Intensive In-Home Services (CMH)

Intensive In-Home Services (CMH)

Intensive In-Home (IIH) service is a team approach designed to address the identified needs of children and adolescents, who 

due to serious and chronic symptoms of an emotional, behavioral, and/or substance use disorders, are unable to remain stable 

in the community without intensive interventions. This service may only be provided to individuals through age 20. This 

medically necessary service directly addresses the recipient’s mental health and/or substance-related diagnostic and clinical 

needs. The needs are evidenced by the presence of a diagnosable mental, behavioral, or emotional disturbance (as defined 

by DSM-IV-TR and its successors), with documentation of symptoms and effects reflected in the comprehensive clinical 

assessment and the Person Centered Plan. This team provides a variety of clinical rehabilitative interventions available 24 

hours a day, 7 days a week, 365 days a year.

This is a time-limited, intensive child and family intervention based on the clinical needs of the youth (through the age of 20 for 

Medicaid-funded services and through the age of 17 for State-funded services). The service is intended to:

▪ reduce presenting psychiatric or substance abuse symptoms, 

▪ provide first responder intervention to diffuse current crisis, 

▪ ensure linkage to community services and resources, and 

▪ prevent out of home placement for the child.

IIH services are authorized for one individual child in the family. The parent/caregiver must be an active participant in the

treatment. The team provides individualized services that are developed in full partnership with the family. Effective 

engagement, including cultural sensitivity, is essential in providing services in the family’s living environment. Services are 

generally more intensive at the beginning of treatment and decrease over time as the youth’s skills develop.

This team service includes a variety of interventions that are available 24 hours a day, 7 days a week, 365 days a year and 

are delivered by the IIH staff, who maintain contact and intervene as one organizational unit. IIH services are provided through 

a team approach; however, any one or more team members as clinically indicated may deliver discrete interventions. Not all 

team members are required to provide direct intervention to each child on the caseload. The Team Leader must provide direct 

clinical interventions with each child. The team approach involves structured, face-to-face, scheduled therapeutic interventions 

to provide support and guidance across multiple functional domains including emotional, medical and health. This service is 

not delivered in a group setting.

IIH services are delivered to children and adolescents, primarily in their living environments, with a family focus, and include 

but are not limited to the following interventions as clinically indicated:

▪ Individual and family therapy 

▪ Substance abuse treatment interventions 

▪ Developing and implementing a home-based behavioral support plan with the youth and his or her caregivers 

▪ Psychoeducation, which imparts information to the recipients, families, caregivers, and/or other

▪ Individuals involved with the recipient’s care about the recipient’s diagnosis, condition, and treatment.

▪ Intensive case management, assessment, planning, linkage and referral to paid and natural supports monitoring and 

follow up

▪ Arranges for psychological and psychiatric evaluations 

▪ Crisis management

The IIH Team shall provide “first responder” crisis response, as indicated in the Person Centered Plan, 24 hours a day, 7 days 

a week, 365 days a year to recipients of this service.

In partnership with the youth, his or her family, and the legally responsible person, as appropriate, the Licensed or Qualified 

Professional is responsible for convening the Child and Family Team, which is the vehicle for the person-centered planning 

process. The Licensed or Qualified Professional is responsible for monitoring and documenting the status of the recipient’s 

progress and the effectiveness of the strategies and interventions outlined in the Person Centered Plan. The Licensed or 

Qualified Professional consults with identified medical (such as primary care and psychiatric) and non-medical providers [for 

example, the county department of social services (DSS), school, the Department of Juvenile Justice and Delinquency 

Prevention (DJJDP)], engages community and natural supports, and includes their input in the person-centered planning 

process.

For Medicaid-funded IIH services, a signed service order shall be completed by a physician, licensed psychologist, physician 

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assistant, or nurse practitioner according to his or her scope of practice and shall be accompanied by other required 

documentation as outlined elsewhere in this policy (DMA Clinical Coverage Policy 8A, Enhanced Mental Health and Substance 

Abuse Services). Each service order shall be signed and dated by the authorizing professional and shall indicate the date on 

which the service was ordered. A service order shall be in place prior to or on the day that the service is initially provided in 

order to bill Medicaid for the service. The service order shall be based on a comprehensive clinical assessment of the recipient’s 

needs. For State-funded services, it is recommended that a service order be completed prior to or on the day that the service 

is initially provided.

