In Lieu of Services Policy

In Lieu of Services (ILOS) are services that have been approved by the NC Department of Health and Human Services (NCDHHS) to be medically appropriate and cost-effective substitutes for covered services or setting under the State Medicaid Plan.

This policy ensures that In Lieu of Services made available to Alliance members are developed, approved, deployed, changed, terminated and administered according to NCDHHS requirements.

Alliance may offer ILOS, but members are not required to use an ILOS. Alliance will not offer any ILOS without written approval from NCDHHS, including ILOS that have been previously approved by NCDHHS.

Before offering ILOS services, Alliance will submit an ILOS Service Request Form for approval by NCDHHS. The same form will be submitted when Alliance wants to offer an ILOS previously approved by NCDHHS for another health plan.

Alliance will not change, reduce or remove ILOS without written approval from NCDHHS during a contract year.

Alliance will notify members of a change, removal, or reduction of ILOS by mail at least 30 days before the effective date of the change.

Alliance will update all marketing and educational material to reflect approved changes to ILOS at least 30 days before the effective date of the change.

Alliance monitors the cost-effectiveness of each approved ILOS by tracking utilization and expenditures at least quarterly or more frequently if overutilization or overspending is identified. ILOS monitoring will also be increased if requested by NCDHHS.