Issued: July 1, 2025
Effective July 1, 2025, Partners Health Management will implement a newly approved In Lieu of Service (ILOS), Transitional Youth Services (TYS), for NC Medicaid Direct members.
What is happening?
Transitional Youth Services (TYS), an In Lieu of Service (ILOS) for NC Medicaid Direct members, will be effective and available beginning July 1, 2025. This service was previously known as Young Adults in Transition (YAT) and had been sunset by the N.C. Department of Health and Human Services (NCDHHS). The redefined Transitional Youth Services has been formally approved and reinstated as a Medicaid Direct ILOS to better support transition age youth in their move toward independence.
Where can providers find additional information?
For clinical information, providers can refer to the Partners ILOS Transitional Youth Services (TYS) service definition located on the Partners Provider Knowledge Base: https://legacy.providers.partnersbhm.org/service-definitions/
Transitional Youth Services Overview
- Service Code: H2022 U5
- Unit Definition: 1 unit = 1 week
- Anticipated Length of Stay: 9–12 months
- Prior Authorization:
- Pass-through of nine months
- Notification SAR is required within one week of service initiation for the first nine months (no documentation needed for UM).
- Submit service authorization request (SAR) in ProAuth.
- No medical necessity review.
- Documentation needed for the medical record:
- CCA
- Life Skills Assessment
- Treatment Plan/PCP
- Service order signed by a licensed clinician, physician, licensed psychologist, physician assistant or nurse practitioner
- Reauthorization:
- Up to 60 days after passthrough
- The expected length of stay is up to 12 months per treatment episode
- Submit SAR in ProAuth
- Full medical necessity review with all clinical documentation attached
- Documentation needed for UM:
- CCA
- Life Skills Assessment
- Updated Treatment Plan/PCP
- Service Order signed by a licensed clinician, physician, licensed psychologist, physician assistant or nurse practitioner
- Entrance Requirements:
- Comprehensive Clinical Assessment (or approved equivalent)
- Life Skills Assessment
- Person-Centered Plan and service order from a qualified clinician
- Eligibility Criteria:
- Age 16–21
- Diagnosed with a mental health or substance use disorder
- Deficits in at least one independent living skill or essential life component
What do providers need to do?
- Review the Service Definition: Familiarize yourself with the Transitional Youth Services (TYS) service requirements, eligibility criteria, staffing qualifications, and documentation standards. https://legacy.providers.partnersbhm.org/service-definitions/
- Ensure Staff Qualifications: Verify that assigned staff meet the required qualifications for delivering TYS, including Qualified Professional status and appropriate supervisory credentials.
- Prepare for Service Delivery:
- Ensure processes are in place for completing Comprehensive Clinical Assessments and Life Skills Assessments.
- Develop Person-Centered Plans and service orders prior to initiating services.
Who should providers contact if they have additional questions?
Providers should email UMQuestions@PartnersBHM.org if they have questions.