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NC Medicaid has changed the start date for Tailored Plans to October 1, 2023. Until then people will keep getting services the way they do now.

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Current Service Needs

Providers are needed in the areas defined on this page.

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Providers interested in any of the below service categories should complete and submit a provider application request and any additional information specifically requested. Please note that all interested Providers are required to be enrolled in NCTracks for the sites and service for any Provider Application Request that is being submitted.

Innovations Waiver Supported Living

Providers needed who can support all three levels.

Provider Qualifications
Provider Agencies in PIHP network. State Nursing Board regulations must be followed for tasks that present health and safety risks to the person/s as directed by the PIHP Medical Director or Assistant Medical Director.

Staff or live-in caregiver are at least 18 years of age and meet the following requirements:

  • If providing transportation, have valid NC driver‚Äôs license or other valid driver‚Äôs license, a safe driving record an acceptable level of automobile liability insurance
  • Criminal background check presents no health and safety risk to person/s
  • Not listed in NC Health Care Abuse Registry
  • Qualified in CPR and First Aid
  • Qualified in the customized needs of the beneficiary as described in the ISP
  • High school diploma or equivalency (GED)
  • Paraprofessionals providing this service must also be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204 (b) (c) and (f) and according to licensure or certification requirements of the appropriate discipline.

Waiver Definition

Supported Living provides a flexible partnership that enables a NC Innovations beneficiary to live in their own home with support from an agency that provides individualized assistance in a home that is under the control and responsibility of the beneficiary.

The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the beneficiary, budget management, attending appointments, and interpersonal and social skills building to enable the beneficiary to live in a home in the community. Training activities, supervision, and assistance may be provided to allow the beneficiary to participate in home life or community activities. Other activities include assistance with monitoring health status and physical condition, and assistance with transferring, ambulation, and use of special mobility devices.

Service Goal: Supported Living provides a flexible partnership that enables a NC Innovations beneficiary to live in their own home with support from an agency that provides individualized assistance in a home that is under the control and responsibility of the beneficiary as specified in the person-centered plan.

Minimum Requirements

  • Provider must be enrolled in NCTracks.
  • Provider must be qualified in the customized need of the beneficiaries as described in the individual support plan.
  • Provider must be willing and able to provide all three levels of care as outlined in the NC Medicaid: North Carolina Innovations Clinical Coverage Policy 8P, found here https://medicaid.ncdhhs.gov/media/11377/open

Interested providers should submit the¬†Alliance Provider Application Request¬†to¬†[email protected].

Providers are expected to meet all requirements of the Innovations Waiver and Alliance enrollment, and contracting requirements to include being enrolled in NCTracks.

Interested providers should complete the provider application request and submit to¬†[email protected]¬†for consideration.

Child Psychiatric Residential Treatment Facility (PRTF), Level IV, Level III, Level II group and family, and Facility-Based Crisis (FBC) Providers

North Carolina’s six Local Management Entities/Managed Care Organizations (LME/MCOs) launched the NC Child and Family Improvement Initiative on May 1, 2022, to create a statewide solution to the current pressing challenges of the service delivery system for youth in foster care.

Building on the early successes of the NC Child and Family Improvement Initiative, the LME/MCOs are moving forward to formalize a statewide network of child treatment providers to ensure that youth in the foster care system have continuity of care without delay when moving from one area of North Carolina to another.

When is this happening? August 1, 2022.

How is this affecting providers?
From August 1, 2022, through August 30, 2022, all LME/MCOs are offering an open enrollment period for child Psychiatric Residential Treatment Facility (PRTF), Level IV, Level III, Level II group and family, and Facility-Based Crisis (FBC) providers to ensure that children and adolescents have access to the services they need statewide. 

Provider Action Required
If you are a child PRTF, Level IV, Level III, Level II group and family, or FBC provider and you want to join Alliance’s network, please submit the Provider Application Request.

Please note that your enrollment with NCTracks is a prerequisite. Data for the provider agency, including NPI, taxonomy, sites, and affiliated clinicians, must all be in NCTracks and successfully enrolled to continue to contract with Alliance or to make changes to your contract with Alliance.

