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Medicaid B - Community Support Team (CST)

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About

Coverage

Medicaid B

Diagnosis Group(s)

Developmental Disability, Mental Health, Substance Use

Age Group(s)

18-20, Adult, Child

Reference Documents

Authorization

Submission Requirements

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)
  • Functional Assessment
  • Comprehensive Clinical Assessment (CCA) or CCA addendum if length of stay exceeds 6 months

Service Definition Authorization Parameters

  • No prior authorization required for first 36 units of service for 3 calendar days
  • Pass through available once per treatment episode per state fiscal year

Initial:

  • Up to 128 units/60 days
  • Up to 420 units/60 days if searching for stable housing

Concurrent:

  • Up to 192 units/90 days
  • Up to 630 units/90 days if searching for stable housing

COVID Prior Approval Flexibility:

  • Waive Prior Approval for Concurrent Requests

Locus Level

1 2 3 4 5 6
Green check Green check

ASAM Level of Care

2.1

Service Codes & Descriptions

  • H2015HT HF - CST LCAS, other SA
  • H2015HT HF CR CST LCAS, other SA
  • H2015HT HF GT CR CST LCAS, other SA
  • H2015 HT HM - CST Paraprofessional
  • H2015 HT HM CR - CST Paraprofessional
  • H2015 HT HM GT CR- CST Paraprofessional
  • H2015 HT HN - CST QP/AP
  • H2015 HT HN CR - CST QP/AP
  • H2015 HT HN GT CR- CST QP/AP
  • H2015 HT HO - CST Team Lead
  • H2015 HT HO CR - CST Team Lead
  • H2015 HT HO GT CR- CST Team Lead
  • H2015 HT U1 - CST NC Peer Support Specialist
  • H2015 HT U1 CR - CST NC Peer Support Specialist
  • H2015 HT U1 GT CR- CST NC Peer Support Specialist

Full Service Definition

<a target="_blank" href="https://medicaid.ncdhhs.gov/media/7926/open">Download PDF</a>