funding only. Please reference the Psychological Testing section of the Benefit Grid (https://providers.partnersbhm.org/benefit-grids/) for applicable benefit limits.

  • 96105 – Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour.
  • 96127 – Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument.

Electronic Visit Verification Implementation Extended

NC Medicaid’s implementation of Electronic Visit Verification (EVV) for the Innovations Waiver, TBI Waiver and (b)(3) services administered by the LME/MCOs has been moved to Aug. 31, 2021. This new date is to allow for additional provider integration and engagement with HHAeXchange. Effective Aug. 31, 2021, 100% of provider claims must pass EVV validation to be reimbursed.

Providers must continue to collaborate, test and operationalize the EVV process with applicable LME/MCOs and their EVV vendor. Providers shall submit claims with EVV data prior to the Aug. 31, 2021 date as they are ready to do so. Providers who cannot demonstrate their engagement with an EVV vendor by Aug. 31, 2021, will not be reimbursed for EVV applicable services after Aug. 31, 2021, until they come into compliance.

If you have questions, please contact Medicaid.EVV@dhhs.nc.gov.

View the NC Medicaid announcement.

State-Funded Day Supports

LME-MCO Joint Communication Bulletin #J396,released on June 18, 2021, outlines several changes to the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS) Day Supports State-funded service definition effective July 1, 2021.

Effective July 1, 2021:

  • Individuals new to the Day Supports service should enroll in Day Supports (Group) and utilize the new NCTracks procedure code (YM590) effective July 1, 2021. Day Supports (YM580) will be closed to new admissions.
  • Individuals currently enrolled in Day Supports should transition to Day Supports (Group) or another service by Jan. 31, 2022. Upon transitioning to the new service, the expectation is to utilize the new NCTracks procedure code (YM590). The current NCTracks procedure code (YM580) will expire effective Feb. 1, 2022.

Effective July 1, 2021 State Funded Day Supports (Group YM590) service requirements are as follows:

  • Day Supports is a group service that provides assistance to individuals 16 years of age and older with acquisition, retention, or improvement in socialization and daily living skills and is one option for a meaningful day activity.
  • Group services are provided as outlined within the Person-Centered Plan (PCP) or Individual Support Plan (ISP) are able to be fully addressed.
  • Maximum group service ratio: Paraprofessional to Individual ratio is 1:4 as long as services outlined within the PCP or ISP are able to be fully addressed.
  • The service is often provided in a licensed Day Supports provider facility or by an Adult Day Health provider that serves individuals with Intellectual and Developmental Disabilities (I/DD) or Traumatic Brain Injury (TBI); however, this service may be delivered in the community as well.
  • The service requires a NC Support Needs Assessment Profile (NC-SNAP) score at Level 2 or higher, a Supports Intensity Scale (SIS) rating at Level C or higher, or a TBI Assessment requiring a moderate to high level of supervision and support in most settings.
  • A psychological, neuropsychological, or psychiatric evaluation supported by appropriate psychological/neuropsychological testing that denotes an I/DD diagnosis as defined by G.S. 122C-3(12a) must be completed by a qualified licensed professional prior to the provision of this service. For individuals with a TBI, a clinical exam completed by a qualified licensed professional is required noting a TBI diagnosis as defined by G.S. 122C-3(38a).
    • This requirement will apply to members who are NEW to state-funded Day Supports or has had an authorization lapse for 30 days or more. Members currently authorized for YM580 who submit a Service Authorization Request to transfer to YM590 without a gap in services will not need to have functional eligibility re-determined for I/DD state funded services.
    • An update/addendum to the psychological evaluation completed by the appropriate qualified licensed professional can be used to attest to (as appropriate): continuation of prior testing, if the disability manifested prior to age 18 or 22 and/or if the disability is likely to continue indefinitely.
  • Service authorization must be completed by a Qualified Professional prior to the day services are provided.
  • A service order must be signed by a qualified professional, physician, licensed psychologist, physician assistant, or nurse practitioner, consistent with their scope of practice prior to or on the first day Day Supports (I/DD and TBI) services are rendered.
  • Individuals participating in the following programs are not eligible for Day Supports services: Home & Community Based Services (HCBS) waiver members/beneficiaries, individuals receiving I/DD or TBI-related (b)(3) day services or individuals receiving Medicaid In Lieu Of Services (ILOS) which include a meaningful day component.
  • The service may not exceed three hours per day on school days for individuals 16-22 years of age who have not graduated from high school.
  • The service may not exceed 30 hours a week.
  • Transportation to/from the individual’s home, the Day Supports facility and points of travel in the community as outlined in the PCP or ISP is included to the degree that such travel is not reimbursed by another funding source and not for personal use. Transportation to and from the licensed day program is the responsibility of the DS provider.

If you have questions, please contact I/DD Utilization Management at 704-884-2605.

