Family and Children's Medicaid MA-3540 Medicaid Covered Services
iX. RESIDENTIAL SERVICES
Refer to DMA’s website at http://www.dhhs.state.nc.us/dma/mp/mpindex.htm for specific coverage criteria, prior approval requirements, and service limitations.
A. Covered Services
1. Level II, III, IV - Residential Services
2. Psychiatric Residential Treatment Facility Services (PRTF)
1. This service is available for recipients under the age of 21 or who are in treatment at age 21. Continued treatment can be provided until the recipient turns 22 as long as it is medically necessary.
2. Residential services can be accessed through screening and triage at the mental health center or through a community supports provider after a diagnostic assessment has determined the need.
C. Prior Approval
1. It is the provider’s responsibility to obtain prior approval if needed. (Refer to II.G. for additional information.)
2. A referral is required for children under age 21 from the local management entity, Medicaid enrolled psychiatrist, or Carolina Access PCP.