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NC Medicaid Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans will launch July 1, 2024. Choice period ends on May 15, 2024. Please call to select your PCP. Find PCPs available in our health plan.

Effective February 1, 2024, citizens of Harnett County are being served by Alliance Health. Access more information for or for providers.

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Medicaid B: Inpatient Hospitalization

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About

Coverage Information Icon

Medicaid Direct (Medicaid B)

Diagnosis Group(s) Information Icon

Developmental Disability, Mental Health, Substance Use

Age Group(s) Information Icon

18-20, Adults 18+, All, Child

Authorization

Submission Requirements Information Icon

Acute and Subacute Services Provided in an Institute for Mental Disease (IMD):

  • Service Authorization Request (SAR)

State Hospital Mental Health/Substance Abuse (MHSA) Inpatient:

  • Service Authorization Request (SAR)
  • Certificate of Need (CON) if under 21 years old
  • Comprehensive Clinical Assessment (CCA) or Diagnostic Assessment (DA)
  • I/DD exception form per Diversion Law, if applicable

Inpatient Hospital Substance Abuse Treatment:

  • Service Authorization Request (SAR)
  • Certificate of Need (CON) if under 21 years old for freestanding psychiatric facility
  • Comprehensive Clinical Assessment (CCA) or Diagnostic Assessment (DA)

Non-State Hospital Mental Health/Substance Abuse (MHSA) Inpatient:

  • Service Authorization Request (SAR)
  • Certificate of Need (CON) if under 21 years old for freestanding psychiatric facility
  • Comprehensive Clinical Assessment (CCA) or Diagnostic Assessment (DA)

Service Definition Authorization Parameters Information Icon

Acute and Subacute Services Provided in an Institute for Mental Disease (IMD):

  • Adults ages 21-64
  • Prior approval required

InitialUp to 7 days
Concurrent:  Up to 4 days

For MH admissions, authorization may not exceed 15 days per admission AND no more than 15 days per calendar month

State Hospital Mental Health/Substance Abuse (MHSA) Inpatient:

  • Under age 21 and Over age 64
  • Prior approval is not required upon admission through the first 72 hours of service

Initial: up to 7 calendar days
Concurrent: up to 7 calendar days

Inpatient Hospital Substance Abuse Treatment:

  • Children and Adults
  • Prior approval is not required upon admission through the first 72 hours of service

Initial: up to 7 calendar days
Concurrent: up to 3 calendar days

Non-State Hospital Mental Health/Substance Abuse (MHSA) Inpatient:

  • Children and Adults
  • Prior approval is not required upon admission through the first 72 hours of service

Initial: up to 7 calendar days
Concurrent: up to 3 calendar days

 

 

 

ASAM Level of Care Information Icon

4

Service Codes & Descriptions

  • 0101 All-inclusive room and board
  • 0114 Psychiatric
  • 0160 General
  • 0204 -All inclusive room and board
  • H2036- Medically Monitored Detox/AD

Full Service Definition

<a target="_blank" href="https://medicaid.ncdhhs.gov/8b-inpatient-behavioral-health-services/download?attachment">Download PDF</a>