We encourage you to contract with each LME/MCO to maximize statewide resources and service access for children and adolescents. For more information about becoming an in-network provider, please use the following links:

Alliance Health (Cumberland, Durham, Johnston, Mecklenburg, Orange and Wake counties)

Eastpointe (Duplin, Edgecombe, Greene, Lenoir, Robeson, Sampson, Scotland, Warren, Wayne and Wilson counties)

Partners Health Management (Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Stanly, Surry, Union, and Yadkin counties)

Sandhills Center (Anson, Davidson, Guilford, Harnett, Hoke, Lee, Montgomery, Moore, Randolph, Richmond and Rockingham counties)

Trillium Health Resources (Beaufort, Bertie, Bladen, Brunswick, Camden, Carteret, Chowan, Columbus, Craven, Currituck, Dare, Gates, Halifax, Hertford, Hyde, Jones, Martin, Nash, New Hanover, Northampton, Onslow, Pamlico, Pasquotank, Pender, Perquimans, Pitt, Tyrrell, and Washington counties)

Vaya Health (Alamance, Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Caswell, Chatham, Cherokee, Clay, Franklin, Graham, Granville, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Person, Polk, Rowan, Stokes, Swain, Transylvania, Vance, Watauga, Wilkes, and Yancey counties)

What if a provider does not want to join an LME/MCO network at this time?

For providers who do not want to join an LME/MCO network, all LME/MCOs are offering out-of-network agreements for community-based and non-hospital services. While the NC DHHS directs reimbursement for these services to be 90% of the Medicaid rate, the LME/MCOs have agreed to pay at least 100% of the Medicaid rate for these services to strengthen the statewide network and service capacity.

If you have questions, please contact our Provider Enrollment at [email protected]

Innovations Specialized Consultative Services

Licensed independent professionals (LIPs) to provide Innovations specialized consultative services that supply expertise, training and technical assistance in a specialty area to assist family members, support staff and other natural supports in assisting Innovations beneficiaries with developmental disabilities who have long-term intervention needs.

  • Interested LIPs should have at least one year of documented experience in writing behavior intervention plans for the I/DD population and meet the qualifications in the service definition, Clinical Coverage Policy 8P.
  • Interested LIPs should complete the Provider Application Request and submit it with a current CV.

TBI Waiver Service Needs

Day Supports

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • Provider agencies: NC G.S. 122 C-3 and NC Administrative Code Title 10A, subchapters 26B, 26C, 27C, 27D, 27E, and 27G.
  • The organization must have achieved national accreditation.

Waiver Definition

Day Supports is a group, facility-based service that provides assistance to the individual with rehabilitation, retention, or modification of socialization and daily living skills and is one option for a meaningful day. Day Supports may include prevocational and vocational activities.

Day Supports emphasizes inclusion and independence with a focus on enabling the individual to attain or maintain his/her maximum self-sufficiency, increase self-determination, and enhance the person’s opportunity to have a meaningful day.

Minimum Requirements

  • Approved as a provider in the PIHP provider network.
  • Upon enrollment with the PIHP, the organization must have achieved national accreditation with at least one of the designated accrediting agencies.
  • The organization must be established as a legally constituted entity capable of meeting all the requirements of PIHP.
  • Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204 (b)(c)(f) and according to licensure or certification requirements of the appropriate discipline.
  • Providers are expected to meet the requirements of the CMS approved TBI Waiver and Alliance credentialing, enrollment and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Crisis Supports

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • Agency: Provider agencies who operate licensed facilities. Must be licensed according to NC Administrative Code 10A 27G.5100 or have waiver of licensure.
  • Agency: Independent practitioners, licensure specific to discipline, if applicable.
  • Agency: Provider agencies primary crisis response. Provider agency verifies employee qualifications at the time employee is hired; if provider is an individual practitioner, the PIHP verifies employee qualifications prior to contracting with individual and at least every three years thereafter.
  • Crisis services staff must have access to a board-eligible or board-certified psychiatrist or psychiatric nurse practitioner with a minimum of one year of experience serving individuals with TBI and mental health needs or a physician assistant with a minimum of one year of experience serving individuals with TBI and mental health needs.
  • In addition, all crisis services staff must have access to a licensed practicing psychologist with a minimum of one year of experience in working with individuals with TBI.¬†

Waiver Definition

Crisis Supports provides intervention and stabilization for individuals experiencing a crisis. Crisis Supports are for individuals who experience acute crises and who present a threat to the person’s health and safety or the health and safety of others.

