Issued: May 14, 2024

The Department is delaying some Medicaid clinical coverage policies (CCP) and State-funded Service Definitions for Substance Use Withdrawal Management Services until further notice. The CCPs and services were scheduled to begin May 1, 2024, but are being delayed to allow health plans and service providers to align with coverage requirements and applicable licensure rule waivers.

Due to the delay, the Department is also reinstating some CCPs and State-funded service definitions that were scheduled to sunset on May 1.

What is happening?

Delayed Clinical Coverage Policies and State-funded Service Definitions

The following Medicaid clinical coverage policies (CCP) and State-funded Service Definitions scheduled to begin May 1, 2024, have been delayed:

  • CCP 8A-7, Ambulatory Withdrawal Management (WM) Without Extended On-Site Monitoring, 1-WM
  • CCP 8A-8, Ambulatory Withdrawal Management with Extended On-Site Monitoring, 2-WM
  • CCP 8A-10, Clinically Managed Residential Withdrawal Management, 3.2-WM
  • CCP 8A-11, Medically Monitored Inpatient Withdrawal Management, 3.7-WM
  • CCP 8A-12, Substance Abuse Intensive Outpatient Program (SAIOP) CP 8A-13
  • CCP 8A-13, Substance Abuse Comprehensive Outpatient Treatment (SACOT)
  • State-Funded Ambulatory Withdrawal Management without Extended Onsite Monitoring Services
  • State-Funded Ambulatory Withdrawal Management with Extended Onsite Monitoring Services
  • State-Funded Clinically Managed Residential Withdrawal Management Services
  • State-Funded Medically Monitored Inpatient Withdrawal Management Services
  • State-Funded Substance Abuse Intensive Outpatient Program (SAIOP)
  • State-Funded Substance Abuse Comprehensive Outpatient Treatment (SACOT)

Clinical Coverage Policies and State-funded Services Reinstated

Coverage for the following services will continue as outlined in Clinical Coverage Policy 8A – Enhanced Mental Health and Substance Abuse Services, the State-Funded Enhanced Mental Health & Substance Use Services 2024, and the State-Funded MH/DD/SA Service Definitions. (The Partners Benefit Grid limits will revert to the original service guidelines.)

  • CCP 8A, Ambulatory Detox
  • CCP 8A, Non-Hospital Medical Detox
  • CCP 8A, Substance Abuse Comprehensive Outpatient Treatment (SACOT)
  • CCP 8A, Substance Abuse Intensive Outpatient Program (SAIOP)
  • State-Funded Social Setting Detox

Where can providers find additional information?

For more information, providers can refer to the applicable communication bulletin:

https://medicaid.ncdhhs.gov/blog/2024/05/08/behavioral-health-clinical-coverage-policy-updates

Who should providers contact if they have additional questions?

Providers should email UMQuestions@PartnersBHM.org if they have questions.