Provider Requirements

IIH services shall be delivered by practitioners employed by mental health or substance abuse provider organizations that

▪ meet the provider qualification policies, procedures, and standards established by DMA; 

▪ meet the provider qualification policies, procedures, and standards established by the Division of Mental Health, 

Developmental Disabilities and Substance Abuse Services (DMH/DD/SAS); and

▪ fulfill the requirements of 10A NCAC 27G.

These policies and procedures set forth the administrative, financial, clinical, quality improvement, and information services 

infrastructure necessary to provide services. Provider organizations shall demonstrate that they meet these standards by being 

endorsed by the Local Management Entity (LME). As part of the endorsement, the Provider must notify the LME of the 

therapies, practices, or models that the provider has chosen to implement. Additionally, within one year of enrollment as a 

provider with DMA, the organization shall achieve national accreditation with at least one of the designated accrediting 

agencies. (Providers who were enrolled prior to July 1, 2008, shall have achieved national accreditation within three years of 

their enrollment date.) The organization shall be established as a legally constituted entity capable of meeting all of the 

requirements of the Provider Endorsement, Medicaid Enrollment Agreement, Medicaid Bulletins, and service implementation 

standards.

For Medicaid services, the organization is responsible for obtaining prior authorization from Medicaid’s approved vendor for 

medically necessary services identified in the Person Centered Plan. For State- funded services, the organization is 

responsible for obtaining prior authorization from the LME. The IIH service provider organization shall comply with all applicable 

federal and state requirements. This includes, but is not limited to, DHHS statutes, rules, policies, and Implementation Updates; 

Medicaid Bulletins; and other published instruction.

Staffing Requirements

All treatment shall be focused on, and for the benefit of, the eligible recipient of IIH services. The service model requires that 

IIH staff provide 24-hour-a-day coverage, 7 days a week, 365 days a year. This service model is delivered by an IIH team 

comprised of one full-time equivalent (FTE) team leader and at least two additional full-time equivalent positions as follows:

▪ one FTE team leader who is a Licensed Professional who has the knowledge, skills, and abilities required by the 

population and age to be served (may be filled by no more than two individuals). A provisionally licensed or boardeligible Qualified Professional actively seeking licensure may serve as the team leader conditional upon being fully 

licensed within 30 months from the effective date of this policy. For provisionally licensed team leaders hired after the 

effective date of this policy, the 30- month timeline begins at date of hire.

AND

▪ one FTE Qualified Professional who has the knowledge, skills, and abilities required by the population and age to be 

served (may be filled by no more than two individuals).

AND

▪ one FTE Qualified Professional or Associate Professional who has the knowledge, skills, and abilities required by the 

population and age to be served (may be filled by no more than two individuals).

For IIH services focused on substance abuse interventions, the team shall include at least one Certified Clinical Supervisor 

(SIC), Licensed or Provisionally Licensed Clinical Addiction Specialist (LCAS), or Certified Substance Abuse Counselor 

(CSAC) as a member of the IIH team. 

All staff providing Intensive In-Home Services to children and families must have a minimum of one (1) year documented 

experience with this population.

No IIH Team member who is actively fulfilling an IIH Team role may contribute to the staffing ratio required 

for another service during that time. When fulfilling the responsibilities of IIH services, the staff member 

shall be fully available to respond in the community.

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The Department of Health and Human Services, Division of Medical Assistance hereby provides notice of its intent to amend 

the Medicaid State Plan pages Attachment 4.19-B, Section 13, Page 7 and Attachment 4.19-B, Supplement 6, Page 7. 

Effective October 1, 2014, the team-to-family ratio in the Intensive In-Home (IIH) service definition is revised from 1:8 to 1:12. 

Effective January 1, 2015, the reimbursement rate for IIH is reduced by 1%. This change in methodology is required by 

Sections 12H.4 and 12H.14A of Session Law 2014 – 100.

