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Medicaid B - Assertive Community Treatment Team (ACTT)

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About

Coverage

Medicaid B

Diagnosis Group(s)

Mental Health, Substance Use

Age Group(s)

18-20, Adult, Child

Authorization

Submission Requirements

Assertive Community Treatment Team (ACTT)

  • Initial: Service Authorization Request (SAR), Service Order, Comprehensive Clinical Assessment (CCA)
  • Concurrent: Service Authorization Request (SAR), Updated Person Centered Plan (PCP)

Assertive Community Treatment Team (ACTT) Step Down

  • Initial: Service Authorization Request (SAR), Service Order, Comprehensive Clinical Assessment (CCA)
  • Concurrent: Service Authorization Request (SAR), Updated Person Centered Plan (PCP)

Child Assertive Community Treatment Team (ACTT) H0040 HA U5 U1

  • Initial: Service Authorization Request (SAR), Person Centered Plan (PCP) with Service Order, Comprehensive Clinical Assessment (CCA)
  • Concurrent: Service Authorization Request (SAR), Updated Person Centered Plan (PCP)

Service Definition Authorization Parameters

Adult Assertive Community Treatment Team (ACTT)

  • Clinical Coverage Policy 8A-1
  • Initial: 6 months/4 units per month
  • Concurrent: 12 months/4 units per month

Adult Assertive Community Treatment Team (ACTT) Step Down

  • In Lieu of Service Definition
  • Initial: up to 6 months
  • Concurrent: up to 6 months
  • Billing limits of 2 units per month. Service must go through end of the month

Child Assertive Community Treatment Team (ACTT) H0040 HA U5 U1

  • Initial: 6 months/4 units per month
  • Concurrent: 1 month/4 units per month

COVID Prior Approval Flexibility
Adult ACTT and ACTT Step Down: Waive prior approval for concurrent requests

Authorization Guidelines

Locus Level

1 2 3 4 5 6
Green check Green check Green check

Calocus Level

1 2 3 4 5 6
Green check Green check

Service Codes & Descriptions

  • H0040 - Assertive Community Treatment Team/IDDT
  • H0040 CR - Assertive Community Treatment Team/IDDT
  • H0040 GT CR- Assertive Community Treatment Team/IDDT
  • H0040 HA U5 TS- ACTT Child- encounters
  • H0040 HA U5 U1- ACTT Child
  • H0040 TS - ACTT Step down
  • H0040 TS CR - ACTT Step down
  • H0040 TS GT CR- ACTT Step down

Full Service Definition

<a target="_blank" href="https://medicaid.ncdhhs.gov/media/7925/open">Download PDF</a>

Alliance Statement of Work