Partners Health Management is notifying providers of updates to NC Medicaid Clinical Coverage Policy (CCP) 8G: Peer Support Services, which became effective Sept. 1, 2026. NC Medicaid has published a revised version of the policy that includes updates to the service definition, eligibility and medical necessity criteria, authorization requirements, service orders, documentation standards, provider responsibilities, and program requirements.
What’s happening
NC Medicaid’s revised CCP 8G includes several significant policy updates related to Peer Support Services (PSS). Key changes include, but are not limited to:
- Revised admission, continued stay, and discharge criteria.
- Service orders for Peer Support Services are now valid for nine consecutive months, rather than one year.
- Enhanced provider program requirements and documentation standards.
- Updated provider requirements include enhanced expectations related to Certified Peer Support Specialist (CPSS) program oversight, documentation, staffing, and service delivery practices.
Important Implementation Guidance for Partners Providers
While the updated CCP 8G is effective Sept. 1, 2026, Partners will continue to follow the current implementation of PSS Non-Quantitative Treatment Limitations (NQTLs) through Sept. 30, 2026. Refer to the Partners Health Management Benefit Grid for the authorization guidelines. Partners and Vaya Health will merge on Oct. 1, 2026, to form Vaya Partners. Effective Oct. 1, 2026, Vaya Partners will implement the merger-related flexibilities outlined in the Sept. 2, 2026, Provider Alert.
What providers need to do?
Providers should:
- Review the updated policy in its entirety: NC Medicaid Clinical Coverage Policy 8G: Peer Support Services.
- Evaluate current service delivery, documentation, and authorization practices for consistency with the updated policy.
- Ensure clinical, supervisory, and billing staff are aware of the policy revisions.
- Continue following current Partners PSS NQTL implementation requirements through Sept. 30, 2026.
- Effective Oct. 1, 2026, follow the merger-related flexibilities outlined in the Sept. 2, 2026, Provider Alert.
Who can providers contact if they have questions?
- For authorization-related questions: UMQuestions@partnersbhm.org
- For claims-related questions: ClaimsDepartment@partnersbhm.org
- For provider-related questions: PNRelations@partnersbhm.org