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Innovations Specialized Consultative Services

Licensed Independent Professionals (LIPs) to provide Innovations Specialized Consultative Services that supply expertise, training and technical assistance in a specialty area to assist family members, support staff and other natural supports in assisting Innovations beneficiaries with developmental disabilities who have long-term intervention needs.

• Interested LIPs should have at least one year of documented experience in writing behavior intervention plans for the I/DD population and meet the qualifications in the service definition, Clinical Coverage Policy 8P.
• Interested LIPs should complete the Provider Application Request and submit it with a current CV.

TBI Waiver Service Needs

Specialized Consultative Services

Who Can Provide Per the Waiver:

• Provider Agency: National Accreditation Required
• Individual Independent Practitioners-Licensure specific to discipline, if applicable

Waiver Definition:

Specialized Consultation Services provide expertise, training and technical assistance in a specialty area:

Specialty Areas: Neuro/psychology, behavior intervention, speech therapy, therapeutic recreation, augmentative communication, assistive technology equipment, occupational therapy, physical therapy, nutrition, and other licensed professionals who possess experience with individuals with traumatic brain injury

Service Goal: to assist family members, support staff and other natural supports in assisting individuals with traumatic brain injury

Minimum Requirements:

• A minimum of 500 hours supporting individuals with TBI
• Staff must hold appropriate NC license for physical therapy, occupational therapy, speech therapy, psychology, behavioral analysis (licensure subject to psychology board implementation date) and nutrition; state certification for recreational therapy; board certified behavior analyst-MA; master’s degree and expertise in augmentative communication; state certification in assistive technology.
• Qualified in the customized need of the beneficiaries as described in the Individual Support Plan
• Must be enrolled in NCTracks

Interested providers please submit the TBI Waiver – Allied Health Provider and Specialized Consultative Application Request, Agency Summary or CV that demonstrates the minimum of 500 hours supporting individuals with TBI, copy of appropriate license(as applicable), and copy of national accreditation (as applicable).

Allied Health: Physical Therapy, Occupational Therapy and Speech and Language Therapy

Who Can Provide Per the Waiver:

• PT/OT/SLP Provider Agencies
• Individual Licensed Therapists

Staff must hold appropriate NC license for Occupational Therapy, Physical Therapy, or Speech and Language Therapy.

Service Definition:

Occupational Therapy: The goal of Occupational therapy is to assist individual with TBI achieve greater independence by regaining physical, perceptual, and cognitive skills through exercises and other related activities.

Speech and language Therapy: The goal of Speech and Language Therapy is to assist individuals with TBI who have difficulties with communication, eating, drinking or swallowing.

Physical Therapy: Physical Therapy is a treatment approach to assist individuals with TBI that addresses the promotion of sensor motor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation

Waiver Minimum Allied Health Requirements:

• A minimum of 500 hours supporting individuals with TBI
• Staff must hold appropriate NC license for physical therapy, occupational therapy, speech therapy
• Qualified in the customized need of the beneficiaries as described in the Individual Support Plan
• Must be enrolled in NCTracks

Interested providers please submit the TBI Waiver Provider Application Request, Agency Summary or CV that demonstrates the minimum of 500 hours supporting individuals with TBI, and copy of appropriate license (as applicable).

Research Based Behavioral Health Treatment(RB-BHT) for Autism Spectrum Disorder(ASD)

Research-Based-Behavioral Health Treatments (RB-BHT) services are researched-based behavioral intervention services that prevent or minimize the disabilities and behavioral challenges associated with Autism Spectrum Disorder (ASD) and promote, to the extent practicable, the adaptive functioning of a beneficiary. RB-BHT demonstrate clinical efficacy in treating ASD: prevent or minimizes the adverse effects of ASD; and promote, to the maximum extent possible, the functioning of a beneficiary.

Providers are expected to meet the requirements of the NC Medicaid Clinical Coverage Policy 8F and Alliance credentialing, enrollment and contracting requirements to include being enrolled in NCTracks.

Interested providers should complete the Provider Application request and submit to providerhelpdesk@alliancehealthplan.org for consideration.

New Medication-Assisted Treatment (MAT: Buprenorphine) Service Definition Modifiers for Medicaid-Funded Outpatient Services

Alliance has developed a new service definition modifier to support implementation of evidence-based Medication-Assisted Treatment for individuals diagnosed with Opioid Use Disorder. This service must be provided by psychiatrists who have been approved to prescribe buprenorphine (including monotherapy or FDA-approved buprenorphine combination therapies) and who adhere to evidence-based treatment requirements as described in the Scope of Work.

The new service codes are modifications of existing psychiatry evaluation and management (E&M) codes and will be reimbursed at a higher rate than existing E&M codes to cover the additional provider expenses associated with fidelity to medication-assisted treatment requirements. Eligible providers include Licensed Independent Practitioner (LIP) psychiatrists and provider agencies. Providers who are interested in adding this service to their contracts must meet the following requirements:

1. Psychiatrist with an office in the Alliance Behavioral Healthcare catchment area.
2. Provider must submit documentation demonstrating that psychiatrist has been approved by the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to prescribe buprenorphine.
3. Provider must submit policies and procedures specific to opioid treatment and a program overview that describes how the program will adhere to MAT requirements as described in the Scope of Work.

Please submit a Provider Application Request with attachments noted in numbers 2 and 3 above.