Important Alliance Updates

Alliance Health will be implementing several changes that will impact provider operations and services available through our benefit plan. The changes are the reinstatement of certain prior authorization requirements and a hold on authorizing in lieu of Long Term Community Supports, Levels 3-5 for members not already receiving these services.

Statewide policy changes, including opening provider networks and expanding payment flexibilities, as well as rapid increases in Medicaid and healthcare costs, have significantly increased service spending at Alliance and across the public system. While NCDHHS’s recent reversal of certain Medicaid provider rate cuts is welcome, it does not resolve the broader funding and cost pressures that led Alliance to reevaluate the additional supports we have offered for years, above and beyond state requirements, to better serve individuals with complex needs. We now must pull back those additional supports while keeping all mandated, medically necessary services in place, so that we can protect the long-term stability of the health plan and continue managing high-quality care for individuals with some of the most complex needs.

Prior Authorization Requirements

To ensure appropriate utilization and access to behavioral health services, Alliance will reinstate prior authorization requirements for several behavioral health services over the next several months beginning February 1, 2026. To support the transition back to prior authorization requirements, Alliance will implement this transition in phases. Access the complete list of services for which changes to prior authorization requirements will apply. This document outlines the phased approach for implementation, as well as the authorization guidelines for initial/concurrent/applicable pass-throughs.

The first set of services that will move back under prior authorization requirements includes Intensive In-Home, Peer Support, Community Support Team, and Mobile Crisis services for initial and/or concurrent requests. Prior authorization requirements for these services will go into effect February 1, 2026. Your agency can begin submitting requests for dates of service February 1, 2026 and beyond at this time. When submitting requests for these services, please include clinical information supporting treatment. The request should include, but is not limited to, current clinical information supporting the need for the service, complete treatment plans, service orders, and for concurrent requests, the history within the service and response to treatment (i.e., treatment progress, identified barriers, goal outcomes). To further support this transition, Alliance will also accept retrospective requests (for dates of service beginning February 1, 2026) until April 3, 2026. After this date, Alliance will follow established Medicaid policy related to retrospective requests and will not allow backdating.

Please continue to check Provider Updates in Provider Central on the Alliance Health website. All service authorization requirements are available in the Alliance Procedure Code look-up tool.

Temporary Change to Available Member Benefits

Alliance is putting a hold on authorizing in lieu of Long Term Community Supports, Levels 3-5, for members not previously authorized to receive these services. Members who already receive these services will not be impacted by this change. This change will go into effect on February 1, 2026.  Please continue to review provider announcements for any change to this action.  The following in lieu of service codes fall under the freeze:

• T2016 U5 U3 – Long Term Community Supports (LTCS), Level 3
• T2016 U5 U4 – Long Term Community Supports (LTCS), Level 4
• T2016 U5 U6 – Long Term Community Supports (LTCS), Level 5

This change will not affect in lieu of service Long Term Community Supports, Level 1 (T2016 U5 U1) and Level 2 (T2016 U5 U2), which are still available for members. 

All-Provider Meeting

This information will be reviewed at the next All-Provider Meeting scheduled for January 21.