CurrentchocchildrenshospitalorangecountyhealthalliancePolicy 8H-2
Individual Placement and Support (IPS) - NC Core Alternative Payment Model
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Governs provision, documentation, reporting, utilization management, and billing of IPS services under the NC DHHS 1915(i) and State Funded IPS Service Definition for providers participating in the Alliance program.
Policy Summary
Payerchocchildrenshospitalorangecountyhealthalliance
PolicyIndividual Placement and Support (IPS) - NC Core Alternative Payment Model
Policy CodePolicy Policy 8H-2
Change TypeNo material changes
Effective DateNov 1, 2024
Last ReviewNov 1, 2024
Next Review DateN/A
Key ActionUpload Network Evaluation approval letter to the Alliance Claims System (ACS) prior to billing for milestones that require review and approval.
SourceLink
POLICY UPDATE CHANGES
No material clinical or coverage changes in this revision.
$2,120Milestone 1 (Engagement) rate
$4,240Milestone 2 (Career Profile) rate
10 business daysNetwork Evaluation review turnaround
$1,590Milestone 6 monthly rate
Milestone payment and documentation requirements
Milestone payment and documentation criteria
Milestone payments are available for specified IPS activities; some milestones require review and approval by Network Evaluation Staff with an approval letter uploaded to the Alliance Claims System (ACS) prior to billing. Documentation requirements vary by milestone.
Milestone 1 - Engagement; Funder: Alliance; Rate: $2,120; Frequency: Once per provider per episode; Authorization: No prior authorization required; Documentation: Not specified in milestone text.
Milestone 2 - Career Profile; Funder: Alliance; Rate: $4,240; Frequency: Once per provider per episode; Authorization: No prior authorization required; Documentation: Not specified in milestone text.
Milestone 3A - IPS Job Search; Funder: EIPD; Rate: $2,910; Frequency: Multiple; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: progress notes showing job search activities or development of tools to aid job search; Job Search Log with application date, employer, position, method of submission, and follow-up details; Copy of Job Search Plan from the Career Profile; Job start and job support plan if employment secured.
Milestone 3B - Employer Networking; Funder: EIPD; Rate: $3,410; Frequency: Multiple; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: evidence of a minimum of 12 face-to-face meetings with employers (priority to IPE and Career Profile vocational goal); copy of job search plan in Career Profile; employer contact log including date, employer, point of contact, contact details, purpose, and outcome.
Milestone 3C - IPS Job Placement; Funder: EIPD; Rate: $2,160; Frequency: Multiple; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: three progress notes showing face-to-face contact and interventions supporting job retention.
Milestone 4 - Job Support & Vocational Recovery; Funder: EIPD; Rate: $4,240; Frequency: Multiple; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: progress notes or summaries documenting interventions and progress supporting job retention; documentation of discussion with VR Counselor and agreement on date of vocational recovery.
Milestone 5A - Vocational Recovery + 30 days; Funder: EIPD; Rate: $2,120; Frequency: Multiple; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: progress notes or monthly summary showing minimum of two face-to-face contacts including updates on work satisfaction or issues impacting job retention for 30 days after outcome.
Milestone 5B - Vocational Recovery + 60 days; Funder: EIPD; Rate: $2,120; Frequency: Multiple; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: progress notes or monthly summary showing minimum of two face-to-face contacts including updates on work satisfaction or issues impacting job retention for 60 days after outcome.
Milestone 5C - Vocational Recovery + 90 days; Funder: EIPD; Rate: $2,120; Frequency: Multiple; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: progress notes or monthly summary showing minimum of two face-to-face contacts including updates on work satisfaction or issues impacting job retention for 90 days after outcome.
Milestone 6 - Long-term Follow-Along; Funder: Alliance; Rate: $1,590 per month; Frequency: Once per calendar month, time unlimited; Authorization: No prior authorization required; Documentation: Not specified in milestone text.
Milestone 7 - Career Advancement; Funder: Alliance; Rate: $743; Frequency: Three times per provider per episode; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: documentation that the individual has received a promotion (internal or external).
Milestone 8 - Educational Advancement; Funder: Alliance; Rate: $1,060; Frequency: Three times per provider per episode; Authorization: Review/Approved by Network Evaluation Staff; Provider must submit Network Evaluation approval letter in ACS at time of claim submission; Documentation required for review: documentation of GED/HS equivalency completion and/or short-term certification up to 6 months, or end-of-semester documentation of participation in higher education or longer certification.
Milestone 9 - Vocational Recovery & Independence / Successful IPS Closure; Funder: Alliance; Rate: $1,590; Frequency: Once per provider per episode; Authorization: No prior authorization required; Documentation: Not specified in milestone text.
Submission and review process for milestones requiring Network Evaluation approval: For milestones to be reviewed by Network Evaluation, all required documentation must be submitted to PNDPROVIDERREPORTS@alliancehealthplan.org with the email subject line containing Provider Name and Milestone Number. Network Evaluation will review submitted documents within 10 business days. Upon successful review an approval letter will be emailed to the provider; the provider must upload the approval letter in ACS as proof of eligibility for the milestone payment before billing using the associated milestone code.
