There are Federal changes to Medicaid and new laws are changing the rules for NC Medicaid. Some people with Medicaid will have to follow new rules to keep their coverage. For more information, visit Medicaid is Changing | NC Medicaid.

Effective July 1, 2026, WakeMed is no longer in Alliance’s network for Tailored Plan services. Services provided by WakeMed after this date may be treated as out-of-network. Get full details here.

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Non Medicaid: Clinically Managed Residential Services

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About

Coverage

Non-Medicaid (State)

Diagnosis Group(s)

Substance Use

Age Group(s)

Adults 18+, Child

Reference Documents

State-Funded Clinically Managed Residential Services

Authorization

Submission Requirements

Please refer to service definition for additional details regarding Authorization Submission Requirements.

Initial:

Service Authorization Request (SAR)
Comprehensive Clinical Assessment (CCA) or Diagnostic Assessment (to include ASAM Criteria Assessment)
Person Centered Plan (PCP) with Service Order

Concurrent:

Service Authorization Request (SAR)
Updated Person Centered Plan (PCP)
Updated ASAM Criteria Assessment

Authorization Duration and Limits

45 day maximum length of stay per episode

ASAM Level of Care

3.5

Request Prior Approval from Alliance Health

Service Codes & Descriptions

H0012 HA – Adolescent
H0012 HB – Adult
H0012 HD – Pregnant and Parenting

Full Service Definition

<a target="_blank" href="https://www.ncdhhs.gov/documents/state-funded-clinically-managed-residential-services/open">Download PDF</a>

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