The Team Leader is responsible for the following: 

▪ Providing individual and family therapy for each youth served by the team 

▪ Designating the appropriate team staff such that specialized clinical expertise is applied as clinically indicated for each 

child

▪ Providing and coordinating the assessment and reassessment of the recipient’s clinical needs 

▪ Providing clinical expertise and guidance to the IIH team members in the team’s interventions with the recipient 

▪ Providing the clinical supervision of all members of the team for the provision of this service. An individual supervision 

plan is required for all IIH team members exclusive of the Team Leader

The Licensed or Qualified Professional has responsibility for the following: 

▪ Coordinates and oversees the initial and ongoing assessment activities 

▪ Convening the Child and Family Team for person-centered planning 

▪ Completing the initial development and ongoing revision of the Person Centered Plan and ensuring its implementation 

▪ Consulting with identified medical (for example, primary care and psychiatric) and non-medical (for example, DSS, 

school, DJJDP) providers, engaging community and natural supports, and including their input in the person-centered 

planning process 

▪ Ensuring linkage to the most clinically appropriate and effective services including arranging for psychological and 

psychiatric evaluations 

▪ Providing and coordinating behavioral health services and other interventions for the youth or other family members 

with other licensed professionals and Child and Family Team members. 

▪ Monitoring and documenting the status of the recipient’s progress and the effectiveness of the strategies and 

interventions outlined in the Person Centered Plan

All IIH staff have responsibility for the following under the direction of the team leader: 

▪ Participating in the person-centered planning process 

▪ Assisting with implementing a home-based behavioral support plan with the youth and his or her caregivers as 

indicated in the Person Centered Plan 

▪ Providing psycho-education as indicated in the Person Centered Plan 

▪ Assisting the team leader in monitoring and evaluating the effectiveness of interventions, as evidenced by symptom 

reduction and progress toward goals identified in the Person Centered Plan 

▪ Assisting with crisis interventions 

▪ Assisting the team leader in consulting with identified providers, engaging community and natural supports, and 

including their input in the person-centered planning process

The team leader shall supervise all members of the IIH services team. Persons who meet the requirements specified for 

Qualified Professional or Associate Professional status according to 10A NCAC 27G .0104 and who have the knowledge, 

skills, and abilities required by the population and age to be served may deliver IIH services. Family members or legally 

responsible persons of the recipient may not provide these services for reimbursement.

Note: Supervision of IIH staff is covered as an indirect cost and therefore should not be billed separately as an IIH service.

Staff Training

The following are the requirements for training staff in IIH:

All IIH Team Staff

1. Within 30 days of hire to provide IIH services, all staff shall complete the following training requirements:

▪ 3 hours of training in the IIH service definition required components 

▪ 3 hours of crisis response training 

▪ 3 hours of PCP Instructional Elements (required for only IIH Team Leaders and IIH QP staff responsible for 

PCP) training

AND

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2. Within 90 days of hire to provide this service, or by June 30, 2011 for staff who were currently working as 

an IIH Team member as of January 1, 2011, all IIH staff must complete the following training requirements:

IIH staff must complete 24 hours* of training (a minimum of 3 days) in one of the designated therapies, 

practices or models below specific to the population(s) to be served by each IIH Team. The designated 

therapies, practices or models are as follows:

▪ Cognitive Behavior Therapy or

▪ Trauma-Focused Therapy (For Example: Seeking Safety, Trauma Focused CBT, Real Life Heroes) or 

▪ Family Therapy (For Example: Brief Strategic Family Therapy, Multidimensional Family Therapy, Family 

Behavior Therapy, Child Parent Psychotherapy, or Family Centered Treatment)

The Ship Group Community Services has adopted Cognitive Behavior Therapy as our treatment 

modality.

A. Practices or models must be treatment focused, not prevention focused. 

B. Each practice or model chosen must specifically address the treatment needs of the population to be served by each 

IIH. 

C. Cognitive Behavior Therapy training must be delivered by a licensed professional. 

D. Trauma-focused therapy and family therapy training must be delivered by a trainer who meets the qualifications of the 

developer of the specific therapy, practice or model and meets the training standard of the specific therapy, practice or 

model. If no specific trainer qualifications are specified by the model then the training must be delivered by a licensed 

professional.