These behaviors may result in the person losing his or her home, job or access to activities and community involvement. Crisis Supports promote prevention. of crises as well as assistance in stabilizing the individual when a behavioral crisis occurs.

Crisis Supports are an immediate intervention available 24 hours per day, seven days per week, to support the individual.

Minimum Requirements

  • Crisis services staff must have access to a board-eligible or board-certified psychiatrist or psychiatric nurse practitioner with a minimum of one year of experience serving individuals with TBI and mental health needs or a physician assistant with a minimum of one year of experience serving individuals with TBI and mental health needs.
  • In addition, all crisis services staff must have access to a licensed practicing psychologist with a minimum of one year of experience in working with individuals with TBI. Providers are expected to meet the requirements of the CMS approved TBI Waiver and Alliance enrollment and contracting requirements to include being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Residential Supports

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • Unlicensed Supervised Living Facility: Unlicensed supervised living facilities may serve only one adult in accordance with state rule at 10ANCAC 27 G.5601(b)(1)(2). Supervised Living License F: NC Administrative Code 10 A 27G.560; statutory authority: NC General Statute 143B 147
  • Supervised Living: Type C 10 A NCAC 27G.5600, statutory authority: NC General Statute 143B-147

*For members living in a 5600A or a family care home, periodic services are permissible under TBI Waiver. (Residential TBI Waiverservice may not be billed for these members.)

Waiver Definition

Residential Supports provides individualized services and supports to enable a person to live successfully in a group home or alternate family living setting of their choice and be an active participant in their community. The intended outcome of the service is to increase, regain, or maintain the person’s life skills, provide the supervision needed, maximize their self-sufficiency, increase self-determination and ensure the person’s opportunity to have full membership in their community. Residential Supports consist of an integrated array of individually designed training activities which may be rehabilitative or maintenance, assistance and supervision.

Residential Support Levels are determined using the process below:

  • Level 1 requires a minimum of 1:3 staff to beneficiary ratio during day and evening shifts and non-awake supervision during overnight shift or an awake staff person covering more than one site during the overnight shift.
  • Level 2 requires a minimum of 1:3 staff to beneficiary ratio during day and evening shifts and awake, on-site supervision during overnight shift.
  • Level 3 requires a minimum of 1:1 staff to beneficiary ratio during the day and evening shifts and awake, on-site supervision during overnight shift

Minimum Requirements

  • Supervised Living facilities, type C, serve adults whose primary diagnosis is a developmental disability and may be licensed for 6 beds or less.
  • Supervised Living Facilities, type C, must be approved as a provider in the PIHP provider network
  • Supervised Living Facilities, type F, serve no more than 3 minors or 3 adults with a developmental disability.
  • Supervised Living Facilities, type F, must be approved as a provider in the PIHP provider network
  • Unlicensed Supervised Living Facilities may serve only one adult in accordance with State Rule at 10A NCAC 27 G.5601(b)(1)(2).
  • Unlicensed Supervised Living Facilities must be approved as a provider in the PIHP provider network
  • Residential Supports are provided to individuals who live in a community residential setting that meets the home and community based characteristics as outlined in Appendix C of the TBI Waiver document.
  • Residential Supports may additionally be provided in an AFL situation. The site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for the cost of care. These sites are licensed or unlicensed in accordance with state ruleA minimum of 500 hours supporting individuals with TBI.

Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204 (b) (c) (f) and according to licensure or certification requirements of the appropriate discipline

Providers are expected to meet the requirements of the CMS approved TBI Waiver and Alliance credentialing, enrollment and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Respite

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • Provider agencies, facility based and in-home services: NC General Statute 122C
  • Nursing respite provider: Licensed by the NC DHHS, Division of Health Services regulation in accordance with NC General Statute 131E,Article 6, Part C and, as applicable, NC General Statute 122C.
  • Provider agencies, nursing respite:¬† Licensed by the NC DHHS, Division of Health Services regulation in accordance with NC General Statute 131E, Article 6, Part C and, as applicable, NC General Statute 122C.
  • Private respite homes: Private home respite services serving individuals outside their private home are subject to licensure under NC G.S. 122C Article 2 when: more than two individuals are served concurrently or either one or two children, two adults, or any combination thereof, are served for a cumulative period of time exceeding 240 hours per calendar year.
  • Home care agencies: Licensed by the NC DHHS, Division of Health Services Regulation in accordance with NCGS 131E, Article 6,Part C, and North Carolina Administrative Code 10A, Chapter 13-J.

