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The document defines the service, outlines eligibility criteria and covered versus not-covered circumstances, including state-fund-specific requirements, admission, continued stay, transition, and discharge standards. It specifies coverage requirements, prior approval steps, service order and documentation needs, eligible provider billing and licensing, provider certifications and staffing/training expectations, plus program requirements, compliance obligations, audits, and regulatory authority. 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and Substance Use Services  \nState-Funded Clinically Managed Residential Services  \nDate of Amendment-January 1, 2026  \n| NC Division of Mental Health,\u003Cbr>Developmental Disabilities, and\u003Cbr>Substance Use Services | State-Funded Clinically Managed Residential Services\u003Cbr>Date Published: January 1, 2026 |\n| --- | --- |\n\nTable of Contents  \n1.0 Description of the Service .......................................................................................................4  \n1.1 Definitions ............................................................................................................................5  \n2.0 Eligibility Criteria .....................................................................................................................5  \n2.1 Provisions ............................................................................................................................5  \n2.1.1 General ........................................................................................................................5  \n3.0 When the Service is Covered .................................................................................................6  \n3.1 General Criteria Covered ....................................................................................................6  \n3.2 Specific Criteria Covered.....................................................................................................6  \n3.2.1 Specific Criteria Covered by State-Funds ....................................................................6  \n3.2.2 Admission Criteria ........................................................................................................6  \n3.2.3 Continued Stay Criteria ................................................................................................7  \n3.2.4 Transition and Discharge Criteria .................................................................................7  \n4.0 When the Service is Not Covered ...........................................................................................8  \n4.1 General Criteria Not Covered ..............................................................................................8  \n4.2 Specific Criteria Not Covered ..............................................................................................8  \n4.2.1 Specific Criteria Not Covered by State-Funds .............................................................8  \n5.0 Requirements for and Limitations on Coverage......................................................................8  \n5.1 Prior Approval ......................................................................................................................8  \n5.2 Prior Approval Requirements ..............................................................................................9  \n5.2.1 General ........................................................................................................................9  \n5.2.2 Specific.........................................................................................................................9  \n5.3 Limitations or Requirements................................................................................................9  \n5.4 Service Orders ....................................................................................................................9  \n5.5 Documentation Requirements ........................................................................................... 10  \n5.5.1 Contents of a Service Record .................................................................................... 10  \n6.0 Provider(s) Eligible to Bill for the Service .............................................................................. 10  \n6.1 Provider Qualifications and Occupational Licensing Entity Regulations ........................... 10  \n6.2 Provider Certifications ","cbCaieCw6xXwSmt8","https://ap.wps.com/l/cbCaieCw6xXwSmt8","pdf",422792,44,"English","# Description of the Service\n## Definitions\n# Eligibility Criteria\n## Provisions\n### General\n# When the Service is Covered\n## General Criteria Covered\n## Specific Criteria Covered\n### Specific Criteria Covered by State-Funds\n### Admission Criteria\n### Continued Stay Criteria\n### Transition and Discharge Criteria\n# When the Service is Not Covered\n## General Criteria Not Covered\n## Specific Criteria Not Covered\n### Specific Criteria Not Covered by State-Funds\n# Requirements for and Limitations on Coverage\n## Prior Approval\n### Prior Approval Requirements\n#### General\n#### Specific\n## Limitations or Requirements\n## Service Orders\n## Documentation Requirements\n### Contents of a Service Record\n# Provider(s) Eligible to Bill for the Service\n## Provider Qualifications and Occupational Licensing Entity Regulations\n## Provider Certifications\n### Staffing Requirements\n### Staff Training Requirements\n## Program Requirements\n# Additional Requirements\n## Compliance\n## Audits and Compliance Reviews\n## Regulatory Authority\n# Policy Implementation and History\n# Attachment A: Claims-Related Information\n## Claim Type\n## ICD-10-CM and PCS\n## Code(s)\n## Modifiers","[{\"question\":\"What are the eligibility criteria for state-funded clinically managed residential services?\",\"answer\":\"The document provides eligibility criteria, including provisions and distinctions that determine when services are covered versus not covered. It also specifies specific criteria covered by state funds and related admission, continued stay, transition, and discharge standards.\"},{\"question\":\"When are the services covered and when are they not covered?\",\"answer\":\"Coverage depends on general and specific covered criteria, including additional criteria covered by state funds. The document also lists general and specific criteria under which the service is not covered, including criteria not covered by state funds.\"},{\"question\":\"What requirements must providers meet to bill for the service?\",\"answer\":\"Providers must meet qualifications and occupational licensing regulations, complete required provider certifications, and satisfy staffing and staff training requirements. The document also defines program requirements and outlines coverage limitations and documentation expectations.\"}]","State-Funded Clinically Managed Residential Services - Date of Amendment - January 1, 2026 | PDF",1789990131,111]