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NC Department of Health and Human Services Division of Mental Health, Developmental Disabilities, and Substance Abuse Services
 
 

Advocacy and Customer Service

Frequently Asked Questions

What does the North Carolina Division of Social Services do to assist individuals and families in need of basic support and services?

The North Carolina Division of Social Services is a federally mandated, state supervised, county administered, social services system. This means the federal government authorizes national programs and a majority of the funding and the state government provides oversight and support, but it is the 100 local County Department of Social Services that deliver the services and benefits. You may access the home page at: http://www.ncdhhs.gov/dss/.

Where can I find information regarding customer service trainings, educational materials and customer service initiatives?

Customer service refers to the way any organization or business responds to the needs and requests from both outside and within the agency. The goal of customer service is to provide the best possible service to the people of North Carolina in a prompt and courteous manner. This section includes information regarding customer service trainings, educational materials and customer service initiatives.

  • DHHS Customer Service Site
  • Customer Service functions Training curriculum, which will be posted on DMH/DD/SAS website
  • Customer Service activities calendar to include trainings (curriculum, FISH, Customer Service forums, etc.)

Who is responsible for regulating mental health group homes, nursing homes, adult care homes, acute and home care services, jail facilities, detention centers and maintaining the health care personnel registry?

The Division of Facility Services (DFS) regulates mental health and group care facilities, medical and emergency medical services and health care personnel information. DFS ensures that people are safe, and that the care in these facilities is adequate. DFS makes certain that medical facilities are licensed and built only when there is a need for them. The following link explains these responsibilities: http://www.ncdhhs.gov/dhsr/index.html.

What is the role of the Division of Medical Assistance?

The Division of Medical Assistance (DMA) provides access to medically necessary health care services to eligible North Carolina residents. DMA manages Medicaid and NC Health Choice for Children for the state of North Carolina. Medicaid is a health insurance program for certain low-income and needy people paid with federal, state, and county dollars. DMA oversees these programs; however, individuals need to apply for these programs at their local Division of Social Services office. Local office addresses can be found online at http://www.ncdhhs.gov/dss.

What if I have questions and concerns about Medicaid services such as primary care, dental care, pharmacy benefits, etc.?

DMA's Managed Care Customer Service Unit provides information to callers regarding Medicaid covered services or resources that are available to help resolve problematic issues and/or navigate the Medicaid health care system.  The DMA Managed Care Customer Service Unit can be reached at (919) 855-4780.  More information is available at http://www.ncdhhs.gov/dma/mc.htm

What if my child’s treatment provider determines that my child needs a service that is not covered in the North Carolina Medicaid Plan or that my child needs more of a service then is covered in the North Carolina Medicaid Plan? How do we request the service(s)?

Your child’s physician or other licensed clinician may determine that your child needs a treatment service that is not normally covered by the North Carolina Medicaid Plan to correct or ameliorate a defect, physical or mental illness or a condition. Under a federal law called Early Periodic Screening, Diagnostic and Treatment (EPSDT) if a service does not appear in the North Carolina State Medicaid plan you may request the service if your child’s doctor or clinician has determined it is medically necessary to correct or ameliorate a defect, physical or mental illness or a condition.

You may obtain more information about EPSDT at http://www.ncdhhs.gov/dma/epsdt/ by selecting “Consumer Links” and scrolling down the page to the topic “Programs for families and Children” and under this heading selecting “Health Check and EPSDT”. To obtain an EPSDT request form from the DMH/DD/SAS web site go to the home page and select “Communication Bulletins and Announcements” and scroll down to the EPDST announcement dated 4/17/06. The forms are submitted to the Division of Medical Assistance but are then forwarded to Value Options for review.   To learn more about the Value Options review process go to http://www.valueoptions.com/ and scroll down the page to the topic “EPSDT Services”.

How do LMEs report complaints to DMH/DD/SAS?

