ModifiedNorth Carolina MedicaidPolicy 8-A

Psychosocial Rehabilitation During Disaster

Customize your policy alerts

Sign up for North Carolina Medicaid Policy 8-A alerts

Get alerted when Policy 8-A changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

This policy governs an alternative or in-lieu-of Psychosocial Rehabilitation service for adults with mental health diagnoses during declared state or national disasters or emergencies when regular in-person services cannot be safely provided. It establishes eligible populations, remote and in-person service delivery, authorization, clinical criteria, documentation, staffing, billing, and utilization limits.

Policy Summary

PayerNorth Carolina Medicaid

PolicyPsychosocial Rehabilitation During Disaster

Policy CodePolicy 8-A

Change TypeModified

Effective DateN/A

Next Review DateN/A

Key ActionObtain LME-MCO authorization and include the service amount, duration, and frequency in the member’s person-centered plan before services are provided.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

18+Minimum member age

Up to 4015-minute units per week per person

$5.89Alternative PSR rate per 15-minute unit

90 daysMaximum initial authorization period

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

ModifiedNorth Carolina MedicaidPolicy 8-A

Psychosocial Rehabilitation During Disaster

Customize your policy alerts

Sign up for North Carolina Medicaid Policy 8-A alerts

Get alerted when Policy 8-A changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Policy Summary

PayerNorth Carolina Medicaid

PolicyPsychosocial Rehabilitation During Disaster

Policy CodePolicy 8-A

Change TypeModified

Effective DateN/A

Next Review DateN/A

Key ActionObtain LME-MCO authorization and include the service amount, duration, and frequency in the member’s person-centered plan before services are provided.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

18+Minimum member age

Up to 4015-minute units per week per person

$5.89Alternative PSR rate per 15-minute unit

90 daysMaximum initial authorization period

180 daysMaximum reauthorization period

DailyExpected contact or documented contact attempts for remote PSR members

Coverage Criteria

Entrance Criteria

The beneficiary is eligible for this service when all of the following criteria are met:

ALL of the following

A mental health diagnosis is present.
Level of Care Criteria are met.
At least TWO of the following are adversely affected
- Employment.
- Management of financial affairs.
- Ability to procure needed public support services.
- Appropriateness of social behavior.
- Activities of daily living.
The individual's level of functioning may indicate a need for psychosocial rehabilitation if the beneficiary has unmet needs related to recovery and regaining the skills and experience needed to maintain personal care, meal preparation, housing, or to access social, vocational, and recreational opportunities in the community.

Continued Stay Criteria

The beneficiary is eligible to continue this service if any of the following circumstances apply:

ANY of the following

The desired outcome or level of functioning has not been restored, improved, or sustained over the time frame outlined in the beneficiary's PCP.
The beneficiary continues to be at risk for relapse based on history or the tenuous nature of the functional gains.
The beneficiary has achieved initial rehabilitation goals in the PCP goals and continued services are needed in order to achieve additional goals.
The beneficiary is making satisfactory progress toward meeting rehabilitation goals.
The beneficiary is making some progress, but the specific interventions need to be modified so that greater gains, which are consistent with his or her rehabilitation goals, are possible or can be achieved.

PSR cannot be provided during the same authorization period with Partial Hospitalization or Assertive Community Treatment. The MCO may waive this exclusion during a period of state or national emergency if needed to support members during the period of crisis.

Coding and Payment

Psychosocial Rehabilitation During Disaster Procedure CodemixedCovered

H2017	Psychosocial Rehabilitation
U5	Modifier shown with the Psychosocial Rehabilitation During Disaster procedure code

Comparable State Plan Service Payment ArrangementHCPCS

H2017

Psychosocial Rehabilitation

Alternative Service Payment ArrangementmixedCovered

H2017	Psychosocial Rehabilitation During Disaster
22	Code shown after H2017 for the alternative service payment arrangement

Unit of Service

Unit of service15 minutes

ServicePsychosocial Rehabilitation (PSR) During Disaster

Rate per unit$5.89

Alternative Service Weekly Maximum

Weekly maximumUp to 40 units per week

Unit definition15-minute unit

Rate per unit

Provider Requirements and Action Items

Prior Authorization

LME-MCO Authorization Required

Authorization by the LME-MCO is required for PSR services. Utilization management must be performed by the LME-MCO.

The amount, duration, and frequency of services must be included in the individual's PCP and authorized on or before the day services are provided.
Initial authorization should not exceed 90 days.
Reauthorization should not exceed 180 days and must be documented in the service record.
Reauthorization requirements may be waived during a declared state or national emergency.

Documentation Required

PCP and Authorization Documentation

Before services are delivered, the provider must ensure the individual's PCP specifies the amount, duration, and frequency of PSR and that the services are authorized on or before the date of service.

