Issued: July 6, 2022
This Provider Alert is an update to the Partners’ Provider Alert: Utilization Management COVID-19 Flexibilities Update published on March 31, 2022.
Reminder: On June 15, 2022, NC Medicaid released SPECIAL BULLETIN COVID-19 #251: Sunsetting of Temporary COVID-19 Flexibilities Tied to the NC State of Emergency. This is an update to SPECIAL BULLETIN COVID-19 #237.
This Bulletin identifies all temporary Behavioral Health policy flexibilities outlined in COVID-19 Special Bulletin that were to be end-dated as of June 30, 2022. Partners Utilization Management (UM) will allow a transition period for retroactive Service Authorization Requests (SAR) submission through August 15, 2022. Providers will need a SAR that is effective July 1, 2022, for continuation of the service that sunset on June 30, 2022.
Please see link for more details.
Below table identifies the Behavioral Health Service that were set to end by June 30, 2022.
The following services below identify changes in staffing and/or program delivery that were to sunset on June 30, 2022. For more details, please refer to bulletin:
Services include:
- Assertive Community Treatment Team (ACTT H0040, H0040 OT, H0040 DJ GT CR, H0040 DJ CR, H0040 GT CR, H0040 CR, H0040 DJ)
- Child and Adolescent Day Treatment (CADT H2012 HA, H2012 HA CR, H2012 HA GT CR)
- Community Support Team (CST H2015 HT HM CR; H2015 HT U1 CR; H2015 HT HN CR; H2015 HT HF CR; H2015 HT HO CR; H2015 HT HO CR; H2015 HT HM GT CR; H2015 HT U1 GT CR; H2015 HT HN GT CR; H2015 HT HF GT CR; H2015 HT HO GT CR; H2015 HT U1 DR CR; H2015 HT HF DJ CR; H2015 HT HO DJ CR; H2015 HT HM DJ CR; H2015 HT HN DJ CR, H2015 HT U1, H2015 HT HM, H2015 HT HN, H2015 HT HF, H2015 HT HO, H2015 HT U1 DJ, H2015 HT HM DJ, H2015 HT HN DJ, H2015 HT HF DJ, H2015 HT HO DJ)
- Comprehensive Clinical Assessment (CCA) is required for flex codes. CCA will be required for treatment beyond six months.
- Allow functional assessments and crisis interventions to be completed by telehealth or telephonic modalities, as clinically appropriate.
- Facility Based Crisis Adolescent: (S9484 HA).
- Intensive In-Home (IIH H2022, H2022 CR, H2022 GT CR)
- Mobile Crisis Management (MCM H2011, H2011 CR, H2011 GT CR)
- Multisystemic Therapy (MST H2033 M4-M5; H2033 M4-M5 GT CR)
- Waive maximum of 480 units per 3 months sunsetting.
- Outpatient Opioid Treatment (OOT H0020, H0020 U3 OU, H0020 U3 OU OT, H0020 OT, H0020 U3 OU CR, H0020 GT CR, H0020 CR)
- Peer Support Services (PSS H0038 HQ; H0038 HK U4; H0038 HQ U4 DJ; H0038 U4 DJ; H0038 GTCR; H0038 DJ CR; H0038 CR; H0038 HQ DJ; H0038 HK; H0038 DJ; H0038 HQ GT CR; H0038 HQ CR; H0038 HQ IN; H0038 CR IN; H0038 IN; H0038 HQ DJ GR CR; H0038 HQ DJ CR; H0038 DJ GT CR). Allow Telehealth (GT) and telephonic (KX).
- Residential Level I (H0046 CR; H0046)
- Residential Level II (H2020 CR; S5145 CR; S5145 CR DD; S5145 DD; S5145 HA ST; S5145 TF; S5145 HA; S5145 HT; S5145; H2020)
- Residential Level III (H0019 HQ; H0019 TJ; H0019 TJ PB; H0019 TJ HE; H0019 TJ CR; H0019 HQ CR)
- Residential Level IV (H0019 UR CR; H0019 U5 CR; H0019 HK CR)
- Substance Abuse Comprehensive Outpatient Treatment (SACOT H2035; H2035 GT CR; H2035 OT)
- Substance Abuse Intensive Outpatient Program (SAIOP H0015; H0015 AD; H0015 GT CR; H0015 AD GT CR; H0015 OT)
- Substance Abuse Medically Monitored Community Residential (H0013, H0013 CR)
The following testing codes can continue to be provided via Telehealth after June 30, 2022 using the GT modifier:
96130 GT – Psychological Evaluation and Interpretation– 1 hour
96131 GT – Psychological Evaluation and Interpretation– each additional 1 hour
96132 GT – Neuropsychological Evaluation and Interpretation– 1 hour
96133 GT – Neuropsychological Evaluation and Interpretation– each additional 1 hour
Changes to Outpatient Behavioral Health Services, including E/M codes and (b)(3) services have been made into permanent policy. Use Modifier GT for interactive audio-visual communication and KX via telephonic, audio-only. For more details, please see link below for Behavioral Health Clinical Coverage Policies: 8A, 8A-1, 8A-2, 8A-5, 8A-6, 8C, 8D-2 and 8G: https://medicaid.ncdhhs.gov/behavioral-health-clinical-coverage-policies
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