Issued: August 5, 2019
State-Funded Peer Support Services
As noted in Joint Communication Bulletin #J332, State-Funded Peer Support Services (PSS) service definition, effective August 1, 2019, the State-Funded Peer Support Services (PSS) service definition is live and supersedes any existing alternative PSS service definitions. The following Y-codes in Partners’ current Benefit Plan end on July 31, 2019:
|YA-309||Peer Support Group|
|YA-343||Peer Support Hospital Discharge & Diversion – Ind|
Partners has developed the following crosswalk to ensure all variations of this service are captured. Partners will update the existing codes in provider contracts inside of AlphaMCS and send out contract amendments reflecting the new codes. No action is required by existing peer support service providers in order to make this change.
|Peer Support Services Cross Walk|
|Service Code Ending 7/31/2019||Service Code Start 8/1/2019|
|YA343 Peer Support Individual||H0038 Peer Support Individual|
|YA308 Peer Support Individual Timely Follow-Up||H0038 TY Peer Support Individual Timely Follow-Up|
|YA309 Peer Support Group||H0038 HQ Peer Support Group|
It is important to note that although the new definition imposes Prior Authorization after the first 24 units, Partners has opted to continue with the Unmanaged Benefit for State-Funded Peer Support. Effective August 1, 2019, a Person Centered Plan (PCP) and Comprehensive Clinical Assessment (CCA) are required documents for any new members beginning Peer Support Services. All “existing/current” Peer Support Services members MUST have a PCP and CCA on file for continued service delivery by September 1, 2019.
Please direct all questions to the MHSU Utilization Management Workgroup at 704-842-6436.
Updates to Behavioral Health I/DD Tailored Plan eligibility and enrollment
This communication was released via NCTracks on behalf of Dave Richard, Deputy Secretary for NC Medicaid, on Friday, August 2, 2019:
The Department of Health and Human Services has issued several updates to the March 2019 eligibility and enrollment policy guidance for Behavioral Health I/DD Tailored Plans. The Department is committed to ensuring that Medicaid beneficiaries are enrolled in and transitioned as seamlessly as possible to the managed care plan or delivery system that is best suited to meet the needs. Updates to the policy guidance were made in response to stakeholder feedback, and to operationalize efficient and effective processes for Behavioral Health I/DD Tailored Plan eligibility and enrollment. These updates include:
- Additional claims/encounter data markers to determine eligibility based on functional impairment for qualifying diagnoses of serious mental illness or serious emotional disturbance.
- New forms for beneficiaries assigned to Standard Plans to request to stay in NC Medicaid Direct (fee for service) and the LME-MCO.
- Updated enrollment policy to transition Standard Plan enrollees who urgently need a service covered only by NC Medicaid Direct/LME-MCO. A new policy is added for urgent transfer requests.
- Change reflecting substance abuse intensive outpatient program (SAIOP) and substance abuse comprehensive outpatient treatment program (SACOT) services will be covered only by Behavioral Health I/DD Tailored Plans, instead of both Standard Plans and Behavioral Health I/DD Tailored Plans.
The full text of the update, changes to Appendix B of the final guidance policy, and new provider and beneficiary attestation forms are available on the DHHS Medicaid Transformation web page at https://www.ncdhhs.gov/assistance/medicaid-transformation/proposed-program-design/policy-papers.