Skip to content

Provider Alert

Update – Provider Rate Reduction Implementation

Issued: October 31, 2025 Earlier this year, the North Carolina Department of Health and Human Services (NCDHHS) requested additional funding from the General Assembly to fully support the state’s Medicaid rebase. The final appropriation from the General Assembly was less than requested, resulting in a funding shortfall. To address this shortfall, NCDHHS developed a plan

Provider Alert: SUD Update, Letter of Support Process for New Waiver Requests, and OTP Waiver Renewals

Issued: October 24, 2025 Partners Health Management is providing updates on NC Medicaid’s Substance Use clinical coverage policies and temporary waiver requests, and information on Opioid Treatment Plan waiver renewals. Clinical coverage policy updates are effective Jan. 1, 2026. SUD Clinical Coverage Policy Updates and Temporary Waiver Requests What is happening? Clinical Coverage Policies NC

CMS-Approved NQTLs: Staggered Implementation Plan and Provider Guidance

Issued: October 8, 2025 Effective Dates: Dec. 1, 2025, and Jan. 1, 2026 This communication provides updates and clarifications for providers and Tailored Care Managers regarding the application of CMS-approved Non-Quantitative Treatment Limitations (NQTLs) to Behavioral Health and Substance Use Disorder services. These changes align with Parity compliance requirements and outline the staggered implementation plan