Waiver Definition

Respite services provide periodic or scheduled support and relief to the primary caregiver(s) from the responsibility and stress of caring for the individual. This service may also be used to provide temporary relief to individuals who reside in licensed and unlicensed AFLs.

Minimum Requirements

  • Approved as a provider in the PIHP provider network.
  • The organization must be established as a legally constituted entity capable of meeting all of the requirements of PIHP.
  • Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204(b)(c)(f) and according to licensure or certification requirements of the appropriate discipline.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver and Alliance credentialing, enrollment and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Life Skills Training

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • The organization must have achieved national accreditation.
  • The organization must be approved as a provider in the PIHP provider network:

Waiver Definition

Life Skills Training provides rehabilitation and skill building to enable the beneficiary to acquire and maintain skills, which support more independence as specified in the person-centered plan. Life Skills Training offers rehabilitative and skill building supports to individuals that are supported in their own home and do not receive residential supports. Life Skills Training augments the family and natural supports of the beneficiary and consists of an array of services that are required to maintain and assist the beneficiary to live in community settings. Life Skill Training does not stem from a licensed facility like Day Supports, nor does it focus on prevocational training This service is distinctive from personal care by the presence of rehabilitation.

Minimum Requirements

  • Provider agency that holds national accreditation.
  • Approved as a provider in the PIHP provider network.
  • The organization must be established as a legally constituted entity capable of meeting all of the requirements of PIHP.
  • Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204(b)(c)(f) and according to licensure or certification requirements of the appropriate discipline.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver and Alliance credentialing, enrollment and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

In-home Intensive (add on to Life Skills Training)

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • The organization must have achieved national accreditation.
  • The organization must be approved as a provider in the PIHP provider network:

Waiver Definition

In-Home Intensive support is available to support beneficiaries in their private home when the beneficiary needs extensive support and supervision. Rehabilitation, maintenance support, and/or supervision are provided to assist with positioning, intensive medical needs, elopement, and/or behaviors that would result in injury to self or others. Participant training. In-home Intensive Services are for when Life Skills Training hours are not enough.

Requires prior authorization and must be approved by Alliance at a minimum every 90 days.

Minimum Requirements

  • Provider agency that holds national accreditation.
  • Approved as a provider in the PIHP provider network.
  • The organization must be established as a legally constituted entity capable of meeting all of the requirements of PIHP.
  • Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204 (b) (c) (f) and according to licensure or certification requirements of the appropriate discipline.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver and Alliance credentialing, enrollment and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Personal Care

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • Personal Care Service Provider: Approved as a provider in the PIHP provider network in accordance with requirements for services in NC General Statute 122-C. and national accreditation.
  • Home Care Agency: Licensed by the NC DHHS Division of Health Service Regulation as a Home Care Agency in accordance with NC General Statute 131-E and NC Administrative Code 13J, chapter 13, subchapter J.
  • Approved as a provider in the PIHP provider network.

Waiver Definition

Personal Care services under the waiver include support, supervision and engaging participation with eating, bathing, dressing, personal hygiene and other activities of daily living.

Support and engaging the beneficiary describes the flexibility of activities that may encourage the beneficiary to maintain skills gained during habilitation while also providing supervision for independent activities.

Personal care services do not include medical transportation and may not be provided during medical transportation and medical appointments. Beneficiaries who live in licensed residential facilities, licensed AFL homes, licensed foster care homes or unlicensed alternative family living homes serving one adult, may not receive any aspect of this service nor any other state plan personal care service. Personal Care cannot be provided in a licensed program.

