8B , Inpatient Behavioral Health Services - ncdhhs 2025

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The document outlines the NC Division of Medical Assistance's Clinical Coverage Policy No: 8-B for Inpatient Behavioral Health Services under Medicaid and Health Choice. It details eligibility requirements, coverage criteria, limitations, and provider qualifications for inpatient treatment of beneficiaries with acute psychiatric or substance use disorders. The policy emphasizes the need for prior approval, documentation standards, and specific criteria for admission and continued stay in psychiatric facilities. Additionally, it includes provisions related to EPSDT for beneficiaries under 21 years of age and outlines billing procedures and service definitions.
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The number of therapy sessions Medicaid covers varies by state and individual plan. Some states may offer unlimited sessions, while others may have limits. For example: Some states cover up to 30 sessions per year.
The level of care and time to stabilization is developed by the multidisciplinary team and dependent on an individuals specific needs, but a typical adult stay is one week. A typical child/adolescent or older adult patient stay is two weeks due to specialized needs during and after the hospitalization.
Key Takeaways. Inpatient care is the most intensive treatment for mental health, referred to as the highest level of care. The two main types of inpatient mental health treatment are hospitalization and residential treatment.
NC Medicaid may help pay for certain medical expenses including: Doctor Bills. Hospital Bills. Prescriptions (Excluding prescriptions for Medicare beneficiaries) Vision Care. Dental Care. Medicare Premiums. Nursing Home Care. Personal Care Services (PCS), Medical Equipment, and Other Home Health Services.
On average, you might expect to pay between $500 and $2,000 per day for inpatient treatment. This can add up to $15,000 to $60,000 for a typical 30-day stay. Costs may include comprehensive care such as psychiatric evaluations, individual therapy, group sessions, and medication management.

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Most people receiving NC Medicaid must get health care services from a Standard Plan. Standard Plans offer physical health, pharmacy (prescriptions), care management and basic behavioral health services for members.
Behavioral health generally refers to mental health and substance use disorders, life stressors and crises, and stress-related physical symptoms. Behavioral health care refers to the prevention, diagnosis and treatment of those conditions.

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8-B Amended Date: May 1, 2025

Jun 1, 2023 Inpatient Behavioral Health Services provide hospital treatment in a hospital setting 24 hours a day. Supportive nursing and medical care are

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