Can Associates Provide Healthy Blue Care Together Outpatient Plus?

Yes, conditionally. Healthy Blue Care Together’s Outpatient Plus guideline allows associate licensed professionals to deliver this therapy-and-support service through nationally accredited organizations in its enhanced-services network. Clinicians must be credentialed in the Care Together network, employed by a network provider and have the required knowledge, skills and at least one year of experience. This is a specific Medicaid In Lieu of Services (ILOS) pathway, not blanket permission to bill ordinary psychotherapy under a supervisor.

The payer guideline is active, effective and last reviewed February 10, 2026; its history records approval on that date. Care Together’s current provider resources and member benefits pages list Outpatient Plus. These rules concern that product and service, not every Healthy Blue North Carolina benefit or contract.

Which clinicians can deliver therapy?

Page 3 names Licensed or Associate Licensed Professionals. It requires relevant knowledge and skills for the population served and at least one year of experience. The organization must be nationally accredited, comply with NC Medicaid Clinical Coverage Policy 8C and participate in the Care Together enhanced-services network. Individual credentialing and employment by a network provider are separate requirements.

The guideline does not enumerate associate license abbreviations. It does not independently confirm every LCMHCA, LCSWA or LMFTA application, nor does it describe an unlicensed student therapy pathway. The payer must approve the actual clinician and program participation; associate licensed professional does not mean any trainee.

Qualified Professionals have a different role

Licensed and associate licensed professionals provide therapy. Qualified Professionals from the same organization handle care monitoring, support, education and reinforcement of skills introduced in therapy. They coordinate under the clinician’s direction and follow an individualized supervision plan. The QP support role is not permission to perform psychotherapy merely because a clinician supervises the work.

The program specifies new-hire and quarterly training, clinical admission reviews and individualized professional development. Staff supervision and team meetings are included in the service rate rather than separately billable activities.

Which members and services qualify?

Outpatient Plus combines outpatient therapy with monitoring, support and care management for members ages 4 and older whose complex clinical needs ordinary outpatient care cannot adequately address. It sits between standard outpatient care and more intensive supports such as Intensive In-Home or Community Support Team services. A diagnosis alone is insufficient: the guideline requires a comprehensive clinical assessment, coordination needs and its additional clinical indicators.

Prior authorization is required before or on the first service date, initially for 90 days, followed by reviews every 30 days. A licensed clinician must sign a service order. The care plan must describe collaboration with Care Together to avoid duplicate services. The usual maximum length is 180 days; for members 21 and older, an exceptional additional authorization of up to 60 days may be approved.

What code applies, and whose NPI is used?

Page 4 lists H2021 with modifier U5 for Outpatient Plus, with one unit representing 30 days and payment based on the fee schedule or contract. That program-specific code is not a general associate modifier for individual psychotherapy. The guideline does not specify billing-versus-rendering NPI fields or authorize substituting a supervisor’s NPI for the clinician who provided therapy. Obtain claim instructions for the contracted program before submitting a claim.

Only one Outpatient Plus provider may serve a member during an active authorization period. The service cannot overlap with individual or family therapy and the other intensive or residential services listed in the guideline. Care Together also reviews documentation for 50% face-to-face therapy over the life of the case and an average of 2–4 hours of documented services weekly.

Primary sources

Care Together Outpatient Plus guideline — pages 2–5 and approval history on page 7

Care Together provider resources — current ILOS policy list

Care Together member benefits — Outpatient Plus

Frequently Asked Questions

Does Care Together allow associate licensed professionals in Outpatient Plus?

Yes, subject to individual network credentialing, employment by an accredited enhanced-network organization, relevant knowledge and skills, and at least one year of experience. Member eligibility, authorization and service requirements also apply.

Can a student provide therapy under this guideline?

The therapy category names licensed or associate licensed professionals. It does not establish an unlicensed student therapy pathway. QP monitoring and support duties are a separate role, not general supervised psychotherapy permission.

Should the associate bill Outpatient Plus under the supervisor’s NPI?

The guideline does not give that instruction. It lists H2021 U5 and a 30-day billing unit, but billing and rendering NPI roles require the contracted program’s claim instructions. Supervision alone does not establish permission to substitute the supervisor’s identity.

Does this rule apply to ordinary Healthy Blue psychotherapy?

No general rule is established here. This answer concerns Healthy Blue Care Together Outpatient Plus, an ILOS program with enhanced-network and agency requirements. It should not be applied automatically to ordinary outpatient psychotherapy or another Healthy Blue product.