The official posting of mental health, substance use disorder, and intellectual and developmental disability service definitions are found within the various clinical coverage policies published by the NC Division of Medical Assistance. These definitions are located on DMA’s Clinical Coverage Policy web page, which includes, but is not limited to, the following clinical coverage policies:
- 8A – Enhanced Mental Health and Substance Abuse Services
- 8C – Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers
- 8D-1 – Psychiatric Residential Treatment Facilities for Children Under the Age of 21
- 8D-2 – Residential Treatment Services
Service definitions for services funded through the State (the NC Division of Mental Health/Developmental Disabilities/Substance Abuse Services)
Partners also offers what are called B3 Services. Section 1915(b)(3) of the Medicaid Waiver enables states to provide health-related services in addition to those in the approved NC Medicaid Plan to enrollees participating in the 1915(b) waiver.
B3 services are approved by the Centers for Medicare and Medicaid Services (CMS) and meet all applicable CMS requirements. B3 Services:
- are cost-effective, supplemental services and supports;
- are aimed at decreasing hospitalization and helping individuals remain in their homes and communities (when preferred and appropriate);
- cannot be used for people who do not have Medicaid; and
- include mental health, intellectual and developmental disability, and substance use services.
B3 Service Definitions
‘In Lieu Of’ Services
Partners can develop and present ideas for new services to the NC Division of Medical Assistance (DMA) for approval. These services are covered through “Alternative” or “in lieu of” service definitions. These services are not available in the traditional benefit plan and are different from B3 services. DMA can approve these new services for reimbursement under Medicaid, and in some cases, with State funding.
In Lieu Of Service Definitions: