Community Support Team (CST): (AMH/SA)

Community Support Team (CST): (AMH/SA)

Service Definition and Required Components

Community Support Team (CST) services consist of community-based mental health and substance abuse rehabilitation 

services and necessary supports provided through a team approach to assist adults* in achieving rehabilitative and recovery 

goals. It is intended for individuals with mental illness, substance abuse disorders, or both who have complex and extensive 

treatment needs. The individual’s clinical needs are evidenced by the presence of a diagnosable mental illness, substancerelated disorder (as defined by the DSM-IV-TR and its successors), or both, with symptoms and effects documented in the 

comprehensive clinical assessment and the Person Centered Plan.

*Note: The age at which a recipient is considered an “adult” is determined by the funding source. State- funded services begin 

at age 18; Medicaid-funded services begin at age 21 unless the recipient is eligible through EPSDT.

This is an intensive community-based rehabilitation team service that provides direct treatment and restorative interventions 

as well as case management. CST is designed to

▪ reduce presenting psychiatric or substance abuse symptoms and promote symptom stability, 

▪ restore the recipient’s community living and interpersonal skills, 

▪ provide first responder intervention to deescalate the current crisis, and 

▪ ensure linkage to community services and resources.

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 CST staff, who maintain contact and intervene as one organizational unit. CST services are provided 

through a team approach; however, discrete interventions may be delivered by any one or more team members as clinically 

indicated. Not all team members are required to provide direct intervention to each recipient on the caseload. The Team Leader 

must provide direct clinical interventions with each recipient. The team approach involves structured, face-to-face, scheduled 

therapeutic interventions to provide support and guidance in all areas of functioning in life domains: emotional, social, safety, 

housing, medical and health, educational, vocational, and legal.

The CST Licensed or Provisionally Licensed team leader drives the delivery of this rehabilitative service. In partnership with 

the recipient, the assigned CST Qualified Professional identified as the person responsible for the Person Centered Plan has 

ongoing clinical responsibility for developing and revising the Person Centered Plan.

Under the direction of the Team Leader, CST services are delivered to recipients, with a team approach, primarily in their living 

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

▪ Individual therapy 

▪ Behavioral interventions such as modeling, behavior modification, behavior rehearsal 

▪ Substance abuse treatment interventions 

▪ Development of relapse prevention and disease management strategies to support recovery

▪ Psychoeducation for the recipient, families, caregivers, and/or other individuals involved with the recipient about the 

recipient’s diagnosis, symptoms, and treatment.

▪ Psychoeducation regarding the identification and self-management of the prescribed medication regimen, with 

documented communication to prescribing practitioner(s)

▪ Intensive case management 

• assessment

• planning 

• linkage and referral to paid and natural supports 

• monitoring and follow-up

▪ Arranging for psychological and psychiatric evaluations and 

▪ Crisis management, including crisis planning and prevention

For Medicaid-funded CST 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 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.

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Provider Requirements

CST 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 the 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 authorization from the LME. The CST provider organization shall comply with all applicable federal 

and state requirements. This includes but is not limited to North Carolina Department of Health and Human Services (DHHS) 

statutes, rules, policies, and Implementation Updates; Medicaid Bulletins; and other published instruction.

Staffing Requirements

CST shall be comprised of three full-time staff positions as follows:

␣ One full-time equivalent (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 board-eligible 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 who is a Qualified Professional, Associate Professional, Paraprofessional, or Certified Peer Support 

Specialist, and 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 CST 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 team.

The Team Leader shall meet the requirements specified for Licensed or Provisionally Licensed status according to 10A NCAC 

27G. 0104 and have the knowledge, skills, and abilities required by the population and age to be served. Persons who meet 

the requirements specified for Qualified Professional, Associate Professional, or Paraprofessional 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 CST services.

