(Formerly referred to as Social Setting Detox)

All Counties

For Medicaid Direct and Tailored Plan, providers are needed across the Partners 15-county catchment area to serve adult members.

Clinically Managed Residential Withdrawal Management (WM) is a facility-based crisis service that provides 24-hour supervision and support for individuals who are intoxicated or experiencing withdrawal. This service is classified as ASAM Level 3.2 and is appropriate for individuals who are not at risk for severe withdrawal or medical complications.

This level of care:

• Provides structured monitoring and supportive withdrawal management
• Utilizes peer and social supports within a clinically supervised setting
• Operates under established clinical protocols with physician availability 24 hours a day
• Coordinates with other levels of care to ensure continuity of treatment

The focus of this service is to support safe withdrawal from substances and facilitate timely transition into ongoing treatment and recovery services. This is a new substance use disorder treatment service added to the Medicaid service array.

Provider Qualifications

Refer to Clinical Coverage Policy 8A-10 for complete provider qualification requirements.

Next Steps

Providers must meet all applicable requirements.

• Providers currently enrolled in the Partners Provider Network should complete the Provider Change Form.
• Providers not enrolled in the Partners Provider Network who wish to offer this service must submit the Request for Consideration Form.

Enrollment with NCTracks is required. The agency, NPI, taxonomy, service locations and clinicians must be enrolled in NCTracks in order to contract with Partners and to make changes to an existing contract.

For additional information about service requirements and enrollment processes, please review:

NCDHHS Clinical Coverage Policies

NC DMA State-Funded Clinical Coverage Policy

Provider Enrollment & Maintenance – Partners Health Management – Provider Knowledge Base

Substance Abuse Medically Monitored Community Residential Treatment

For Medicaid Direct and State-funded services, providers are needed across Partners’ 15-county-catchment area. This crisis service is required to serve adult members.

Medically Monitored Community Residential Treatment (MMCRT) is a non-hospital rehabilitation facility for adults, with 24-hour-a-day medical or nursing monitoring, where a planned program of professionally directed evaluation, care and treatment for the restoration of functioning for beneficiaries with alcohol and other drug problems or addiction occurs.

A comprehensive clinical assessment is one mechanism to demonstrate medical necessity for a service and to assess and identify an individual’s needs. A service order for MMCRT must be completed by a physician, licensed psychologist, physician assistant or nurse practitioner according to their scope of practice prior to or on the day that the services are to be provided.

Provider Qualifications

Refer to Clinical Coverage Policy 8A for Provider Qualifications.

Next Steps

Providers are expected to meet all requirements. Interested providers who are enrolled in Partners’ Provider Network should complete the Provider Change Form.

Interested providers who are NOT enrolled in Partners’ Provider Network and want to provide this service should submit the Request for Consideration Form. Please note that enrollment with NCTracks is required. The agency, NPI, taxonomy, sites and clinicians must be enrolled in NCTracks to continue to contract with Partners and make changes to your contract with Partners.

For more details about the services, requirements and to access forms, please see the below links:

NCDHHS Clinical Coverage Policies

NCDHHS State-Funded Service Definitions

Provider Enrollment & Maintenance – Partners Health Management – Provider Knowledge Base

All Counties

A Multidisciplinary Evaluation (MDE) is an important tool that helps identify an individual’s competency in partnership with guardianship proceedings. The evaluation is ordered by the clerk of court. An MDE is defined as an evaluation that contains current medical, psychological and social work evaluations. The MDE may include current evaluations by professionals in other disciplines, including, but not limited to, education, vocational rehabilitation, occupational therapy, vocational therapy, psychiatry, speech-and-hearing and communications disorders. The statutory definition of an MDE contemplates a dynamic and multifaceted evaluation that covers various areas of a respondent’s cognitive and functional capacity. Qualified providers must have access to the specialists needed to perform the evaluations. Providers can engage one or more providers to conduct the evaluations identified by the clerk in the order.

Provider Qualifications

For more information, please refer to NC Legislation Chapter 35A.

Next Steps

Providers are expected to meet all requirements. Interested providers who are enrolled in Partners’ Provider Network should complete the Provider Change Form.

Interested providers who are NOT enrolled in Partners’ Provider Network and want to provide this service should submit the Request for Consideration Form. Please note that enrollment with NCTracks is required. The agency, NPI, taxonomy, sites and clinicians must be enrolled in NCTracks to continue to contract with Partners and make changes to your contract with Partners.

For more details about the services, requirements and to access forms, please see the below links:

NCDHHS Clinical Coverage Policies

NC DMA State-Funded Clinical Coverage Policy

Provider Enrollment & Maintenance – Partners Health Management – Provider Knowledge Base

All Counties

Psychological testing involves the culturally and linguistically appropriate administration of standardized tests to assess a beneficiary’s psychological or cognitive functioning. Testing results must inform treatment selection and treatment planning. Psychological services for children and adolescents are goal-directed interventions designed to enable children, adolescents and their families to cope more effectively with complex problems. Services may include comprehensive psychosocial assessments and treatment planning, goal directed psychotherapy (individual, group or family) and referral to other behavioral health resources as needed. These services involve the identification of and intervention with children and adolescents who may be at risk for developing more serious emotional or behavioral problems as well as those who are already experiencing these problems.

Provider Qualifications

In addition to physicians, the following providers can bill for these services: a. Licensed Psychologist (LP); b. Licensed Psychological Associate (LPA); c. Clinical Mental Health Counselor (LCMHC); d. Licensed Clinical Mental Health Counselor Associate (LCMHCA); e. Licensed Clinical Social Worker (LCSW); f. Licensed Clinical Social Worker Associate (LCSWA); g. Licensed Marriage and Family Therapist (LMFT); h. Licensed Marriage and Family Therapist Associate (LMFTA); i. Licensed Clinical Addiction Specialist (LCAS); j. Licensed Clinical Addiction Specialist Associate (LCASA); k. Licensed Physician Assistant (PA); l. Nurse Practitioner (NP), including Psychiatric Mental Health Nurse Practitioner (PMHNP);

Refer to NC Medicaid: 8C  for a full list of Provider Qualifications.

Next Steps

Providers are expected to meet all requirements. Interested providers who are enrolled in Partners’ Provider Network should complete the Provider Change Form.

Interested providers who are NOT enrolled in Partners’ Provider Network and want to provide this service should submit the Request for Consideration Form. Please note that enrollment with NCTracks is required. The agency, NPI, taxonomy, sites and clinicians must be enrolled in NCTracks to continue to contract with Partners and make changes to your contract with Partners.

For more details about the services, requirements and to access forms, please see the below links:

NC Medicaid

NCDHHS Clinical Coverage Policies

Provider Enrollment & Maintenance – Partners Health Management – Provider Knowledge Base

Outpatient Behavioral Health Services | NC Medicaid