Minimum Requirements

  • A personal care service agency must hold national accreditation.
  • Home care agency must be licensed by the NC DHHS Division of Health Service regulation as a home care agency in accordance with NC General Statute 131-E and NC Administrative Code 13J, chapter 13, subchapter J.
  • Approved as a provider in the PIHP provider network.
  • The organization must be established as a legally constituted entity capable of meeting all of the requirements of PIHP.
  • Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204(b)(c)(f) and according to licensure or certification requirements of the appropriate discipline.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver and Alliance credentialing, enrollment and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Supported Employment

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • Provider agency that holds national accreditation.
  • Approved as a provider in the PIHP provider network.

Waiver Definition

Supported Employment Services provides assistance with choosing, acquiring, and maintaining a job for individuals for whom competitive employment has not been achieved and/or has been interrupted or intermittent as specified In the person-centered service plan.

The intent of Initial Supported Employment is to assist individuals with developing skills to seek, obtain and maintain competitive employment or develop and operate a micro-enterprise. The employment positions are found based on individual preferences, strengths, and experiences. Job finding is not based on a pool of jobs that are available or set aside specifically for individuals with disabilities.

Minimum Requirements

  • Provider agency: national accreditation.
  • Approved as a provider in the PIHP provider network.
  • The organization must be established as a legally constituted entity capable of meeting all of the requirements of PIHP.
  • Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204 (b) (c) (f) and according to licensure or certification requirements of the appropriate discipline.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver and Alliance credentialing, enrollment, and contracting requirements including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Community Networking

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • Provider agency that holds national accreditation.
  • Approved as a provider in the PIHP provider network.

 Waiver Definition

Community Networking services provide individualized day activities that support the beneficiary’s definition of a meaningful day in an integrated community setting, with people who are not disabled as specified in the person-centered plan. This service is provided separate and apart from the beneficiary’s private residence, other residential living arrangement, and/or the home of a service provider. These services do not take place in licensed facilities and are intended to offer the beneficiary the opportunity to develop meaningful community relationships with non-disabled individuals. Services are designed to promote maximum participation in community life while developing natural supports within integrated settings. Community Networking services enable the beneficiary to increase or maintain their capacity for independence and develop social roles valued by non-disabled members of the community. As beneficiaries gain skills and increase community connections, service hours should fade; however, a formal fading plan is not required.

Minimum Requirements

  • Provider agency that holds national accreditation.
  • Approved as a provider in the PIHP provider network.
  • The organization must be established as a legally constituted entity capable of meeting all of the requirements of PIHP.
  • Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204(b)(c)(f) and according to licensure or certification requirements of the appropriate discipline.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver and Alliance credentialing, enrollment, and contracting requirements including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Natural Supports and Education

Orange and Mecklenburg Counties only

Who can provide per the waiver

  • Provider agency that holds national accreditation.
  • Approved as a provider in the PIHP provider network.

 Waiver Definition

Caregiver support. Natural Supports Education provides training to families and the beneficiary’s natural support network. Provides education and training on rehabilitation and/or compensatory intervention/strategies and provide education and training in the use of specialized equipment and supplies In addition to individualized natural support education, reimbursement will be made for enrollment fees and materials related to attendance at conferences and classes by the primary caregiver.

Minimum Requirements

  • Provider agency that holds national accreditation.
  • Approved as a provider in the PIHP provider network.
  • The organization must be established as a legally constituted entity capable of meeting all of the requirements of PIHP.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver and Alliance credentialing, enrollment and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Specialized Consultative Services

All Alliance regions

Who can provide per the waiver

  • Provider agency that holds national accreditation.
  • Individual independent practitioners: Licensure specific to discipline, if applicable.

Waiver Definition

Specialized consultation services provide expertise, training, and technical assistance in a specialty area.

Specialty Areas: Neuro/psychology, behavior intervention, speech therapy, therapeutic recreation, augmentative communication, assistive technology equipment, occupational therapy, physical therapy, nutrition, and other licensed professionals who possess experience with individuals with traumatic brain injury.

Service Goal: To assist family members, support staff, and other natural supports in assisting individuals with traumatic brain injury.

