Personal Care Services Overview – Behavioral Health
Personal Care Services (PCS) for I/DD and Behavioral Health include a personal care component. These services include:
- Community Living and Supports (CLS)
- 1915(i) Individual and Transitional Support (ITS)
- Supported Living Periodic
These services require Electronic Visit Verification (EVV). EVV confirms that services are delivered as authorized, supports timely service delivery and ensures compliance with state and federal requirements.
For EVV requirements for Physical Health PCS, visit our Personal Care Services – Physical Health page.
Contact Information
For questions about Electronic Visit Verification, Partners maintains a dedicated EVV Help Desk:
Email: EVVSupport@PartnersBHM.org.
For guidance on submitting authorizations under the ALL Code, review the following resources:
Eligibility for 1915(i) services is determined through Clinical Coverage Policies 8H-3 and 8H-5.
1915(i) services are for individuals aged 3+ with:
- Intellectual or Developmental Disabilities (I/DD)
- Traumatic Brain Injury (TBI)
- Severe Mental Illness (SMI/SPMI)
- Severe Emotional Disturbance (SED)
- Severe Substance Use Disorders (SUD)
1915(i) does not require institutional level of care.
To request 1915(i) services, contact the assigned Tailored Care Manager through Partners Care Connections Screening & Referral:
(704) 842-6311
ScreeningandReferral@PartnersBHM.org
Eligibility for the Medicaid 1915(c) Waiver, most commonly referred to as “NC Innovations,” is defined by Clinical Coverage Policy (CCP) 8P.
Members must meet Intermediate Care Facility for Individuals with an Intellectual Disability (ICF-IID) Level of Care per CCP 8E.
NC Innovations provides an alternative to institutional placement and supports individuals with I/DD in community settings.
For more information, visit our Registry of Unmet Needs page.
The 21st Century Cures Act requires NC Medicaid to begin using an Electronic Visit Verification (EVV) system for Home Health Care Services (HHCS) and Personal Care Services (PCS) for both physical and behavioral health services.
Partners Health Management and HHAeXchange have announced an update for providers regarding P.O. Box addresses for service location.
1915(i) Services
| Service Code | Description | Authorization |
|---|---|---|
| T1019 U4 | 1915(i) Individual and Transitional Support | Same as Service Code/Name |
| T2013 TF U4 | 1915(i) Community Living & Supports | T2013TFU4 ALL Code: “1915i CLS Services”* |
| T2013 TF HQ U4 | 1915(i) CLS Group | T2013TFU4 ALL Code: “1915i CLS Services”* |
NC Innovations Waiver Services
| Service Code | Description | Authorization |
|---|---|---|
| T2013 TF | Community Living & Supports | T2013TF ALL Code: “Community Living and Supports”* |
| T2013 TF HQ | CLS Group | T2013TF ALL Code: “Community Living and Supports”* |
| T2033 U1 | Supported Living Periodic | Same as Service Code/Name |
*1915(i) CLS and Innovations CLS authorizations are approved under the appropriate ALL Code. The ALL code includes CLS services that are not subject to EVV requirements, including T2012GC and T2012GCU4 for CLS Live-in Caregiver (RADSE) and T2012 and T2012U4 for CLS Community Only.
For submitting prior authorization requests using the CLS All Code, view the Prior Authorization Submission Instructions – Community Living & Supports (CLS).
For more information on documentation and authorization requirements, refer to Partners’ Benefit Grid.