MedicaidCoverageHigh impact
Updated Reminder: Requirements for Research-Based Behavioral Health Treatment Service Delivery – Aug. 5, 2026
NC Medicaid - NCDHHS·NC · Psychiatry·Specialty Services
Effective date
Aug 1, 2026
We identified it
Aug 6, 2026
Summary
NC Medicaid updated its Research-Based Behavioral Health Treatment (RB-BHT) policy effective August 1, 2026, requiring paraprofessionals to obtain BACB or QABA certification within 120 days, removing telehealth for paraprofessional services (CPT 97152-97154), limiting LQASP telehealth to 50% of visits, and requiring quarterly reauthorization for treatment plans exceeding 16 hours per week. Billing teams must immediately stop accepting telehealth claims for paraprofessional RB-BHT services and implement new prior authorization and supervision documentation requirements.
Action Required
REQUIREMENTS:
By August 1, 2026 (EFFECTIVE NOW - 1 day old policy):
- Billing team must immediately DENY or REJECT all telehealth claims submitted for CPT codes 97152, 97153, and 97154 (paraprofessional RB-BHT services). Update billing system to block telehealth modifier (GT or 95) on these codes.
- Billing team must update prior authorization system to flag and require NEW authorizations for any RB-BHT treatment plan exceeding 16 hours per week when the case comes up for reauthorization. Do NOT modify existing authorizations until reauth is requested.
- Billing team must verify that all paraprofessionals billing RB-BHT services have proof of BACB Registered Behavior Technician OR QABA Applied Behavior Analysis Technician certification on file. For existing staff, 120-day grace period expires October 30, 2026.
- Providers must add attestation to treatment plans documenting:
* For paraprofessionals with >200 hours RB-BHT in 6 months: at least 10% of services include LQASP observation and direction
* LQASP supervision ratio requirements per updated CCP 8F
* For LQASP-delivered 97155 services: telehealth use does NOT exceed 50% per 180-calendar day period per beneficiary
- Billing team must implement claims auditing to identify paraprofessional telehealth submissions and deny them with remittance advice directing providers to CCP 8F.
Before October 30, 2026:
- Billing and compliance teams must verify all existing paraprofessionals have obtained qualifying certification. Flag any uncertified staff in billing system and prevent their claims from processing after grace period expires.
Consequences of non-compliance:
- Claims for paraprofessional telehealth (97152-97154) will be denied.
- Claims from uncertified paraprofessionals (after Oct 30, 2026) will be denied.
- Treatment plans >16 hours/week submitted for reauth without new prior authorization will be denied.
- Services delivered without proper LQASP observation documentation may trigger provider investigation for compliance violations.