1915(b)/(c) Medicaid Waiver for MH/DD/SA Services

In April 2005, the N.C. Department of Health and Human Services (DHHS) began the MH/DD/SAS Health Plan, a pilot project where Medicaid-funded services for mental health, substance abuse, and development disabilities are provided on a capitation basis in a five-county area through a prepaid inpatient health plan (PIHP) under a 1915(b)/(c) Medicaid waiver. PBH, formerly know as Piedmont Behavioral Healthcare, a local management entity (LME), operates the PIHP. DHHS has elected to expand this waiver beyond PBH to be phased-in statewide.

• DHHS Waiver Advisory Committee (DWAC)
  
• DMA/MCO Draft Contract Template (PDF, 4.85 MB)
• MHDDSAS Health Plan Waiver (PDF, 736KB)
• Waiver Strategic Plan
• Archived 1915 b/c Waiver Content

• LME-MCO Location Map (as of March 27, 2013)
• Contact information

The North Carolina Innovations Waiver is a resource for funding services and supports for people with intellectual and other related developmental disabilities that are at risk for institutional care in an Intermediate Care Facility for Individuals with Mental Retardation (ICF-MR).

Innovations Plus is designed to provide an array of community-based services and supports to promote choice, control, and community membership.  These services provide a community-based alternative to institutional care for persons who require an ICF-MR level of care and meet additional eligibility criteria for this waiver.

• Link to Innovations
• Link to Innovations Plus page for providers
• Link to Innovations Plus page for beneficiaries

• MH/DD/SAS 1915 (b)(c) Waiver Care Coordination Fact Sheet (May 2011)(PDF, 117KB)
• MH/DD/SAS 1915 (b)(c) DDWaiver Fact Sheet - Final (April 2011)(PDF, 156KB)
• MH/DD/SAS 1915 (b)(c) Waiver Fact Sheet (April 2011)(PDF, 145KB)
• DHHS 1915(b)/(c) Waiver Entity Project Presentation, March 10, 2010 (PDF, 100KB)
• Presentation to the NC Council, June 2009 (PDF, 63KB)
• Medicaid Contract Training (PDF, 12KB)

Special Medicaid Bulletins

• 1915 (b)/(c) Waiver Expansion in Coastal Care - (February 2013)
• 1915 (b)/(c) Waiver Expansion in MeckLINK - (February 2013)
• 1915 (b)/(c) Waiver Expansion in CoastalCare - (January 2013)
• CAP I/DD Waiver Transitions in Mecklenburg County - (January 2013)
• 1915 (b)/(c) Waiver Expansion in Mecklenburg County - (January 2013)
• Addition of Medical Evaluation and Management (E/M) Codes for Use by Psychiatric Nurse Practitioners - (January 2013)
• Services and Local Management Entity-Managed Care Organizations (LME-MCOs) - (January 2013)
• 1915 (b)/(c) Waiver Expansion (January 2013) -SUPERSEDED BY - 1915 (b)/(c) Waiver Expansion in Mecklenburg County
• Extension of CAP-I/DD Waiver (January 2013) (Note: This is an update to the Special Medicaid Bulletin regarding CAP I/DD published in October 2012)
• 1915 (c) Innovations Waiver Expansion (October 2012)
• CAP I/DD Waiver Approval, Process for Submitting Authorization Requests, and Appeal Rights (October 2012)
• Treatment of Confidential Information under N.C.G.S. §122C (July 2012)
• Behavioral Health and I/DD Updates (June 2012)
• 1915b/c Medicaid Waiver Expansion Update (April 2012)
• 1915b/c Medicaid Waiver Expansion Update (March 2012)
• 1915b/c Medicaid Waiver Expansion (February 2012)

News Alert Archive

• 2012
• 2011

MCO Communication Bulletins

MCO-Provider Contracts

• General Template (PDF, 118 KB)
• Appendix G for Hospitals (PDF, 26KB)
• Appendix G for Agencies (PDF, 32KB)
• Appendix G for LIPS (Pending)
• Appendix G for ICF-IDDs (PDF, 32KB)
• ED Reimbursement Form (PDF, 122KB)

Effective July 1, 2012, all LMEs and LME-MCOs will use the Gold Star Rating and Monitoring Process for Providers to conduct provider monitoring.
This practice is consistent with the 1915 b/c Medicaid Waiver model developed by PBH and retains fidelity to that model pursuant to S.L. 2011-264. To standardize the process across the state, DHHS has provided the following tools for LMEs and LME-MCOs. In order to access the tools, you may download them from the following links:

• Division of MH/DD/SAS page on Gold Star Monitoring

• Financial Reporting Guide PDF
• Financial Reporting Template XLS

All waiver-related questions should be submitted by e-mail to DMA.waiver@dhhs.nc.gov.

Additional information is also available on the DMH/DD/SAS website.