Behavioral Health Services
Behavioral Health services provide customers with medically necessary diagnostic, therapeutic, rehabilitative, palliative or case management needs.
Announcement: TBI Waiver Application and 1915(b) Waiver Update
The N.C. TBI Waiver application and the 1915(b) Waiver Update to include the N.C. TBI Waiver were submitted to the Centers for Medicare & Medicaid Services (CMS) on Feb. 29, 2016.
Questions, comments and requests for printed copies may be submitted via email at TBIfeedback@dhhs.nc.gov or via voicemail at 919-855-4108.
Local Management Entities – Managed Care Organizations (LME-MCOs) are public managed care organizations that provide a comprehensive behavioral health services plan under the NC 1915(b)(c) Waiver for people in need of mental health, developmental disability or substance use services. LME-MCOs are regionally based. An LME-MCO directory can be found at: https://www.ncdhhs.gov/providers/lme-mco-directory
Medicaid enrollees may contact the LME-MCO in their region for information about and referral to mental health, developmental disability and substance use services.
Behavioral health services for Medicaid enrollees with mental illness, developmental or other intellectual disability, and substance use diagnoses are provided under the North Carolina 1915(b)(c) Medicaid Waiver program. The 1915(b)(c) Medicaid Waiver allows North Carolina to enroll individuals into a state and federally approved managed care program for behavioral health services.
The 1915 (b) waiver can be found at https://www2.ncdhhs.gov/ncinnovations/pdf/1915b-waiver-renewal.pdf
The 1915(c) waiver can be found at https://www2.ncdhhs.gov/ncinnovations/pdf/1915c-home-community-based-services-waiver.pdf
LME-MCOs set the fee schedules for their own provider networks. LME-MCO fee schedules can be obtained by contacting the LME-MCO. The LME-MCO directory can be found at https://www.ncdhhs.gov/providers/lme-mco-directory
Fee schedules for providers of services not covered under the LME-MCO (providers of services for children age 0-3, Health Choice enrollees and legal aliens) can be found at https://dma.ncdhhs.gov/document/direct-enrolled-behavioral-health-services
Behavioral Health Clinical Coverage Policies
Behavioral Health Clinical Policies can be found at http://dma.ncdhhs.gov/document/behavioral-health-clinical-coverage-policies
Information about the NC Innovations Waiver can be found at https://www2.ncdhhs.gov/ncinnovations/
Departmental Waiver Advisory Committee (DWAC)
A Departmental Waiver Advisory Committee (DWAC) was established in 2012 as an advisory body to the NC DHHS on statewide implementation of the 1915(b)(c) Medicaid waivers and ongoing waiver operations. The DWAC has provider, recipient, county commissioner, LME-MCO and state staff representation. Waiver related issues are discussed and stakeholder input and guidance are sought through these meetings.
DWAC meetings are held monthly in the Brown Building Hearing Room, conference room #104, on the Dorothea Dix campus from 1:30pm – 3:30pm. Meetings are open to the public.
Meeting minutes and agendas are posted at http://www.ncdhhs.gov/divisions/mhddsas/councils-commissions toward the bottom of the page.
Early and Periodic Screening, Diagnosis and Treatment/EPSDT
Information regarding Early and Periodic Screening, Diagnosis and Treatment/EPSDT can be found on the EPSDT web page or by contacting your LME/MCO. LME-MCO contact information is available on the LME-MCO Directory
Grievances and Appeals
Information regarding grievances and appeals can be obtained by contacting the LME-MCO responsible for your area. LME-MCO contact information is available on the LME-MCO Directory. Additional information an grievances and appeals can be found on the Medicaid "Your Rights" web page.