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
The DHHS Waiver Advisory Committee (DWAC) is an advisory body to DHHS that will provide input and consultation over the following:
- Implementation / Operational phases of the 1915 b/c Medicaid waivers
- Ongoing LME-MCO operations (Medicaid managed care, Innovations, and LME
operations)
The DWAC will meet monthly through 2012, beginning January 2012. In 2013 the DWAC will be reevaluated after all MCOs are operational to ensure that each catchment area has adequate stakeholder representation. In January 2013, the DWAC will transition to quarterly meetings. The chair of DWAC will be selected by its members. Family and consumer members will receive the current standard stipend allowed by state policy. (more)
Contact Information:
DMA.waiver@dhhs.nc.gov
News Alert:
- April 2012 -Provider Enrollment in LME-MCO Medicaid Networks- Medicaid recipients will be mandatorily enrolled into each LME-MCO's benefit plan based upon
county of Medicaid eligibility. As a reminder, providers are required to enroll in the LME-MCO
provider network to ensure that Medicaid services are authorized and that corresponding Medicaid claims are processed by the LME-MCO.CMS requires that each LME-MCO (as they are separate at-risk entities) credential and
enroll their own provider network.
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March 2012 - 1915(b)(c) Medicaid Waiver Expansion Update - Thsi is an update from the
February 2012 Special Bulletin. Providers should verify recipient county of eligibility using the
Recipient Eligibility Verification
tools outlined on the N.C. Division of Medical Assistance (DMA) Website. Beginning in April 2012, the Medicaid card for new recipients and the updated annual card
for current recipients will include the name of each recipient’s LME-MCO based upon
Medicaid county of eligibility. In addition, the Automated Voice Response System (AVRS) has
been updated to include the recipient's LME-MCO.
- February 2012 - Medicaid Waiver Expansion - Please note the following details about the 1915(b)/(c) Medicaid waiver expansion and the
changes it will mean to Medicaid providers. During a transition process over the next year,
Medicaid-funded mental health, substance abuse, and intellectual/developmental disability
services (MH/SA/IDD) will be administered by one of eleven Local Management Entities
(LMEs) operating Medicaid Managed Care Organizations (MCOs) as DMA vendors. Medicaid
recipients will be mandatorily enrolled into each LME-MCO's benefit plan based upon county of
Medicaid eligibility.
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