The Certified Peer Support Specialist shall be an individual who is or has been a recipient of mental health or substance 

abuse services and is committed to his or her own personal recovery. A Certified Peer Support Specialist is a fully integrated 

team member who draws from his or her own experiences and knowledge gained as a recipient to provide individualized 

interventions to recipients of CST services. The Certified Peer Support Specialist validates the recipients’ experiences and 

provides guidance and encouragement in taking responsibility for and actively participating in their own recovery. Certified 

Peer Support Specialists also provide essential expertise and consultation to the entire team to promote a culture in which 

each individual’s point of view and preferences are recognized, understood, respected, and integrated into treatment, 

rehabilitation, and community self-help activities.

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

The CST maintains a maximum caseload of 45 individuals per team. The recipient-to-staff ratio is no more than 15:1. The 

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team caseload will be determined by the level of acuity and the needs of the individuals served. CST is designed to provide

services through a team approach, and not individual staff caseloads. Factors to consider in determining the number of 

individuals to be served include but are not limited to the needs of special populations (persons who are homeless, those 

involved in the judicial system, etc.), the intensity of the needs of the individuals served, individual needs requiring services 

during evening and weekend hours, and geographical areas covered by the team.

The following charts set forth the additional activities included in this service definition. These activities reflect the appropriate 

scopes of practice for the CST staff identified below.

Community Support Team

Team Leader

▪ Provides individual therapy for recipients served by the team 

▪ Behavioral interventions such as modeling, behavior modification, behavior rehearsal 

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

recipient 

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

▪ Provides clinical expertise and guidance to the CST members in the team’s interventions with the recipient 

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

supervision plan is required for all CST members except the Team Leader 

▪ Determines team caseload by the level of acuity and the needs of the individual served 

▪ Facilitates weekly team meetings of the CST 

▪ Monitors and evaluates the services, interventions, and activities provided by the team

Team Leader or Qualified Professional

▪ Provides psychoeducation as indicated in the Person Centered Plan 

▪ Assists with crisis interventions 

▪ Assists the Team Leader with behavioral and substance abuse treatment interventions 

▪ Assists with the development of relapse prevention and disease management strategies 

▪ Coordinates and oversees the initial and ongoing assessment activities 

▪ Develops the initial Person Centered Plan and its ongoing revisions and ensures its implementation 

▪ Consults with identified medical (for example, primary care and psychiatric) and non-medical providers, engages 

community and natural supports, and includes their input in the person-centered planning process 

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

psychiatric evaluations 

▪ Monitors and documents the status of the recipient’s progress and the effectiveness of the strategies and 

interventions outlined in the Person Centered Plan

Associate Professional, Qualified Professional, or Team Leader

▪ Provides psychoeducation as indicated in the Person Centered Plan 

▪ Assists with crisis interventions 

▪ Assists the Team Leader with behavioral and substance abuse treatment interventions 

▪ Assists with the development of relapse prevention and disease management strategies 

▪ Participates in the initial development, implementation, and ongoing revision of the Person Centered Plan

▪ Communicates the recipient’s progress and the effectiveness of the strategies and interventions to the Team Leader 

as outlined in the Person Centered Plan

Paraprofessional

▪ Provides psychoeducation as indicated in the Person Centered Plan 

▪ Assists with crisis interventions 

▪ Assists the Team Leader with behavioral and substance abuse interventions 

▪ Assists with the development of relapse prevention and disease management strategies 

▪ Participates in the initial development, implementation, and ongoing revision of the Person Centered Plan

▪ Communicates the recipient’s progress and the effectiveness of the strategies and interventions to the Team Leader 

as outlined in the Person Centered Plan

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Certified Peer Support Specialist

▪ Serves as an active member of the CST, participates in team meetings, and provides input into the person-centered 

planning process

▪ Guides and encourages recipients to take responsibility for and actively participate in their own recovery

▪ Assists the individual with self-determination and decision-making 

▪ Models recovery values, attitudes, beliefs, and personal action to encourage wellness and resilience 

▪ Teaches and promotes self-advocacy to the individual 

▪ Supports and empowers the individual to exercise his or her legal rights within the community

All staff providing CST services shall have a minimum of 1 year of documented experience with the adult MH/SA population. 

