Issued: October 3, 2024
CORRECTED: October 11, 2024
No prior authorization is required for 1915(i) and (b)(3) Medicaid NC CORE IPS-SE.
What is happening?
Prior authorization is not required for 1915(i) and 1915(b)(3) Medicaid NC CORE IPS-SE. This change is effective Oct. 1, 2024.
Members receiving services under I/DD or TBI will continue to receive H2023U4 1915(i) Supported Employment. Users should continue to follow prior authorization and documentation guidelines for H2023U4 1915(i) Supported Employment.
For members receiving Behavioral Health services, no medical necessity determination will be rendered for:
- 1915(i) Medicaid NC CORE IPS-SE.
- 1915(b)(3) Medicaid NC Core IPS-SE.
- Important information regarding the 1915(b)(3) to 1915(i) transition.
- 1915(b)(3) services under the NC Medicaid Direct Benefit Plan will be phased out by December 31, 2024. Providers will not be able to use the 1915(b)(3) codes after that date.
- Members need to complete transition to 1915(i) by November 30, 2024, or to another appropriate service prior to December 31, 2024.
- The expectation is that the 1915(i) Independent Assessment will be completed before any 1915(b)(3) service is authorized for initial or concurrent review for NC Medicaid Direct members.
- State-funded NC CORE IPS-SE. No prior authorization is required. Benefit limits have not changed.
What should providers do?
Providers should access and review the complete document which includes:
- A chart with the service name, code and documents required for authorization
- An explanation of service limits for milestones
- Changes for submitting claims
Who can providers contact if they have questions?
- Tailored Care Management: TailoredCareManagement@PartnersBHM.org
- Utilization Management: UMQuestions@PartnersBHM.org
- Claims: ClaimsDepartment@PartnersBHM.org