Minimum Requirements

  • A minimum of 500 hours supporting individuals with TBI.
  • Staff must hold appropriate NC licenses for physical therapy, occupational therapy, speech therapy, psychology, behavioral analysis (licensure subject to psychology board implementation date) and nutrition; state certification for recreational therapy; board-certified behavior analyst-MA; master‚Äôs degree and expertise in augmentative communication; state certification in assistive technology.
  • Qualified in the customized need of the beneficiaries as described in the individual support plan.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver and Alliance credentialing, enrollment, and contracting requirements including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Cognitive Rehabilitation

All Alliance regions

Who can provide per the waiver

  • Individual practitioner: Licensure specific to discipline, NC G.S.122C.
  • Provider agency: NC G.S.122C, as appropriate.
  • Staff must hold appropriate NC license.
  • Cognitive rehabilitation (CR) must be provided by independent physicians, neuropsychologists, or psychologists.
  • Degree required in behavioral science field or other appropriate field with appropriate licensure and/or certification for that particular field (i.e., psychology, social work, special education, speech-language pathology, occupational therapy or counseling).
  • Can be LPC, LCSW, special education teachers, occupational therapists and speech-language pathologists, licensed to practice in the State of North Carolina.

Waiver Definition

Cognitive rehabilitation is a one-on-one therapy, utilized for the development of cognitive (thinking) skills to improve functional abilities including but not limited to: attention, memory, problem solving, and to help identify impaired thinking.

Minimum Requirements

  • A minimum of 500 hours supporting individuals with TBI.
  • PhD and master‚Äôs degree: must have 40 hours of training in brain injury and one year of experience working with persons with brain injury; Bachelor‚Äôs degree: must have 40 hours of training in brain injury and three years of experience working in brain injury.
  • Qualified in the customized need of the beneficiaries as described in the individual support plan.
  • Must be enrolled in NCTracks.
  • Providers are expected to meet the requirements of the¬†CMS approved TBI Waiver¬†and Alliance credentialing, enrollment, and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Allied Health: Physical Therapy, Occupational Therapy, and Speech and Language Therapy

All Alliance regions

Who can provide per the waiver

  • PT/OT/SLP provider agencies.
  • Individual licensed therapists.
  • Staff must hold appropriate NC license for occupational therapy, physical therapy, or speech and language therapy.

Service Definition

Occupational Therapy: The goal of occupational therapy is to assist individuals with TBI achieve greater independence by regaining physical, perceptual, and cognitive skills through exercises and other related activities.

Speech and Language Therapy: The goal of speech and language therapy is to assist individuals with TBI who have difficulties with communication, eating, drinking or swallowing.

Physical Therapy: Physical therapy is a treatment approach to assist individuals with TBI that addresses the promotion of sensor motor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation

Waiver Minimum Allied Health Requirements

  • A minimum of 500 hours supporting individuals with TBI.
  • Staff must hold appropriate NC license for physical therapy, occupational therapy, speech therapy.
  • Qualified in the customized need of the beneficiaries as described in the individual support plan.
  • Must be enrolled in NCTracks.
  • Providers are expected to meet the requirements of the¬†CMS-approved TBI Waiver¬†and Alliance credentialing, enrollment, and contracting requirements, including being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Supported Living

All Alliance regions

Who can provide per the waiver

  • Provider agencies in PIHP network. State Nursing Board regulations must be followed for tasks that present health and safety risks to the person/s as directed by the PIHP medical director or assistant medical director. Upon enrollment as a provider, the Agency With Choice (AWC) must have achieved national accreditation with at least one of the designated accrediting agencies. Employers of record (EOR) have an arrangement with an enrolled crisis services provider to respond to person/s crisis situations.

Staff or live-in caregiver are at least 18 years of age and meet the following requirements:

  • If providing transportation, have valid NC driver‚Äôs license or other valid driver‚Äôs license, a safe driving record an acceptable level of automobile liability insurance
  • Criminal background check presents no health and safety risk to person/s
  • Not listed in NC Health Care Abuse Registry
  • Qualified in CPR and First Aid
  • Qualified in the customized needs and TBI needs of the person/s as described in the ISP
  • High school diploma or equivalency (GED)
  • Paraprofessionals providing this service must also be supervised by a qualified professional. Supervision must be provided according to supervision requirements specified in 10A NCAC 27G.0204 (b) (c) and (f) and according to licensure or certification requirements of the appropriate discipline.