(Exception: A Certified Peer Support Specialist is not required to demonstrate 1 year of documented experience in working 

with the adult MH/SA population, as his or her personal experience in MH/SA services fulfills that requirement.)

Family members or legally responsible persons of the recipient may not provide these services for reimbursement.

Staff Training

The following are the requirements for training staff in CST:

All CST Staff

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

AND

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

▪ 3 hours of crisis response training 

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

for PCP)

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

member as of January 1, 2011, all CST staff shall complete the following training requirements:

CST 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 CST Team. The designated therapies, practices or models are as 

follows:

The designated therapies, practices or models are as follows:

▪ Cognitive Behavior Therapy or 

▪ Trauma-Focused Therapy (For Example: Seeking Safety, TARGET, TREM, Prolonged Exposure Therapy for PTSD) 

or

▪ Illness Management and Recovery (SAMHSA Toolkit

http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/illness/default.asp).

1. Practices or models must be treatment focused models, not prevention or education focused models.

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

CST.

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

4. Trauma-focused therapy and Illness Management and Recovery 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 

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scope of practice.

Non-licensed staff [Qualified Professionals, Associate Professionals, Peer Support Specialists, and Paraprofessionals] 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 chosen modality (Cognitive Behavioral 

Therapy, Trauma Focused Therapy, and Illness Management and Recovery (SAMHSA Toolkit)) 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 CBT.

CST Team Leaders

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

by March 31, 2011 for staff who were currently working as a CST Team member as of January 1, 2011, shall completed the 

following training requirements:

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

▪ 12 hours of Person Centered Thinking (PCT) 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 CST 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. 

▪ The12-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 CST 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.

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

member as of January 1, 2011, all CST 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 CST Team Leaders must complete a minimum of 12 hours of clinical supervision training.

All Non-Supervisory CST Staff (QPs, APs, Paraprofessionals and Certified Peer Support Specialists)

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

by June 30, 2011 for staff who were currently working as a CST Team member as of January 1, 2011, shall complete the 

following training requirements:

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

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

certified PCT trainer.

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

Staff who previously worked in CST 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. 

The12-hour PCT training will be portable if an employee changes jobs any time 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 CST within the same agency and had six (6) hours of PCT training under the old requirement 

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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 CST service definition required 

components

▪ 3 hours of crisis response

▪ All Staff 6 hours

▪ 3 hours of PCP Instructional Elements ▪ CST 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

▪ CST Team Lead 25 hours

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

▪ All CST Staff 24 hours

▪ CBT - 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 CST 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.

▪ CST 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 CST Staff 10 hours**

Service Type and Setting

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

and interventions that address the diagnostic and clinical needs of the recipient and also arrange, coordinate, and monitor 

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

environments, such as homes, schools, courts, jails (for State funds only*), secure detention centers (for State funds only*), 

homeless shelters, street locations, libraries, 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 detention centers, or to patients in facilities that have more than 16 beds and that are classified 

as Institutions of Mental Diseases.

CST also includes telephone time with the individual recipient and collateral contact with persons who assist the recipient in 

meeting his or her rehabilitation goals specified in the Person Centered Plan. CST includes participation and ongoing clinical 

involvement in activities and meetings for the planning, development, implementation, and revision of the recipient’s Person 

Centered Plan.

Organizations that provide CST shall provide “first responder” crisis response 24 hours a day, 7 days a week, 365 days a year

to recipients of this service.

Program Requirements

The CST 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.

The CST shall be able to provide multiple contacts a week—daily, if needed—based on the severity of the individual’s mental 

health and substance abuse clinical and diagnostic needs, as indicated in the Person Centered Plan. During a recipient’s first 

month of service, the CST shall provide at least eight (8) contacts. In subsequent months, CST services are provided at least 

once a week.

