Service Definitions Overview
Clinical coverage policies are the primary criteria Partners uses to administer benefits and determine medical necessity. Service definitions and clinical policies guide when and how services are covered for physical health, behavioral health, substance use disorders and intellectual and developmental disabilities.
Contact Information
For more information, or if you have questions about clinical coverage policies:
- Partners’ Tailored Plan Clinical Coverage Policies page
- Partners’ NC Medicaid Direct Clinical Coverage Policies page
- NCDHHS’ Program-Specific Clinical Coverage Policies page
- NCDHHS State-funded Service Definitions page
Partners may propose new services to the NC Division of Health Benefits (DHB) for approval. When approved, these “in lieu of” services are covered as alternatives to standard benefits. They are different from 1915(i) services and may be reimbursed by Medicaid and, in some cases, with state funds.
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- Acute and Subacute Services Provided in an Institute for Mental Disease
- Behavioral Health Urgent Care (BHUC)
- Child Focused Assertive Community Treatment (Child ACT)
- Family Centered Treatment
- High Fidelity Wraparound
- In Home In Lieu Of Service: In Home Therapy Services (IHTS)
- NC Medicaid Direct Long-Term Community Supports (LTCS)
- Rapid Care Services (Low & High)
- Rapid Response Bed Therapeutic Foster Care for Children and Youth
- Residential Services – Complex Needs
- Tailored Plan Long-Term Community Supports LTCS
- Transitional Youth Services
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