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NC Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
 

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Provider Monitoring

The North Carolina Provider Monitoring Process for LME-MCOs

Implementation Date for the New Routine Provider Monitoring Process is March 1, 2014.

Provider Monitoring Tools

Frequenty Asked Questions (FAQs)
(3/25/14)

The DHHS Provider Monitoring process is designed to promote North Carolina’s commitment to ensuring high quality services for individuals with mental health, intellectual/developmental disabilities, and substance abuse issues.  It is the vehicle used for entry into the provider network, for the evaluation of service providers against quantitative and qualitative measures, and for determining advanced placement status, using a series of monitoring tools.  The provider monitoring process is used to monitor both Medicaid and State-funded behavioral health services.

The revision of the tools was done under the auspices of the DHHS-LME/MCO-Provider Collaboration Work Group, which includes representation from the NC Providers Council, Benchmarks, the Professional Association Council, and LME-MCO representatives from the NC Council of Community Programs, the Division of Medical Assistance, the Division of Health Service Regulation, and the Division of Mental Health, Developmental Disabilities and Substance Abuse Services. 

The Provider Monitoring process is used statewide by the LME-MCOs to monitor providers of publicly-funded mh, idd and sa services, regardless of funding source, and includes the tools and guidance for monitoring licensed independent practitioners (LIPs) and mh, idd and sa provider agencies. Routine provider monitoring consists of two components--a routine review and a post-payment review. 

An Introduction to Routine Monitoring of MH/IDD/SA Providers by LME-MCOs through Collaboration and Transparency Updated 2/26/14

The DHHS provider monitoring tools are completely automated for the purpose of tool administration, documentation, scoring, and generation of reports.  The automation of these tools is in direct response to Session Law 2009-451 (SB 202), which directed the Department to explore and implement procedures to reduce the administrative burden on LMEs and providers in demonstrating compliance to state requirements. Instructions for completing the tools are included in the workbooks. 

Routine monitoring consists of a routine review and a post-payment review.

  • For LIPs, that includes the LIP Review Tool and the LIP Post-Payment Review Tool.
  • For provider agencies, the selection of tools is determined by the type services provided.
    • The Routine Monitoring Tool is used except when the agency provides Unlicensed AFL services, in which case the Unlicensed AFL Review Tool is used.
    • The specific post-payment review tool(s) to be used is based on the combination of services included in the sample.
    • For those services that DHSR-MHL surveys on an annual basis (i.e., residential services and opiod treatment services), only a post-payment review is done. 

Refer to the Instructions and Overview sections in each workbook for a detailed description of the  workbooks are organized and for more information on how all the component parts of the review fit together.

DHHS Review Tools for Routine Monitoring of Licensed Independent Practitioners

DHHS Review Tools for Routine Monitoring of Provider Agencies

Frequently Asked Questions (FAQs)

Please send questions or comments about the new tools or the provider monitoring process to the email below. Be sure to include the specific issue in the subject line.


provider.monitoring@dhhs.nc.gov

 

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