Issued: Nov. 4, 2025
Effective Oct. 1, 2025, Partners Health Management implemented the NC Medicaid Rate Reductions changes made by the Division of Health Benefits (DHB). In conjunction with these changes, Partners has made updates to the criteria for new Member Specific Rate Requests (Enhanced Rate Requests).
What is Happening?
Effective Nov. 1, 2025, Partners will implement new eligibility criteria for initial Member Specific Rate Requests (Enhanced Rate Requests). Please see the criteria below:
- Rates will be considered for Residential Treatment only; AND
- Members must be entering an initial episode of care OR have a documented change of clinical presentation; AND
- One of the following eligibility criteria must be met:
- Individuals have demonstrated high-risk safety concerns (physical/sexual aggression, active suicidal ideations and/or homicidal ideations) in the last 90 days.
- Individuals have significant functional impairments related to Autism Spectrum Disorder (ASD), intellectual and developmental disabilities (I/DD) or co-occurring behavioral health diagnoses (with substance use disorder and/or I/DD), and in the last 90 days have demonstrated high intensity behavioral challenges, such as significant aggression, property destruction, self-injurious behaviors and/or have been documented to be at risk of going missing.
Where can providers find additional information?
For additional information, please visit the links below.
- NC Medicaid Rate Reductions – Effective Oct. 1, 2025 | NC Medicaid
- 1, 2025 NC Medicaid Rate Reduction Q&A | NC Medicaid
- Partners Provider Alert issued on 10/31/2025
What do providers need to do?
Providers will continue to submit new Member Specific Rate Requests (Enhanced Rates Requests) to UM Specialized Funding based on the criteria mentioned above.
Who should providers contact if they have additional questions?
Providers should email the following departments if they have questions.
- UM Questions: UMQuestions@partnersbhm.org
- UM Specialized Funding: UMSpecializedFunding@partnersbhm.org
- Provider Account Specialists: PAS@partnersbhm.org