* Licensed professionals (LP) who have documented evidence of post-graduate training in the chosen qualifying practice 

(identified in this clinical coverage policy) dated no earlier than March 20, 2006 may count those training hours toward the 24-

hour requirement. It is the responsibility of the LP to have clearly documented evidence of the hours and type of training 

received.

Licensed (or provisionally licensed, under supervision) staff shall be trained in and provide the aspects of these practice(s) or 

model(s) that require licensure, such as individual therapy or other therapeutic interventions falling within the scope of practice 

of licensed professionals. It is expected that licensed (or provisionally licensed, under supervision) staff will practice within their 

scope of practice.

Non-licensed staff [Qualified Professionals and Associate Professionals] shall be trained in and provide only the aspects of 

these practice(s) or model(s) that do not require licensure and are within the scope of their education, training, and expertise. 

Non-licensed staff will practice under supervision according to the service definition. It is the responsibility of the licensed (or 

provisionally licensed, under supervision) supervisor and the CABHA Clinical Director to ensure that the non-licensed staff 

practice within the scope of their education, training, and expertise and are not providing any services that require licensure.

All follow up training, clinical supervision, or ongoing continuing education requirements for fidelity of the clinical model or 

EBP(s) must be followed.

AND

3. On an annual basis, follow up training and ongoing continuing education for fidelity to the chosen modality 

(Cognitive Behavioral Therapy, Trauma Focused Therapy, Family Therapy) is required. If no requirements have 

been designated by the developers of that modality, a minimum of 10 hours of continuing education in components 

of the selected modality must be completed annually. The Ship Group Community Services has adopted

Cognitive Behavioral Therapy.

IIH Team Leaders

1. In addition to the training required for all IIH staff, IIH Team Leaders, within 90 days of hire to provide this 

service, or by March 31, 2011 for staff who were currently working as an IIH Team member as of January 1, 

2011, must complete the following training requirements: 

▪ 13 hours of Introductory Motivational Interviewing (MI) training by a MINT Trainer** (mandatory 2-day training). 

▪ 11 hours of Introduction to System of Care Training 

▪ 12 hours of Person Centered Thinking (PCT) training from a Learning Community for Person Centered Practices 

certified PCT trainer. 

o All new hires to IIH must complete the full 12-hour training. 

o Staff who previously worked in IIH for another agency and had six (6) hours of PCT training under the old requirement 

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will have to meet the 12-hour requirement when moving to a new company. The 12-hour PCT training will be portable if 

an employee changes jobs anytime after completing the 12-hour requirement, as long as there is documentation of such 

training in the new employer’s personnel records. 

o Staff who previously worked in IIH within the same agency and had six (6) hours of PCT training under the old

requirement may complete the additional six (6) hour PCT/Recovery training curriculum when available as an alternative 

to the full 12-hour training; if not, then the full 12- hour training must be completed.

AND

2. Within 90 days of hire to provide this service, or by June 30, 2011 for staff who were currently working as 

an IIH Team member as of January 1, 2011, all IIH Team Leaders shall complete all supervisory level training 

required by the developer of the designated therapy, practice or model. If no specific supervisory level training 

exists for the designated therapy, practice, or model, then all IIH Team Leaders must complete a minimum of 12 

hours of clinical supervision training.

All Non-Supervisory IIH Staff (QPs and APs)

In addition to the training required for all IIH staff, non-supervisory IIH staff, within 90 days of hire to provide this 

service, or by June 30, 2011 for staff who were currently working as an IIH Team member as of January 1,

2011, will complete the following training requirements:

▪ 13 hours of Introductory Motivational Interviewing (MI) training by a MINT Trainer** (mandatory 2-day training)

▪ 11 hours of Introduction to System of Care Training 

▪ 12 hours of Person Centered Thinking training from a Learning Community for Person Centered Practices certified 

PCT trainer. 

▪ All new hires to IIH must complete the full 12-hour training. 

▪ Staff who previously worked in IIH for another agency and had six (6) hours of PCT training under the old 

requirement will have to meet the 12-hour requirement when moving to a new company. The 12-hour 

PCT training will be portable if an employee changes jobs anytime after completing the 12-hour 

requirement, as long as there is documentation of such training in the new employer’s personnel records. 

