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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

1915(b)/(c) Medicaid Waiver Expansion for Mental Health, Developmental Disabilities, and Substance Abuse 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.

Toward this goal, DMA and the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS) worked in partnership to submit waiver amendment requests to CMS in December 2009 to expand the capitated counties through the modification of the exisiting Piedmont Cardinal Health Plan 1915(b) Freedom of Choice waiver and the modification of the 1915(c) Innovations Home and Community Based Services (HCBS) waiver. Waiver amendments are posted here for review.

 

News Alert:

  • November 1, 2011 -The Department of Health and Human Services is pleased to announce that CenterPoint Human Services LME and Southeastern Center LME have been selected to be the next Local Management Entities (LME) to participate in the 1915 b/c Medicaid waiver for mental health, developmental disabilities and substance abuse services.  Based upon the RFA Desk Review, Wake County is considering alternative options. This will conclude the 2011 RFA 1915 b/c Waiver application process.  DMA and DMHDDSAS will work closely with the selected LMEs as they begin the waiver implementation process.
  • September 30, 2011 - The Division of Medical Assistance (DMA) is pleased to announce that The Durham Center * has been selected to be the next Local Management Entity (LME) to participate under the 1915 b/c Medicaid waiver for mental health, developmental disabilities and substance abuse services. As part of the on-going formal procurement process, The Durham Center submitted a Plan of Correction and had a very successful second site review.

 

Request for Applications

In 2010, DHHS issued a Request for Applications (RFA).  Based on that application process, four LMEs (Western Highlands Network, East Carolina Behavioral Health, Sandhills Center, and Mecklenburg LME) are working toward implementation of Medicaid managed care operations with anticipated start dates in 2012 and 2013.  Our current managed care vendor, PBH will be expanding into the following LME catchment areas in 2012 and 2013:  Alamance-Caswell, Orange-Person-Catham, and Five County.

NEWS ALERT July 27, 2011

On May 20th, DHHS received seven RFA applications from the following LMEs:

  • CenterPoint Human Services (solo application)
  • The Durham Center - with Guilford, Johnston, and Cumberland Counties
  • Eastpointe - with The Beacon Center, and Southeastern Regional
  • Pathways - with Mental Health Partners and Crossroads Behavioral Health
  • Smoky Mountain Center (solo application)
  • Southeastern Center - with Onslow-Carteret Behavioral Healthcare
  • Wake County (solo application)  

The Division of Medical Assistance (DMA) is pleased to announce Eastpointe,  Pathways, and  Smoky Mountain Center * have been selected to be the next Local Management Entities (LME) to participate under the1915 b/c Medicaid Waiver for mental health, developmental disabilities and substance abuse services. The above LMEs were selected through a formal procurement process. The other LME programs that applied will have several options to consider if the wish to remain in the RFA process.

Based upon either the RFA Minimum Requirements and / or RFA Desk Review Requirements CenterPoint, Southeastern Center, and Wake County will need to resubmit their RFA Application to DMA by October 1, 2011 if they wish to remain in the RFA process.   

Existing LME - MCO and previous selected LMEs proceeding forward based upon the 2010 RFA Application process: 

  • (existing MCO) PBH partnering with OPC, Alamance Caswell, and Five County
  • Western Highland Network
  • Mecklenburg County
  • East Carolina Behavioral Health
  • Sandhills Center

* 87 Counties out of 100 counties in North Carolina are now part of helping the State move forward with the behavioral health managed care under the 1915 (b)/(c) Medicaid Waivers.  

 

Additional Information

 

Waiver Submissions to CMS

MH/DD/SA Health Plan (Formerly Piedmont Cardinal Health Plan)

N.C. Innovations (Formerly Piedmont Innovations)

Contact Information

How to Obtain Further Information:
Questions should be directed via email to RFA.Medicaidwaiver@dhhs.nc.gov.