Vaya Health and Partners Health Management will merge to form Vaya Partners effective Oct. 1, 2026. Please review the following information about Vaya Partners rates and the rate request process.
Blended Rate Approach
To determine the Vaya Partners-specific outpatient behavioral health, intellectual/developmental disability (I/DD), and traumatic brain injury (TBI) service rates to become effective Oct. 1, 2026, Vaya Partners conducted a rigorous rate analysis using paid claims and utilization data from both Partners and Vaya from April 1, 2025, through March 31, 2026. Vaya Partners made rate determinations based on this analysis, with the goal of achieving a cost-neutral impact by service type.
Standard Rates
Vaya Partners’ standard rate schedules will go into effect Oct. 1, 2026, for the entire Vaya Partners network. Rate schedules will be posted to the Partners website at partnersbhm.org, the Vaya website at vayahealth.com, and the new Vaya Partners website at vayapartners.org on Sept. 1, 2026.
Provider-specific Rates
In certain limited exceptions, Vaya Partners will allow provider-specific rates that are individual to a provider for sites and/or services. Effective Oct. 1, 2026, Vaya Partners will honor provider-specific rates that are unique to either Partners or Vaya and do not have overlapping billing or service location sites and services at the current rate as of Aug. 26, 2026, until otherwise changed with notice. For provider-specific rates for sites and services that overlap but have different rates across Partners and Vaya, we will determine a blended rate and communicate the new provider-specific rate in advance of implementation.
Provider-specific rates are subject to rate reductions Vaya Partners deems necessary to comply with or implement NCDHHS or legislative changes or to appropriately maintain our medical loss ratio within statutory and contractual limits.
Moratorium on Provider-specific Rates
A moratorium on provider-specific enhanced rate requests will be in effect by Partners and Vaya for the entire month of September 2026 and by Vaya Partners from Oct. 1, 2026, through Jan. 31, 2027. Vaya Partners will not review or consider any enhanced rate request submitted prior to Feb. 1, 2027.
Member-specific Rates
Vaya Partners will honor current member-specific rates approved prior to Aug. 26, 2026, by either Partners or Vaya through their approval timeframe. For approval of the same rate for a new timeframe, providers must submit requests prior to the expiration of the approved timeframe to ensure no lapse in continuity of the rate. Vaya Partners will not retroactively approve an enhanced rate.
Vaya Partners will consider new requests for member-specific enhanced rates in the following circumstances only:
- If a child under age 18 is in the emergency department (ED), all placement options have been exhausted, and residential treatment has not been secured due to the member’s clinical complexity, acuity, and/or support needs. The member may require additional supports or interventions beyond those typically available to safely address identified needs in a community setting.
- If a member with I/DD is in the ED, all placement options have been exhausted, and residential treatment has not been secured due to the member’s clinical complexity, acuity, and/or support needs. The member may require additional supports or interventions beyond those typically available to safely address identified needs in a community setting.
- If a child under age 18 is involved with the Department of Social Services, all residential treatment options have been exhausted, and residential treatment has not been secured due to the member’s clinical complexity, acuity, and/or support needs. The member may require additional supports or interventions beyond those typically available to safely address identified needs in a community setting.
Service Codes
The Vaya Partners website will include a service code and modifier crosswalk on Sept. 1, 2026.
Bundling Services for Electronic Visit Verification (EVV) and (Non-EVV)
Vaya Partners will bundle service codes for Community Living and Supports – EVV and Non-EVV, with a new blended rate for provider organizations. We will publish the blended rate on rate schedules Sept. 1, 2026. The impacted codes are listed in the table below:
| Procedure Code/Modifier | Service Description |
| T2013 TF | Community Living and Supports – EVV |
| T2012 | Community Living and Supports Only in Community, non-EVV |
| T2012 GC | Community Living and Supports, Relatives as Provider, non-EVV |
| T2013TFHQ | Community Living and Supports – Group EVV |
| T2012GC-HQ | Community Living and Supports – Group, Relative as Provider (non EVV) |
| T2012HQ | Community Living and Supports – Group, Only in Community (non-EVV) |
| 1915(i) T2013TFU4 | Community Living and Supports – EVV |
| 1915(i) T2012GCU4 | Community Living and Supports – Relative as Provider, non-EVV |
| 1915(i) T2013TFHQU4 | Community Living and Support Group (EVV) |
Individual and Family Directed Supports (IFDS)
Vaya Partners will share IFDS decisions with Financial Support Service Agencies, Agencies with Choice (AWC), and Employers of Record (EORs) in a separate communication.
This communication bulletin is effective today, Aug. 26, 2026, as posted and is subject to change and update as needed without prior notice.