Waiver Definition

Supported Living provides a flexible partnership that enables a TBI Waiver beneficiary to live in their own home with support from an agency that provides individualized assistance.

The service includes direct assistance as needed with activities of daily living, household chores essential to the health and safety of the beneficiary, budget management, attending appointments, and interpersonal and social skills building to enable the beneficiary to live in a home in the community. Training activities, supervision, and assistance may be provided to allow the beneficiary to participate in home life or community activities. Other activities include assistance with monitoring health status and physical condition, and assistance with transferring, ambulation and use of special mobility devices.

Service Goal: Supported Living provides a flexible partnership that enables a TBI Waiver beneficiary to live in their own home with support from an agency that provides individualized assistance in a home that is under the control and responsibility of the beneficiary as specified in the person-centered plan.

Minimum Requirements

  • Provider must be enrolled in NCTracks.
  • Provider must be qualified in the customized need of the beneficiaries as described in the individual support plan.
  • The Agency With Choice (AWC) must have achieved national accreditation with at least one of the designated accrediting agencies.
  • Employers of record (EOR) have an arrangement with an enrolled crisis services provider to respond to person/s crisis situations.
  • Providers are expected to meet the requirements of the CMS-approved TBI Waiver and Alliance enrollment, and contracting requirements to include being enrolled in NCTracks.

Interested providers should submit the Alliance Provider Application Request to [email protected] and include a copy of day support licensure and national accreditation (as applicable). To learn more about the TBI Waiver see Alliance‚Äôs TBI Waiver web page and/or send questions to TBI waiver communication at [email protected].

Research-Based Behavioral Health Treatment(RB-BHT) for Autism Spectrum Disorder (ASD

Research-based behavioral health treatments (RB-BHT) services are researched-based behavioral intervention services that prevent or minimize the disabilities and behavioral challenges associated with autism spectrum disorder (ASD) and promote, to the extent practicable, the adaptive functioning of a beneficiary. RB-BHT demonstrate clinical efficacy in treating ASD: prevent or minimizes the adverse effects of ASD; and promote, to the maximum extent possible, the functioning of a beneficiary.

Providers are expected to meet the requirements of the NC Medicaid Clinical Coverage Policy 8F and Alliance enrollment, and contracting requirements to include being enrolled in NCTracks.

Interested providers should complete the Provider Application request and submit to [email protected] for consideration.

New Medications for Opioid Use Disorder (MOUD: Buprenorphine) Service Definition Modifiers for Medicaid-Funded Outpatient Services

Alliance has developed a new service definition modifier to support the implementation of evidence-based medication-assisted treatment for individuals diagnosed with Opioid Use Disorder. This service must be provided by psychiatrists who have been approved to prescribe buprenorphine (including monotherapy or FDA-approved buprenorphine combination therapies) and who adhere to evidence-based treatment requirements as described in the scope of work.

The new service codes are modifications of existing psychiatry evaluation and management (E&M) codes and will be reimbursed at a higher rate than existing E&M codes to cover the additional provider expenses associated with fidelity to medication-assisted treatment requirements. Eligible providers include licensed independent practitioner (LIP) psychiatrists and provider agencies. Providers who are interested in adding this service to their contracts must meet the following requirements:

  1. Psychiatrists with an office in the Alliance Health catchment area.
  2. Provider must submit documentation demonstrating that psychiatrist has been approved by the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to prescribe buprenorphine.
  3. Provider must submit policies and procedures specific to opioid treatment and a program overview that describes how the program will adhere to MOUD requirements as described in the scope of work.

Please submit a Provider Application Request with attachments noted in numbers 2 and 3 above.

Fluency in Spanish or Other Languages

Providers that offer services in the Alliance benefit plan that are fluent in Spanish or other languages are invited to submit a Provider Application Request for consideration. Please ensure to include on the request the service(s) and language fluency that you are requesting to provide.

Psychiatrists

Psychiatrists with an office located within the Alliance catchment area.

Experience with the MH/SA/IDD population is required.

This page was last reviewed for accuracy on 10/12/2020