{"data":{"id":"us-nc/n.c.-gen.-stat.-108d-35","jurisdiction":"us-nc","citation":"N.C. Gen. Stat. § 108D-35","heading":"Services covered by PHPs.","body":"(a)\tCapitated PHP contracts shall cover all Medicaid services, including physical health services, prescription drugs, long-term services and supports, and behavioral health services, except as otherwise provided in this section.\n(b)\tThe capitated contracts required by this section shall not cover any of the following:\n(1)\tMedicaid services covered by the local management entities/managed care organizations (LME/MCOs) under the combined 1915(b) and (c) waivers, 1915(b)(3) services, and any services approved under the 1915(i) option shall not be covered under a standard benefit plan, except that all capitated PHP contracts shall cover the following services:\na.\tInpatient behavioral health services.\nb.\tOutpatient behavioral health emergency room services.\nc.\tOutpatient behavioral health services provided by direct-enrolled providers.\nd.\tMobile crisis management services.\ne.\tFacility-based crisis services for children and adolescents.\nf.\tProfessional treatment services in a facility-based crisis program.\ng.\tOutpatient opioid treatment services.\nh.\tAmbulatory detoxification services.\ni.\tNonhospital medical detoxification services.\nj.\tPartial hospitalization.\nk.\tMedically supervised or alcohol and drug abuse treatment center detoxification crisis stabilization.\nl.\tResearch-based intensive behavioral health treatment.\nm.\tDiagnostic assessment services.\nn.\tEarly and Periodic Screening, Diagnostic, and Treatment services.\no.\tPeer support services.\np.\tBehavioral health urgent care services.\nq.\tSubstance abuse comprehensive outpatient treatment program services.\nr.\tSubstance abuse intensive outpatient program services.\ns.\tSocial settings detoxification services.\n(2)\tDental services.\n(3)\tServices provided through the Program of All-Inclusive Care for the Elderly (PACE).\n(4)\tServices documented in an individualized education program, as defined in G.S. 115C-106.3, or other document described in the Medicaid State Plan, and provided or billed by a local education agency, as defined in G.S. 115C-106.3.\n(5)\tServices documented in an individualized family service plan under the Individuals with Disabilities Education Act, 20 U.S.C. § 1436, that are provided and billed by a Children's Developmental Services Agency or by a provider contracted with a Children's Developmental Services Agency to provide those services.\n(6)\tServices for Medicaid program applicants during the period of time prior to eligibility determination.\n(7)\tThe fabrication of eyeglasses, including complete eyeglasses, eyeglass lenses, and ophthalmic frames. (2015-245, s. 4; 2016-121, s. 2(b); 2017-57, s. 11H.17(a); 2017-186, s. 4; 2018-48, s. 1; 2019-81, ss. 12, 14(a); 2021-62, ss. 3.2, 4.9(a); 2021-180, s. 9F.11(c); 2022-74, s. 9D.15(w); 2023-134, s. 9E.22(g).)","path":["Chapter 108D. Medicaid Managed Care Program.","Article 4. Prepaid Health Plans."],"source_url":"https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_108D/GS_108D-35.html","current_through":"S.L. 2026-30","vintage":"","retrieved_at":"2026-08-27T18:16:37Z","sha256":"904c593c22f0ffb9c22be9dfb7bea6d093c32c641213973adf0b8b4ce36a8d66","source_id":"us-nc","stale":false,"prev":"us-nc/n.c.-gen.-stat.-108d-30","next":"us-nc/n.c.-gen.-stat.-108d-40"},"notice":"GroundRules: Original legal text. Not legal advice."}