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 Medicaid has announced the following Medicaid and State-funded clinical coverage policies which go into effect Jan. 1, 2026:
- Substance Use Intensive Outpatient Treatment
- Substance Use Comprehensive Outpatient Treatment
- Clinically Managed Residential Withdrawal Management
- Clinically Managed Low Intensity Residential
- Clinically Managed Population Specific High Intensity Residential
- Clinically Managed High Intensity Residential
- Medically Managed Intensive Inpatient Residential
Temporary Waiver Requests
On Oct. 7, 2025, the Division of Health Service Regulations (DHSR) sent a communication to Substance Use Providers: Request for Waiver 3200 3400 4100 4400 4500 Substance Use Disorder. This communication informed providers that they could request temporary waivers for the following service array:
- 10A NCAC 27G Section .3200, Social Setting Detoxification for Substance Abuse
- 10A NCAC 27G Section .3400, Residential Treatment/Rehabilitation for Individuals with Substance Abuse Disorders
- 10A NCAC 27G Section .4100, Residential Recovery Programs for Individuals with Substance Abuse Disorders and Their Children
- 10A NCAC 27G Section .4400, Substance Abuse intensive Outpatient Treatment Program
- 10A NCAC 27G Section .4500, Substance Abuse Comprehensive Outpatient Treatment Program
- 10A NCAC 27G Section .5600, Supervised Living for Individuals of All Disability Groups
What do providers need to do?
- For each service for which they are requesting a temporary waiver, providers must email Partners Provider Relations Behavioral Health Team at pas@partnersbhm.org. This email must include:
- Request(s) for letters of support for each service
- A signed Waiver of Licensure Rule Request for each service for which they need a Letter of Support
- Partners will process the request and issue a Letter of Support to the provider
- Providers must then send both the Letter of Support from Partners and the signed Waiver Service Request(s) to DHSR’s Mental Health Licensure and Certification Section, Michael Blake, Administrative Supervisor, via email michael.j.blake@dhhs.nc.gov.
- Providers can attend the NC Medicaid Behavioral Health Stakeholder Virtual Office Hours for more information.
Opioid Treatment Program (OTP) Waiver Renewals
On Oct. 13, 2025, DHSR sent a communication to Substance Use Providers: OTP Waiver 2026. This communication informed providers of temporary exemptions from the unsupervised take-home medication requirements.
What is happening?
The Substance Abuse and Mental Health Services Administration (SAMHSA) has granted a temporary exemption from the unsupervised take-home medication requirements of 42 C.F.R. § 8.12(i). These exemptions are necessary to:
- dispense up to seven unsupervised take-home doses of methadone for a patient in treatment 0-14 days;
- up to 14 unsupervised take-home doses of methadone may be provided to the patient in treatment days 15-30; and
- up to 28 unsupervised take-home doses of methadone may be provided to the patient from 31 days in treatment, if the Opioid Treatment Program (OTP) believes the patient can safely handle the amount of take-home medication, with applicable conditions.
What do providers need to do:
- Providers need to send OTP Renewal requests for Letter of Supports along with their Attestation to Partners Provider Relations Team: pnrelations@partnersbhm.org.
- Partners will process the request and issue a Letter of Support to the provider.
- Providers must send signed waivers to DHSR’s Mental Health Licensure and Certification Section. Please refer to Provider Alert for OTP sent from DHSR to OTP providers on Oct 13, 2025.
Who can providers contact if they have questions?
Providers may email their Provider Account Specialist at pas@partnersbhm.org or call the Provider Service Line at 1-877-398-4145.