Staff who previously worked in IIH within the same agency and had six (6) hours of PCT training under 

the old requirement may complete the additional six (6) hour PCT/Recovery training curriculum when 

available as an alternative to the full 12-hour training; if not, then the full 12-hour training must be 

completed.

Motivational Interviewing and all selected therapies, practices and models must be designated in the provider’s program 

description. All staff shall be trained in Motivational Interviewing as well as the other practice(s) or model(s) identified above 

and chosen by the provider. All training shall be specific to the role of each staff member and specific to the population served.

Time Frame Training Required Who Total Minimum Hours 

Required

Within 30 days of 

hire to provide 

service

▪ 3 hours IIH service definition required 

components

▪ 3 hours of crisis response

▪ All Staff 6 hours

▪ 3 hours of PCP Instructional Elements ▪ IIH Team Leaders

▪ QPs responsible for PCP

3 hours

Within 90 days of 

hire to provide this 

service, or by 

March 31, 2011 

for staff members 

of existing 

providers

▪ 13 hours of Introductory Motivational 

Interviewing* (MI)

(mandatory 2-day training)

▪ 12 hours of Person Centered Thinking

▪ 11 hours Introduction to SOC

▪ IIH Team Leaders 36 hours

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Within 90 days of 

hire to provide this 

service, or by June 

30, 2011 for staff 

members of 

existing providers

▪ 13 hours of Introductory Motivational 

Interviewing* (MI)

(mandatory 2-day training)

▪ 12 hours of Person Centered Thinking

▪ 11 hours Introduction to SOC

▪ All Non- Supervisory 

IIH Team Staff

36 hours

▪ To ensure the core fundamental 

elements of training specific to the 

modality** selected by the agency for 

the provision of services are 

implemented a minimum of 24 hours 

of the selected modality must be 

completed.

▪ All IIH Staff 24 hours

▪ All supervisory level training required 

by the developer of the designated 

therapy, practice or model with a 

minimum of 12 hours must be 

completed.

▪ IIH Team Leaders 12 hours

Annually ▪ Follow up training and ongoing 

continuing education required for 

fidelity to chosen modality (CBT)** (If 

no requirements are designated by 

developers of that modality, a 

minimum of 10 hours of continuing 

education in components of the 

selected modality must be 

completed.).

▪ All IIH Staff 10 hours**

* Motivational Interviewing training must be provided by a Motivational Interviewing Network of Trainers (MINT) trainer. **Modalities must be 

ONE of the following: Cognitive Behavioral Therapy, Trauma Focused Therapy, and Family Therapy.

Total hours of training for the IIH staff: 

▪ IIH Staff other than Team Leader and QPs responsible for PCPs – 42 hrs plus required hours for selected model 

▪ QPs responsible for the PCP – 45 hours plus required hours for selected model 

▪ Team Leader – 45 hours plus required hours for selected model and supervisory training requirement AND

▪ Annually, all IIH staff must have a minimum of 10 hours of training (more if fidelity to the model requires it)

Service Type and Setting

IIH is a direct and indirect, periodic, rehabilitative service in which the team members provide medically necessary services

and interventions that address the diagnostic and clinical needs of the recipient. Additionally, the team provides interventions 

with the family and caregivers on behalf of and directed for the benefit of the recipient as well as plans, links, and monitors 

services on behalf of the recipient. This service is provided in any location. IIH providers shall deliver services in various 

environments, such as homes, schools, court, secure juvenile detention centers and jails (for State funds only*), homeless 

shelters, libraries, street locations, and other community settings.

*Note: For all services, federal Medicaid regulations will deny Medicaid payment for services delivered to inmates of public 

correctional institutions, secure juvenile detention centers, or to patients in facilities that have more than 16 beds and that are 

classified as Institutions of Mental Diseases.

The IIH Team shall provide “first responder” crisis response, as indicated in the Person Centered Plan, 24 hours a day, 7 days 

a week, 365 days a year to recipients of this service.

IIH also includes telephone time with the individual recipient and his or her family or caregivers, as well as collateral contact 

with persons who assist the recipient in meeting his or her rehabilitation goals specified in the Person Centered Plan. IIH 

includes participation and ongoing clinical involvement with the Child and Family Team and meetings for the planning, 

development, implementation, and revision of the recipient’s Person Centered Plan.