It is understood that CST is appropriate to serve people who are homeless, transient, and challenging to engage. Therefore, 

the expectation is that collateral contacts made in an attempt to locate and engage the recipient to continue his or her treatment 

be documented in the service record.

CST varies in intensity to meet the changing needs of individuals with mental illness and substance abuse disorders who have 

complex and extensive treatment needs, to support them in community settings, and to provide a sufficient level of service as

an alternative to hospitalization. CST service delivery is monitored continuously and “tTARated,” meaning that when an 

individual needs more or fewer services, the team provides services based on that level of need.

Program services are primarily delivered face-to-face with the recipient and in locations outside the agency’s facility. The 

aggregate services that have been delivered by the endorsed provider site will be assessed and documented annually by each 

endorsed provider site using the following quality assurance benchmarks:

▪ At least 75% of CST services shall be delivered face-to-face by the team with the recipient. The remaining units may 

either be by phone or collateral contacts and

▪ At least 75% of staff time shall be spent working outside of the agency’s facility, with or on behalf of recipients.

Units are billed in 15-minute increments.

Eligibility Criteria

The recipient is eligible for this service when

A. There is documented, significant impairment in at least two of the life domains (emotional, social, safety, housing, 

medical/health, educational, vocational, and legal). This impairment is related to the recipient’s diagnosis and impedes his or 

her use of the skills necessary for independent functioning in the community.

AND

B. 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

C. For recipients with a primary substance-related diagnosis, the American Society for Addiction Medicine Patient

Placement Criteria (ASAM-PPC) are met.

AND

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D. Four or more of the following conditions related to the diagnosis are present:

1. High use of acute psychiatric hospitals or crisis/emergency services, including but not limited to mobile crisis management, in-clinic or 

crisis residential (2 or more admissions in a year), extended hospital stay (30 days within the past year), or psychiatric emergency 

services

2. History of difficulty using traditional services (missing office appointments, difficulty maintaining medication schedules, etc.)

3. Intermittently medication refractory (not achieving full response to medication or sustained reduction of symptoms) or difficulty 

maintaining compliance with taking medication

4. Co-occurring diagnoses of substance abuse (ASAM—any level of care) and mental illness

5. Legal issues (conditional release for non-violent offense; history of failures to show in court, etc.) related to his or her Axis I or Axis II 

MH/SA diagnosis.

6. Homeless or at high risk of homelessness due to residential instability resulting from his or her Axis I or Axis II MH/SA diagnosis

7. Clinical evidence of suicidal gestures, persistent ideation, or both in past 3 months

8. Ongoing inappropriate public behavior in the community within the last 3 months

9. Within the past 6 months, physical aggression, intense verbal aggression, or both toward self or others (due to symptoms associated 

with diagnosis) sufficient to create functional problems in the home, community, school, job, etc.

10. A less intense level of care has been tried and found to be ineffective for the clinical needs of the recipient

AND

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

Carolina community practice standards (for example, American Society for Addiction Medicine, American Psychiatric 

Association) as available.

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 

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

included in the Person Centered Plan.

For Medicaid-funded CST 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 CST 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 CST 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-funded services may cover up to 60 days for the initial authorization period based on medical necessity.

Continued Service Criteria

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

recipient’s Person Centered Plan; or the recipient continues to be at risk for relapse based on current clinical assessment, and 

history, or 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, demonstrates regression, or both in meeting goals through the interventions 

outlined in the Person Centered Plan. The recipient’s diagnosis should be reassessed to identify any unrecognized cooccurring disorders, and treatment recommendations should be revised based on the findings. This includes the 

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consideration of alternative or additional services.

Discharge Criteria

Any one of the following applies:

A. 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.

B. The recipient has achieved positive life outcomes that support stable and ongoing recovery and is no longer in need of 

CST services.

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 CST 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).

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.