LME’S (Local Management Entities) Customer Service representatives assist consumers and family members in resolving complaints. As required by 10A NCAC 27G.0609, an LME is required to collect information about each complaint made to them, analyze the results and submit a quarterly report to the North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services (NC DMH/DD/SAS). Information from this quarterly report is used by each LME and DMH/DD/SAS to assess patterns and help support efforts to improve the quality of care delivered.

If I have a complaint or concern about my treatment, who may I contact locally for assistance?

The duties of this office include working with providers and consumers to resolve issues of concern, assisting with information, referral, and advocacy in obtaining services and assisting consumers and their families in understanding their rights and remedies available to them from the public service system. Each Local Management Entity (LME) has a customer service/consumer affairs office that provides a range of helpful services. You may directly contact your local customer service office. This contact information is provided in word or PDF format.

How may a person, family member, provider or concerned citizen file a complaint/concern about non-Medicaid services delivered within the mental health system?

It's important that consumers and families are central to the decision making. To help with that, they must receive notice of in writing when plans are made to deny, reduce, suspend or stop non- Medicaid services/supports. Reasons must be given, as well as information on appeal complaint/concern process. Did you know that each Local Management Entity has a Customer Service office to assist you? You may find the local office directory by following this link. If you have questions or concerns please contact the North Carolina Division of Mental Health, Developmental Disabilities and Substance Abuse Services, Advocacy and Customer Service Office by clicking on this link.

What types of advocacy organizations operate in the state of North Carolina?

There are many advocacy sources available. Your local management entity may be useful in providing access to local advocacy groups. Other branches of your city or county government also may be able to help. Your physician or an area hospital may be able to make suggestions. Also, your local library and telephone yellow pages may have resource lists for sources of help in your community.

NC CareLink is a web-based search engine that anyone with a computer can use.  Go to https://www.nccarelink.gov to find helpful resources to meet a range of needs, including a list of MH/DD/SAS service providers.

What can you do at the Social Security Office?

The Social Security Administration office is the place where you can apply for a social security number, check your earnings record; apply for Social Security benefits, SSI, and hospital insurance protection and apply for extra help with Medicare prescription drug costs. At the Social Security office you may also enroll for medical insurance; receive assistance with applying for food stamps and get information about rights under the Social Security Act. You can access these services at your local Social Security Office or online at http://www.socialsecurity.gov.

Do you need information about treatment for alcohol and drug addiction?

Alcohol and drug addiction affects thousands of families in North Carolina. Close to a million people have addiction problems in North Carolina and nearly three times as many are affected by another person's drinking.  The Alcohol/Drug Council of North Carolina connects these people with help and hope by linking them to treatment services and providing prevention programs, advocacy and education.  For alcohol and drug abuse information and referral in North Carolina please call 1-800-688-4232 or go to www.alcoholdrughelp.org. Information is also available from Local Management Entities in North Carolina. North Carolina Substance Abuse providers can be found online through NC care LINK.

What is ValueOptions?

ValueOptions provides utilization review for all North Carolina Medicaid covered mental health, developmental disability and substance abuse services. The ValueOptions North Carolina Service Center is located in Research Triangle Park. Beginning January 1, 2002, ValueOptions, Inc. entered into an agreement with the North Carolina Division of Medical Assistance to provide utilization review services for over 1.3 million of the State's Medicaid recipients. Since its inception, ValueOptions has provided utilization management services based on a belief that the most effective treatment is that which is appropriate to the needs of the person being served, easily accessible, provided by competent practitioners, and conducive to family involvement where possible. Treatment should be based upon best practices in the behavioral health care industry. ValueOptions is a clinically focused company driven by the premise that delivering rather than denying care is the key to both optimal clinical outcomes and cost-effective care. For specific information on North Carolina Medicaid, please go to http://www.valueoptions.com/ or contact the NC Public Sector Provider Service Department 1-888-510-1150.

 

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