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Program Requirements

For IIH recipients, all aspects of the delivery of this service occurring per date of service will equal one per diem event of a 

two-hour minimum. It is the expectation that service frequency will decrease over time: at least 12 face-to-face contacts per 

recipient are required in the first month, and at least 6 face-to face contacts per recipient per month are required in the second 

and third months of IIH services. The IIH service varies in intensity to meet the changing needs of individuals, families, and 

caregivers; to assist them in the home and community settings; and to provide a sufficient level of service as an alternative to 

the individual’s need for a higher level of care.

The IIH team works together as an organized, coordinated unit under the direct supervision of the Team Leader. The team 

meets at least weekly to ensure that the planned interventions are implemented by the appropriate staff members and to 

discuss recipient’s progress toward goals as identified in the Person Centered Plan.

This service is billed per diem, with a 2-hour minimum. That is, when the total contact time per date of service meets or exceeds 

2 hours, it is a billable event. Based on the percentages listed below, the 2 hours may include:

▪ direct clinical interventions as identified in the Person Centered Plan 

▪ case management interventions (face-to-face, telephone time, and collateral contacts). Services are delivered face-toface with the youth, family, and caregivers and in locations outside the agency’s facility. Each provider agency will 

assess and document at least annually the aggregate services delivered at each site using both of the following quality 

assurance benchmarks:

▪ At least 60% of the contacts shall occur face-to-face with the youth, family, and caregivers. The remaining units may be 

either telephone or collateral contacts.

▪ At least 60% of staff time shall be spent working outside of the agency’s facility, with or on behalf of the recipients. At 

any point while the youth is receiving IIH services, IIH staff shall link the recipient to an alternative service when clinically 

indicated and functionally appropriate for the needs of the youth and family as determined by the Child and Family 

Team. A full service note is required to document the activities that led to the referral.

It is incumbent upon the IIH provider agency as a professional entity to research and implement evidence based practices 

appropriate to this service definition.

Eligibility Criteria

A recipient is eligible for this service when

A. There is an Axis I or II MH/SA diagnosis (as defined by the DSM-IV-TR or its successors), other than a sole diagnosis 

of developmental disability.

AND

B. Based on the current comprehensive clinical assessment, this service was indicated and outpatient treatment services 

were considered or previously attempted, but were found to be inappropriate or not effective.

AND

C. The youth has current or past history of symptoms or behaviors indicating the need for a crisis intervention as evidenced 

by suicidal/homicidal ideation, physical aggression toward others, self-injurious behavior, serious risk taking behavior (running 

away, sexual aggression, sexually reactive behavior, or substance use).

AND

D. The youth’s symptoms and behaviors are unmanageable at home, school, or in other community settings due to the 

deterioration of his or her mental health or substance abuse condition, requiring intensive, coordinated clinical interventions.

AND

E. The youth is at imminent risk of out-of-home placement based on the child or adolescent’s current mental health or 

substance abuse clinical symptomatology, or is currently in an out- of-home placement and a return home is imminent.

AND

F. There is no evidence to support that alternative interventions would be equally or more effective, based on North 

Carolina community practice standards (Best Practice Guidelines of the American Academy of Child and Adolescent 

Psychiatry, American Psychiatric Association, American Society of Addiction Medicine).

Entrance Process

A comprehensive clinical assessment that demonstrates medical necessity shall be completed prior to provision of this service. 

If a substantially equivalent assessment is available, reflects the current level of functioning, and contains all the required 

elements as outlined in community practice standards as well as in all applicable federal and state requirements, it may be 

used as part of the current comprehensive clinical assessment. Relevant diagnostic information shall be obtained and included 

in the Person Centered Plan.

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For Medicaid-funded IIH services, a signed service order shall be completed by a physician, licensed psychologist, physician 

assistant, or nurse practitioner according to his or her scope of practice. Each service order shall be signed and dated by the 

authorizing professional and shall indicate the date on which the service was ordered. A service order shall be in place prior 

to or on the day that the service is initially provided in order to bill Medicaid for the service. The service order shall be based 

on a comprehensive clinical assessment of the recipient’s needs. For State-funded services, it is recommended that a service 

order be completed prior to or on the day that the service is initially provided.

