Provider Rates Update: January 1, 2024

Alliance is updating its behavioral health rates to reflect the recent increases published by DHHS in accordance with the below announcement.

https://medicaid.ncdhhs.gov/blog/2023/11/15/nc-medicaid-behavioral-health-services-rate-increases

Immediate Action

Medicaid Direct Services

Rates will be posted by December 1, 2023, for the following services with increases becoming effective as of January 1, 2024.

Including:

• Behavioral health residential (levels I-IV)
• Diagnostic assessment
• Research Based Intensive Behavioral Health Treatment (RBI-BHT)
• Crisis Services, including Mobile Crisis Management and Facility-Based Crisis
• Community Support Team (CST)
• Assertive Community Treatment (ACT)
• Intensive In-Home Services (IIHS)
• Partial hospitalization
• Child and adolescent day treatment
• Psychosocial Rehabilitation (Psych Rehab)
• Peer Support
• In Lieu of Services (ILOSs)

TBI 1915(c) Waiver Services

Rates will be posted by December 1, 2023, for January 1, 2024, rates.

Innovations Rates

Rates will be posted by December 1, 2023, for retroactive July 1, 2023, rates.

Coming Soon…

1915(b)(3) and 1915i Services

Updates to the fee schedule will be posted as the conversion from 1915(b)(3) to 1915i is complete. Alliance will adhere to rate increases published by DHHS.

Innovations Waiver Services

Innovations rates have increased retroactively to July 1, 2023. Alliance is taking the necessary steps to implement these increases and to reprocess any affected claims. The new rates will be in our claims system (ACS) as of December 1, 2023. Further communication will be forthcoming concerning the reprocessing of claims.

Providers are encouraged to bill the higher rates for dates of service beginning December 1 so as to minimize the claims that need to be reprocessed.

Outpatient Services

Outpatient behavioral health, including psychotherapy, crisis psychotherapy, family/group therapy, diagnostic evaluations, developmental/psychological testing, and various evaluation and management E&M office visits/consultations performed by psychiatrist or psychiatric nurse practitioner.

Inpatient behavioral health services

Alliance will communicate directly with impacted providers upon review of released rates by DHHS.

Special Note

Rate Floor Guidance

Rate floors are the department-established minimum rate at which PHPs and LME/MCOs are required contractually to reimburse Medicaid providers (“no less than 100 percent of the applicable rate”), unless the PHPs and LME/MCOs and the provider mutually agree to an alternative reimbursement agreement.

Please refer to the “Billing and Reimbursement” article of your provider network contract for the following language: “Alliance will pay the provider the lesser of the provider’s current usual and customary charges or Alliance’s established rate for services.”