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:

Service definitions for State-funded services (the NC Division of Mental Health/Developmental Disabilities/Substance Abuse Services).

(b)(3) Services

Partners also offers what are called (b)(3) 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.

Services are approved by the Centers for Medicare and Medicaid Services (CMS) and meet all applicable CMS requirements. (b)(3) 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.
  • Include mental health, intellectual and developmental disability and substance use services.

‘In Lieu of’ Services

Partners can develop and present ideas for new services to the NC Division of Health Benefits (DHB) 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 (b)(3) services. DHB can approve these new services for reimbursement under Medicaid, and in some cases, with State funding.

Partners’ Medicaid Direct In Lieu of Services Policy.

In Lieu of Service Definitions:

Updated: June 17, 2024