Prior authorization is required on the first day of this service.

For Medicaid-funded IIH services, prior authorization by the Medicaid-approved vendor is required. To request the initial 

authorization, submit the Person Centered Plan with signatures and the required authorization request form to the Medicaidapproved vendor. In addition, submit a completed LME Consumer Admission and Discharge Form to the LME.

For State-funded IIH services, prior authorization by the LME is required. To request the initial authorization, submit a Person 

Centered Plan with signatures, the required authorization request form, and the LME Consumer Admission and Discharge 

Form to the LME.

Medicaid or State funds may cover up to 60 days for the initial authorization period, based on medical necessity.

After the initial authorization has been obtained, the team leader will convene the Child and Family Team, in partnership with 

the youth and his or her family, for the purpose of further developing the Person Centered Plan.

Continued Service Criteria

The desired outcome or level of functioning has not been restored, improved, or sustained over the time frame outlined in the 

youth’s Person Centered Plan; or the youth continues to be at risk for out-of-home placement, based on current clinical 

assessment, history, and the tenuous nature of the functional gains.

AND

One of the following applies:

A. The recipient has achieved current Person Centered Plan goals, and additional goals are indicated as evidenced by 

documented symptoms.

B. The recipient is making satisfactory progress toward meeting goals and there is documentation that supports that 

continuation of this service will be effective in addressing the goals outlined in the Person Centered Plan.

C. The recipient is making some progress, but the specific interventions in the Person Centered Plan need to be modified 

so that greater gains, which are consistent with the recipient's pre-morbid level of functioning, are possible.

D. The recipient fails to make progress, or demonstrates regression, in meeting goals through the interventions outlined in 

the Person Centered Plan. The recipient’s diagnosis should be reassessed to identify any unrecognized co-occurring 

disorders, and interventions or treatment recommendations should be revised based on the findings. This includes 

consideration of alternative or additional services.

Discharge Criteria

Any one of the following applies:

A. The recipient has achieved goals and is no longer in need of IIH services.

B. The recipient’s level of functioning has improved with respect to the goals outlined in the Person Centered Plan, inclusive 

of a transition plan to step down to a lower level of care.

C. The recipient is not making progress or is regressing, and all reasonable strategies and interventions have been 

exhausted, indicating a need for more intensive services.

D. The recipient or legally responsible person no longer wishes to receive IIH services.

E. The recipient, based on presentation and failure to show improvement despite modifications in the Person Centered 

Plan, requires a more appropriate best practice treatment modality based on North Carolina community practice 

standards (for example, National Institute of Drug Abuse, American Psychiatric Association).

In addition, a completed LME Consumer Admission and Discharge Form shall be submitted to the LME.

Note: Any denial, reduction, suspension, or termination of service requires notification to the recipient, legally responsible 

person, or both about the recipient’s appeal rights in accordance with the Department’s recipient notices procedure.

Expected Clinical Outcomes

The expected clinical outcomes for this service are specific to recommendations resulting from clinical assessments and 

meeting the identified goals in the recipient’s Person Centered Plan.

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Expected clinical outcomes include but are not limited to the following:

▪ Decrease in the frequency or intensity of crisis episodes 

▪ Reduction in symptomatology 

▪ Child and family/caregivers’ engagement in the recovery process 

▪ Improved child functioning in the home, school and community settings 

▪ Ability of the child and family/caregiver to better identify and manage triggers, cues, and symptoms 

▪ Child’s sustained improvement in developmentally appropriate functioning in specified life domains 

▪ Child’s utilization increased coping skills and social skills that mitigate life stresses resulting from the recipient’s 

diagnostic and clinical needs 

▪ Reduction of symptoms and behaviors that interfere with the child’s daily living, such as negative effects of substance 

abuse or dependence, psychiatric symptoms, or both

▪ Decrease in delinquent behaviors when present 

▪ Increased use of available natural and social supports by the child and family/caregivers

Documentation Requirements

Refer to DMA Clinical Coverage Policies and the DMH/DD/SAS Records Management and Documentation Manual for a 

complete listing of documentation requirements.

