[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-646256-105":59,"doc-detail-646256-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","imd-ilos-in-lieu-of-service","IMD-ILOS - In Lieu of Service","","IMD-ILOS explains how Carolina Complete Health identifies facilities as Institutions for Mental Disease (IMD) under NC DHHS’s federal definition, and describes “in lieu of” services that function as medically appropriate substitutions for NC Medicaid coverage. It outlines IMD services for behavioral health, including psychiatric and therapeutic interventions and stabilization goals, and specifies that prior authorization is required. The process details monitoring via utilization management, age limits (21–64), admission review intervals, denial timing, SUD bed-day rules, and the applicable revenue code (160) for billing.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/imd-ilos-in-lieu-of-service/646256/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/imd-ilos-in-lieu-of-service/646256.png","ImageObject",300,407,{"name":92,"@type":93},"8796093062539","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-10-23",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What qualifies a facility as an IMD under the referenced definition?","Question",{"text":112,"@type":113},"An IMD is a hospital, nursing facility, or other institution with more than 16 beds primarily engaged in diagnosis, treatment, or care of persons with mental diseases, designed for continuous treatment of acute psychiatric problems.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What prior authorization and monitoring requirements apply to IMD services?",{"text":117,"@type":113},"Prior authorization is required for all inpatient psychiatric and substance use (SUD) services. Carolina Complete Health monitors IMD utilization through its utilization management system.",{"name":119,"@type":110,"acceptedAnswer":120},"How often are admission reviews completed for mental health versus SUD admissions?",{"text":121,"@type":113},"For mental health admissions, an admission review is completed every three days, followed by an administrative denial after 15 days in a calendar month. For SUD admissions, an admission review is completed every seven days as required by the referenced clinical coverage policy.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},646256,1792754259,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":66,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":133,"file_id":134,"file_url":135,"file_type":136,"file_size":137,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":138,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":139,"faqs":140,"seo_title":141,"seo_description":67,"update_tm":129,"read_time":24,"preview_page_count":4},8796093062539,"Institutes for Mental Disease – In Lieu of Service  \nCarolina Complete Health has recognized that your facility has been designated as an Institution for Mental Disease (IMD) based on the federal definition which has been adopted by NC DHHS:  \n“The term ‘institution for mental diseases’ means a hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services. This service is designed to provide continuous treatment for members with acute psychiatric problems.”  \nCarolina Complete Health offers services or settings that are medically appropriate, costeffective substitutions for services covered by NC Medicaid. These are called “in lieu of” services. Carolina Complete Health offers the following in lieu of services:  \nInstitute of Mental Disease (IMD) in lieu of Emergency Department stays and Medical Stays for Behavioral Health Needs: This service offers psychiatric and therapeutic interventions including medication management, group therapy and room and board. The goal of this service is stabilization of psychiatric symptoms to allow for treatment in a less restrictive setting.  \nPrior authorization is required for all Inpatient Psychiatric and Substance Use services. Carolina Complete Health will monitor utilization of IMD through the utilization management system. Carolina Complete Health’s utilization management process for IMD’s is as follows:  \nPlease note the following applies to ages 21 through 64. IMD limits do not apply to kids underage 21 that might also be in a facility.  \n1) For mental health admissions, an admission review is completed every three (3) days followed by an Administrative Denial after fifteen (15) days in a calendar month.  \na. IMDs are able to bill up to fifteen (15) days in a calendar month for mental health admissions.  \n2) For SUD admissions, an admission review is completed every seven (7) days as is required per Clinical Coverage Policy 8B ( [https://medicaid.ncdhhs.gov/media/9841/open](https://medicaid.ncdhhs.gov/media/9841/open) ) which follows how the state ADATCs are also reviewed.  \ncarolinacompletehealth.com  \na. There is no bed day limit for SUD admissions as long as medical necessity for the service continues to be met  \nWhen billing for IMD services, NC DHHS has indicated the revenue code to be used is 160.  \nIf you have further questions or concerns, please contact Provider Relations and Support at  \n(833)-552-3876.  \nResources  \na.  CCH Manuals, Forms, and Guides  \nb.  NC DHHS Behavioral Health Clinical Coverage Policies  \nc.  CCH Clinical Policies  \nnetwork.carolinacompletehealth.com","cbCaiqeJfv3G1u4c","https://ap.wps.com/l/cbCaiqeJfv3G1u4c","pdf",180550,"English","# IMD designation and definition\n# In lieu of services offered\n## IMD in lieu of emergency department and medical stays\n# Authorization, monitoring, and utilization management process\n## Age scope and admission review/denial timelines\n## SUD admissions and bed-day limits\n# Billing guidance and contact resources","[{\"question\":\"What qualifies a facility as an IMD under the referenced definition?\",\"answer\":\"An IMD is a hospital, nursing facility, or other institution with more than 16 beds primarily engaged in diagnosis, treatment, or care of persons with mental diseases, designed for continuous treatment of acute psychiatric problems.\"},{\"question\":\"What prior authorization and monitoring requirements apply to IMD services?\",\"answer\":\"Prior authorization is required for all inpatient psychiatric and substance use (SUD) services. Carolina Complete Health monitors IMD utilization through its utilization management system.\"},{\"question\":\"How often are admission reviews completed for mental health versus SUD admissions?\",\"answer\":\"For mental health admissions, an admission review is completed every three days, followed by an administrative denial after 15 days in a calendar month. For SUD admissions, an admission review is completed every seven days as required by the referenced clinical coverage policy.\"}]","IMD-ILOS - In Lieu of Service | PDF"]