Expected outcomes include but are not limited to the following: 

▪ Increased ability to function in the major life domains (emotional, social, safety, housing, medical/health, educational, 

vocational, and legal) as identified in the Person Centered Plan 

▪ Reduced symptomatology 

▪ Decreased frequency or intensity of crisis episodes 

▪ Increased ability to function as demonstrated by community participation (time spent working,

▪ going to school, or engaging in social activities) 

▪ Increased ability to live as independently as possible, with natural and social supports 

▪ Engagement in the recovery process 

▪ Increased identification and self-management of triggers, cues, and symptoms 

▪ Increased ability to function in the community and access financial entitlements, housing, work, and social opportunities 

▪ Increased coping skills and social skills that mitigate life stresses resulting from the recipient’s diagnostic and clinical 

needs

▪ Increased ability to use strategies and supportive interventions to maintain a stable living arrangement 

▪ Decreased criminal justice involvement related to his or her Axis I or Axis II MH/SA diagnosis

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 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 

␣ Service record number 

␣ Medicaid identification number 

␣ Service provided (for example, CST) 

␣ 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 interventions 

␣ 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 (for paraprofessionals, position is required in lieu of credentials 

with staff signature)

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

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

Utilization Management

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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, 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 as services requested by the recipient’s physician, therapist, or other licensed practitioner. Typically, 

the 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.

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

For State-funded CST 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. 

Reauthorization requests shall be submitted before the initial authorization expires. Medicaid or State funds may cover up to 

60 days for reauthorization, based on the medical necessity documented in the Person Centered Plan, the authorization 

request form, and supporting documentation.

Effective August 1, 2010, no more than 128 units (32 hours) of service per 60 day period may be authorized for a recipient. 

CST services are not intended to remain at this level of intensity for the long term. Services will not be authorized for more 

than six months per calendar year.

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

for authorization reflecting the appropriate level of care and service shall be submitted to the Medicaid-approved vendor for 

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

Units are billed in 15-minute increments.

Service Exclusions and Limitations

An individual may receive CST services from only one CST 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 (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.

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

Abuse Targeted Case Management and Peer Support Services.

CST services may be provided for individuals residing in adult mental health residential facilities: independent living; supervised 

living low or moderate; and group living low, moderate, or high. CST services may not be provided for individuals residing in a 

nursing home facility.

CST services may be billed in accordance with the authorization for services during the same authorization period as 

Psychosocial Rehabilitation services based on medical necessity.

For the purposes of helping a recipient transition to and from a service (facilitating an admission to a service, discharge 

planning, or both) and ensuring that the service provider works directly with the CST Qualified Professional, CST services may 

be provided by the Qualified Professional and billed for a maximum of 8 units for the first and last 30-day periods for individuals 

who are authorized to receive the following service:

▪ Assertive Community Team Treatment

For the purposes of helping a recipient transition to and from a service (facilitating an admission to a service, discharge 

planning, or both), providing coordination during the provision of a service, and ensuring that the service provider works directly 

with the CST Qualified Professional, CST services may be provided by the Qualified Professional and billed for a maximum of 

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8 units for each 30-day period for individuals who are authorized to receive one of the following services:

▪ Substance Abuse Intensive Outpatient Program 

▪ Substance Abuse Comprehensive Outpatient Treatment

Note: The provider of these services becomes responsible for the Person Centered Plan and all other clinical home 

responsibilities.

For the purposes of helping a recipient transition to and from a service (facilitating an admission to a service, discharge 

planning, or both), providing coordination during the provision of a service, and ensuring that the service provider works directly 

with the CST Qualified Professional, CST services may be provided by the Qualified Professional and billed in accordance 

with the authorization for services during the same authorization period for the following services based on medical necessity:

▪ All detoxification services 

▪ Professional Treatment Services in Facility-Based Crisis Programs 

▪ Partial Hospitalization 

▪ Substance Abuse Medically Monitored Community Residential Treatment 

▪ Substance Abuse Non-Medically Monitored Community Residential Treatment

Note: For 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