North Carolina State Health Plan

You’re still in network

You don’t need to do anything. As of January 1, 2026, you will continue to be in network for the Plan as a participating provider in the Aetna Choice® POS II network. You will be reimbursed at your Aetna® contract rates.

Behavioral Health Access Program (BHAP)

The Plan will offer the BHAP beginning January 1, 2026, a custom fee schedule that:

Applies to behavioral health provider types and specialties and a defined list of CPT codes as specified in the BHAP amendment
For psychotherapy, evaluation and management and psychological testing codes, fees are set at 140% of current year NC Medicare rates (updated annually effective May 1st)
ABA is set at NC Medicaid rates
TMS codes are set at Aetna Market Fee Schedule (AMFS) rates

Note there will not be a different behavioral health copay for BHAP providers and they will not have a badge in provider search tools.

You can sign up for BHAP at Go.Aetna.com/ joinbhap by signing an online amendment to your Aetna contract. If you choose not to sign up, you will be paid your Aetna contract rates. The amendment and FAQ document are posted at this site under helpful resources.

Independent Primary Care Providers (PCPs)

The Plan continues to value PCPs and will be rolling out new programs to support independent primary care. Stay tuned for

more information about these efforts. The new program will have a renewed focus on quality, access, and steering members to lower cost care settings.

The payment model, while still being finalized, will be focused on the Aetna fee schedule, Per Attributed Member Per Month payments, and bonuses for steering members to lower cost alternatives where available (e.g., freestanding imaging vs. hospital-based).

Check the State Health Plan provider site for more information: shpnc.org/nc-state-health-plan-network.