State-Funded Community Living and Support

LME-MCO Joint Communication Bulletin #J391, released March 29, 2021, outlines State-funded Community Living and Support service implementation requirements. Effective July 1, 2021, providers will be able to add this service to their contract as their contracted state funds allow.  No additional state funds will be added to provider contacts for this service. The procedure codes are:

  • YM851 – Community Living & Support (I/DD & TBI) Individual
  • YM852 – Community Living & Support (I/DD & TBI) Group

Community Living and Supports (CLS) service requirements are as follows:

  • CLS is an individualized service that enables individuals aged 16 years and older to live successfully in their own home or the home of their family or natural supports and be an active member of the community.
  • This service supports individuals learning, practicing and improving existing skills related to the following: interpersonal skills, independent living, community living, self-care and self-determination.
  • This service requires a NC Support Needs Assessment Profile (SNAP) (Level 3 or higher), Supports Intensity Scale (Level D or higher), or TBI Assessment requiring a moderate to high level of supervision and support in most settings.
  • A psychological, neuropsychological, or psychiatric evaluation, supported by appropriate psychological/neuropsychological testing, that denotes a I/DD diagnosis as defined by G.S. 122C-3(12a) must be completed by a qualified licensed professional prior to the provision of this service. For individuals with a TBI, a clinical exam completed by a qualified licensed professional is required noting a TBI diagnosis as defined by G.S. 122C-3(38a).
    • An update/addendum to the psychological evaluation completed by the appropriate qualified licensed professional can be used to attest to (as appropriate): continuation of prior testing, if the disability manifested prior to age 18 or 22 and/or if the disability is likely to continue indefinitely.
  • Service authorization must be completed by a Qualified Professional prior to the day services are provided.
  • A service order must be signed by a qualified professional, physician, licensed psychologist, physician assistant, or nurse practitioner, consistent with their scope of practice prior to or on the first day CLS (IDD & TBI) services are rendered.
  • Maximum group service ratio: Paraprofessional to Individual ratio is 1:3 as long as services outlined within the Person-Centered Plan (PCP) or Individual Support Plan (ISP) are able to be fully addressed.
  • Individuals receiving this service may not be a HCBS waiver member/beneficiary, or individuals receiving I/DD or TBI-related (b)(3) day services or individuals receiving Medicaid In Lieu of Services (ILOS) which include a meaningful day component.
  • This service may not exceed three hours per day on school days for individuals 16-22 years of age who have not graduated.
  • This service may not exceed 28 hours a week.
  • Transportation to and from the residence and points of travel in the community as outlined in the PCP or ISP is included to the degree that they are not reimbursed by another funding source and for personal use.
  • The paraprofessional is responsible for incidental housekeeping and meal preparation only for the individuals enrolled in this service.

If you have questions, please contact I/DD Utilization Management at 704-884-2605.

AlphaMCS Changes for Standard Plan Implementation

Effective July 1, 2021, you will see changes to information in AlphaMCS related to the display of member eligibility for those members who have transitioned to the Standard Plan as well as changes to the logic for submission of service authorization requests (SARs).

Patient Search: If a member has transitioned to Standard Plan, a popup message will display when the patient is selected after a search in the portal:

Patient Banner: The patient banner will display the following data:

Service Authorization Requests: When creating a SAR, the patient search popup will include the standard plan icon if the current date is within the standard plan eligibility dates for the member. When hovering over the icon, a message will appear stating: “Only retro SAR allowed:  SAR dates of service must be before Standard Plan Effective Date”.

SAR Logic Changes for Standard Plan Members

With submission dates PRIOR to the Standard Plan Effective Date and dates of service prior to Standard Plan Effective Date (ex. 01/02/2021-02/15/2021):

  • New SAR/Authorization will be allowed and processed.

With submission dates PRIOR to the Standard Plan Effective Date and dates of service that OVERLAPS (ex. 05/15/2021-07/31/2021):

  • New SAR/Authorization will be allowed and processed.
  • The LME/MCO has the responsibility to notify the Standard Plan through a standardized format provided by the state.

With submission date and dates of service AFTER the Standard Plan Effective Date (ex. 07/15/2021-09/30/2021):

  • New SAR cannot be submitted.
  • Hovering over icon will read: “Only Retro SAR Allowed: SAR Dates of service must be before Standard Plan Effective Date.”

With submission date AFTER Standard Plan Effective Date and dates of service that OVERLAP or is prior to the Standard Plan Effective Date (ex. 04/15/2021-07/31/2021):

  • The LME/MCO will process the SAR for dates of service prior to Standard Plan Effective Date.
  • The LME/MCO has the responsibility to notify the Standard Plan through a standardized format provided by the state.

If you have questions regarding this information, please contact the Partners IT Service Desk at 704-842-6431.

Joint NC DMHDDSAS and DHB Update for NC Providers

July 8, 2021, 3 p.m.

Register at https://register.gotowebinar.com/register/7809717158703382288.

This call, held the first Thursday of each month, will feature DMHDDSAS and DHB representatives who will present policy updates followed by an open Q&A session. A representative from DHSR will also be on the call to answer questions providers may have.

In consideration of the limited time, providers are asked to review the guidance links (below) on the DHHS website and FAQs on the NC Medicaid site.

Closed Captioning is available at: https://www.captionedtext.com/client/event.aspx?EventID=4823177&Customer…