Background

Psychosocial Rehabilitation (PSR) supports adults with psychiatric disabilities in improving community functioning, managing mental illness, developing independent-living skills, and pursuing functional, social, educational, and vocational goals. During declared disasters or emergencies, PSR may be delivered through in-person, telephonic, or telehealth approaches to maintain continuity of care. Recovery-oriented interventions may address symptom stability, coping, social supports, crisis prevention, and barriers such as housing, transportation, food, and medication access.

Definitions

Psychosocial Rehabilitation (PSR)

Population servedAdults with psychiatric disabilities

PurposeIncrease functioning so individuals can be successful and satisfied in environments of their choice

ApproachSkill and resource development related to community living and recovery, with the least amount of ongoing professional intervention

Telehealth

Communication formatReal-time communication

Communication directionTwo-way

Communication method

Level of Care Criteria

Treatment Modalities

Telephonic and Telehealth PSR

During a declared state or national emergency, PSR may be delivered through any of the following permitted approaches, subject to member consent and applicable telehealth and HIPAA requirements.

Permitted service delivery modalities

In-person service delivery.
Telephonic service delivery.
Telehealth service delivery using real-time, two-way audio and video communication.
Electronic or other communication approaches that support individualized service delivery during the emergency.

Evidence-Based Psychiatric Rehabilitation and Recovery Support

Visit and Utilization Limits

Psychosocial Rehabilitation During Disaster

ServicePsychosocial Rehabilitation During Disaster

Weekly limitUp to 40 units per week

Unit length15 minutes per unit

Policy Summary

PayerNorth Carolina Medicaid

PolicyPsychosocial Rehabilitation During Disaster

Policy CodePolicy 8-A

Change TypeModified

Effective DateN/A

Next Review DateN/A

Key ActionObtain LME-MCO authorization and include the service amount, duration, and frequency in the member’s person-centered plan before services are provided.

SourceLink

On This Page

The beneficiary is not making progress; the rehabilitation goals must be modified to identify more effective interventions.

The beneficiary is regressing; the PCP must be modified to identify more effective interventions.

Comparable State Plan Weekly Units

Weekly units100 per week

Unit definition15-minute unit

Cost per unit$2.69

Procedure codeH2017

Include the amount, duration, and frequency in the person-centered plan (PCP).
Obtain authorization on or before the day services are provided.
Document reauthorization in the service record when applicable; reauthorization should not exceed 180 days unless requirements are waived during a declared emergency.

Unsupported block type: documentation

Documentation Required

Weekly Full-Service Note

A weekly full-service note is required for each member and must document the services provided and support the time billed.

Document the date of service, communication modality, recipient's location, provider's location, and whether others were present.
Document consent for each means of communication and evidence that treatment and communication options were offered as choices.
Include sufficient detail to justify the time spent delivering the service each day.

Note

Coordinate Care and Prevent Duplication

Coordinate PSR with other behavioral health providers, including CST and outpatient treatment practitioners, to support effective care and prevent duplication of services.

Communicate with other behavioral health providers.
Adjust service frequency, duration, and focus as needed.
Avoid duplicating services and coordinate the member's overall plan of care.

Unsupported block type: denial_risk

Denial Risk

Entrance Criteria Not Met

The beneficiary is eligible for PSR only when all entrance criteria are met. If any required criterion is not satisfied, the service is not eligible and may be denied.

A mental health diagnosis must be present.
Level of Care Criteria must be met.
Impaired role functioning must adversely affect at least two of the following: employment; management of financial affairs; ability to procure needed public support services; appropriateness of social behavior; or activities of daily living.
The individual's functioning must indicate a need for psychosocial rehabilitation based on unmet recovery needs and the need to regain skills or experience for personal care, meal preparation, housing, or access to social, vocational, and recreational opportunities in the community.

Audio and video communication between PSR staff and members

Declared Disaster or Emergency

Qualifying emergencyA declared state, local, or national disaster or emergency

Facility-safety conditionRegular licensed facilities cannot be utilized safely

Additional conditionThe LME-MCO has decided to utilize a crisis alternative service definition

PSR interventions may include any of the following evidence-based psychiatric rehabilitation and recovery-support activities, individualized to the member's needs and continuity of care during the emergency.

Examples of PSR interventions

Wellness Management and Recovery or Wellness Recovery Action Planning.
Psychoeducation and related educational resources.
Case management and coordination of care.
Evaluation of social determinants of health and support addressing related barriers.
Crisis counseling, crisis response, and proactive crisis prevention.
Community-based outreach and supports when possible.
Education, leisure, independent-living skills, and socialization opportunities.