Issued: December 31, 2024
This communication provides updates and further clarifications for providers and/or Tailored Care Managers regarding changes to Behavioral Health Clinical Coverage Policies (CCP), Tailored Plan flexibilities and Hurricane Helene flexibilities.
What is happening?
Partners Utilization Management Department is providing further clarification for providers and/or Tailored Care Managers regarding specific CCP changes as outlined for behavioral health on Program Specific Clinical Coverage Policies | NC Medicaid. Click here to review the summary of CCP changes. These policy changes are effective Jan. 1, 2025.
Tailored Plan flexibilities were communicated on Sept. 25, 2024, in a Provider Alert regarding the extension of Tailored Plan Flexibilities extended through Jan. 31, 2025: Provider Alert: Extension of Tailored Plan Launch Flexibilities – Partners Health Management – Provider Knowledge Base.
Hurricane Helene flexibilities were updated on Dec. 12, 2024, to extend flexibilities for both Medicaid members and State-Funded recipients. These bulletins have updated end dates and additional flexibilities for Behavioral Health, Care Management, Innovations and Long-Term Services and Supports. Providers should read the bulletins for complete information on the Hurricane Helene flexibilities: State-Funded flexibilities Medicaid flexibilities
What do providers need to do?
For Behavioral Health CCP Changes:
- Providers should review the CCP changes, effective Jan. 1, 2025, at Program Specific Clinical Coverage Policies | NC Medicaid.
- Providers should review the summary of the CCP flexibilities.
For Tailored Plan Flexibilities:
- Temporary Tailored Plan flexibilities that waive prior to concurrent authorization requirements applies exclusively to Tailored Plan members. Providers must have these authorizations in place by Jan. 31, 2025, for services rendered on or after Feb. 1, 2025, to avoid service interruptions.
For Hurricane Helene Flexibilities:
- Any temporary Hurricane Helene flexibilities that waive prior or concurrent authorization requirements applies exclusively to members and providers affected by Hurricane Helene. Providers must have authorizations in place by Feb. 28, 2025, for services rendered on or after March 1, 2025, to avoid service interruptions.
- Providers should read the bulletins for complete information on the Hurricane Helene flexibilities: State-Funded flexibilities Medicaid flexibilities
Who can providers call if they have questions?
If providers have questions, they can:
- Contact their account specialist or email PAS@PartnersBHM.org (behavioral health) or PHPAS@PartnersBHM.org (physical health).
- Call the Provider Services Line at 1-877-398-4145.
- Email UMQuestions@PartnersBHM.org (behavioral health) or PHUMQuestions@PartnersBHM.org (physical health).
- Call Partners Pharmacy line at 1-866-453-7196 with pharmacy questions.