For this service, one of the documentation requirements is a full service note for each contact or intervention (such as family 

counseling, individual counseling, case management, crisis response) for each date of service, written and signed by the 

person(s) who provided the service, that includes the following:

␣ Recipient’s name 

␣ Medicaid identification number 

␣ Service Record Number 

␣ Service provided (for example, IIH services) 

␣ Date of service 

␣ Place of service 

␣ Type of contact (face-to-face, telephone call, collateral) 

␣ Purpose of the contact 

␣ Description of the provider’s interventions 

␣ Amount of time spent performing the intervention

␣ Description of the effectiveness of the interventions in meeting the recipient’s specified goals as outlined in the Person 

Centered Plan

␣ Signature and credentials of the staff member(s) providing the service 

A documented discharge plan shall be discussed with the recipient and be included in the service record. In addition, a 

completed LME Consumer Admission and Discharge Form shall be submitted to the LME.

Utilization Management

Services are based upon a finding of medical necessity, shall be directly related to the recipient’s diagnostic and clinical needs, 

and are expected to achieve the specific rehabilitative goals specified in the individual’s Person Centered Plan. Medical 

necessity is determined by North Carolina community practice standards as verified by independent Medicaid consultants for 

Medicaid-funded services, or by the LME for state-funded services.

Medically necessary services are authorized in the most cost-efficient mode, as long as the treatment that is made available 

is similarly efficacious to services requested by the recipient’s physician, therapist, or other licensed practitioner. Typically, a 

medically necessary service shall be generally recognized as an accepted method of medical practice or treatment. Each case 

is reviewed individually to determine if the requested service meets the criteria outlined under EPSDT.

No more than one child in the home may receive IIH services during any active authorization period.

For Medicaid, prior authorization by the Medicaid-approved vendor is required according to published policy. For State-funded 

IIH services, authorization is required by the LME prior to the first visit.

The Medicaid-approved vendor or the LME will evaluate the request to determine if medical necessity supports more or less 

intensive services.

Medicaid or State funds may cover up to 60 days for the initial authorization period based on the medical necessity documented 

in the individual’s Person Centered Plan, the authorization request form, and supporting documentation. Submit the 

THE SHIP GROUP COMMUNITY SERVICES 

Policies & Procedures Manual

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reauthorization request before the initial authorization expires. Medicaid- or State-funded services cover up to 60 days for 

reauthorization based on the medical necessity documented in the required Person Centered Plan, the authorization request 

form, and supporting documentation.

If continued IIH services are needed at the end of the initial authorization period, submit the Person Centered Plan and a new 

request for authorization reflecting the appropriate level of care and service to the Medicaid-approved vendor for Medicaid 

services, or to the LME for State-funded services. This should occur before the authorization expires.

This service is billed per diem, with a 2-hour minimum. That is, when the total contact time per date meets or exceeds 2 hours, 

it is a billable event. The 2 hours may include both direct and indirect interventions (face-to-face, telephone time, and collateral 

contacts), based on the percentages listed in Program Requirements.

Service Exclusions and Limitations

An individual may receive IIH services from only one IIH service provider organization during any active authorization period 

for this service.

The following are not billable under this service: 

▪ Transportation time (this is factored in the rate) 

▪ Any habilitation activities 

▪ Any social or recreational activities (or the supervision thereof) 

▪ Clinical and administrative supervision of staff, including team meetings (this is factored in the rate)

Service delivery to individuals other than the recipient may be covered only when the activity is directed exclusively toward the 

benefit of that recipient.

IIH services cannot be provided during the same authorization period as the following services: Mental Health/Substance 

Abuse Targeted Case Management, Multisystemic Therapy; Day Treatment; individual, group and family therapy; Substance 

Abuse Intensive Outpatient Program; child residential treatment services Level II Program Type through Level IV; Psychiatric 

Residential Treatment Facility (PRTF); or substance abuse residential services.

Note: For Medicaid recipients under the age of 21, additional products, services, or procedures may be requested even if they do not appear 

in the N.C. State Plan or when coverage is limited to those over 21 years of age. Service limitations on scope, amount, or frequency described 

in the coverage policy may not apply if the product, service, or procedure is medically necessary