Billing codes and review timeframes
IPS milestone billing codes (mixed funders)mixedCovered
| H2023 U4 | Medicaid 1915(i) IPS/NC Core billing code |
| 1915i-M1 | 1915i - Milestone 1 - Engagement |
| 1915i-M2 | 1915i - Milestone 2 - Intake/Career Assessment |
| 1915i-M3A | 1915i - Milestone 3A - IPS Job Search, EIPD Ineligible |
| 1915i-M3B | 1915i - Milestone 3B - IPS Employer Networking, EIPD Ineligible |
| 1915i-M3C | 1915i - Milestone 3C - IPS Job Placement + 3 Days Support, EIPD Ineligible |
| 1915i-M4 | 1915i - Milestone 4 - Job Support/Vocational Recovery, EIPD Ineligible |
| 1915i-M5A | 1915i - Milestone 5A - Vocational Recovery + 30 Days, EIPD Ineligible |
| 1915i-M5B | 1915i - Milestone 5B - Vocational Recovery + 60 Days, EIPD Ineligible |
| 1915i-M5C | 1915i - Milestone 5C - Vocational Recovery + 90 Days, EIPD Ineligible |
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Network Evaluation documentation review timeframe
Network Evaluation review timeframeNetwork Evaluation will review all submitted milestone documentation within 10 business days.
Submission instructionsAll required documentation for milestones reviewed by Network Evaluation must be emailed to PNDPROVIDERREPORTS@alliancehealthplan.org with the subject line: Provider Name and Milestone Number.
Approval letter requirementUpon successful review, Network Evaluation will email an approval letter to the provider; the provider must upload this approval letter to the Alliance Claims System (ACS) before billing the milestone code.
Billing after approvalAuthorization is not required, but the approval letter must be uploaded to ACS as proof of eligibility before billing the milestone using the associated milestone code (1915i-M1..M9 / SFS-M1..M9).
Documentation destination and proofProviders must include evidence required by each milestone (e.g., progress notes, job search logs, employer contact logs, promotion or education documentation) with their submission to Network Evaluation as specified by the milestone criteria.
Authorization, approval, and claims submission
Prior Authorization
Milestone approval / authorization process — upload Network Evaluation approval letter to ACS before billing
Certain IPS milestones require Network Evaluation Staff review and issuance of an approval letter that the provider must upload to the Alliance Claims System (ACS) before billing; other milestones do not require prior authorization. Network Evaluation will review submitted documentation within 10 business days. Providers must submit the approval letter in ACS at the time of claim submission for milestones designated as “Review/Approved by Network Evaluation Staff.”
- Milestones that require Network Evaluation review and an approval letter to be uploaded to ACS before billing include Milestone 3A (Job Search), Milestone 3B (Employer Networking), Milestone 3C (Job Placement), Milestone 4 (Job Support & Vocational Recovery), Milestone 5A/5B/5C (Vocational Recovery post-outcome periods), Milestone 7 (Career Advancement), and Milestone 8 (Educational Advancement).
- Milestones with “No prior authorization required” include Milestone 1 (Engagement), Milestone 2 (Career Profile), Milestone 6 (Long-term Follow-Along), and Milestone 9 (Successful IPS Closure) per milestone text.
- Network Evaluation Staff provide an approval letter that the provider must submit in ACS at time of claim submission; Network Evaluation will review documents within 10 business days.
Key program definitions
IPS services (definition & requirements)
DefinitionIndividual Placement and Support (IPS) services as defined by NC DHHS Clinical Coverage Policy 8H-2 or the State Funded IPS Service Definition.
Program requirementProviders must adhere to NC DHHS Clinical Coverage Policy 8H-2 (1915(i) IPS) or the State Funded IPS Service Definition when providing IPS services.
EIPD vendor requirementIPS providers must be vendors of NC DHHS Employment and Independence for People with Disabilities (EIPD) and are required to refer all individuals to EIPD at initiation of services.
Steering committeeIPS providers will develop a steering committee that includes representatives from all stakeholder groups to oversee implementation and educate stakeholders about the practice.
EIPD (Employment and Independence for People with Disabilities)
EIPD definitionNC DHHS Employment and Independence for People with Disabilities (EIPD).
Vendor & referral requirementIPS providers must be vendors of EIPD and refer all individuals to EIPD at the initiation of services.
Role in milestonesSeveral milestones (e.g., Milestone 3 and 5 series) are funded by or require coordination with EIPD per milestone specifications.
Policy Summary
Payerchocchildrenshospitalorangecountyhealthalliance
PolicyIndividual Placement and Support (IPS) - NC Core Alternative Payment Model
Policy CodePolicy Policy 8H-2
Change TypeNo material changes
Effective DateNov 1, 2024
Last ReviewNov 1, 2024
Next Review DateN/A
Key ActionUpload Network Evaluation approval letter to the Alliance Claims System (ACS) prior to billing for milestones that require review and approval.
SourceLink
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