COMMUNITY LIVING AND SUPPORT SERVICES PROVIDER IN NORTH CAROLINA

COMMUNITY LIVING AND SUPPORT SERVICES PROVIDER IN NORTH CAROLINA

PROMOTING INDEPENDENT LIVING AND SOCIAL INCLUSION THROUGH PERSONALIZED SUPPORT

Community Living and Support Services in North Carolina assist individuals with disabilities or chronic conditions in maintaining independence within their community. These services offer assistance with daily living activities, skill development, and community integration to enhance quality of life. Community Living and Support Services are authorized under North Carolina Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: North Carolina Department of Health and Human Services (NCDHHS)

Role: Administers Medicaid waiver funding for Community Living and Support Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: North Carolina Division of Health Benefits (NC Medicaid)

Role: Manages Medicaid waiver services and oversees Medicaid provider participation.

Agency: North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS)

Role: Provides oversight for community living services targeting individuals with developmental disabilities and behavioral health needs.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure Medicaid-funded Community Living and Support Services meet quality, safety, and person-centered care standards.

2. COMMUNITY LIVING AND SUPPORT SERVICES OVERVIEW

Community Living and Support Services help individuals live independently by offering assistance with daily tasks, fostering social skills, and supporting community involvement.

Approved providers may deliver:

• Personal Care Assistance: Helping with grooming, dressing, hygiene, and meal preparation.

• Community Integration: Facilitating participation in social, recreational, and community activities.

• Life Skills Training: Teaching skills like budgeting, communication, and personal care.

• Health and Safety Monitoring: Supporting safe living environments and daily wellness.

• Companionship: Reducing social isolation through supportive interactions.

• Transportation Assistance: Helping individuals access community resources and appointments.

• Self-Advocacy Support: Empowering individuals to make decisions about their care.

• Behavioral Support: Assisting with emotional regulation and positive behavioral practices.

• Documentation: Maintaining records of support plans, progress, and community involvement.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

• Register the business entity with the North Carolina Secretary of State.

• Obtain EIN from the IRS and NPI (Type 2).

• Enroll as a Medicaid Waiver Community Living and Support provider via the NCTracks Provider Portal.

• Maintain general liability and professional liability insurance.

• Develop policies for independent living, community integration, and client safety.

• Ensure staff complete required background checks, health screenings, and training in community support.

4. NORTH CAROLINA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application via the NCTracks Portal for Community Living and Support Services under HCBS waivers.

Application and Documentation Submission:

• Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, community support policies, and staff training documentation.

Program Readiness Review:

• NCDHHS and DMH/DD/SAS evaluate provider readiness, including support protocols, safety standards, and staff qualifications.

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Community Living and Support Services using designated billing codes.

5. REQUIRED DOCUMENTATION

• Articles of Incorporation or Business License (North Carolina Secretary of State)

• IRS EIN confirmation

• NPI confirmation

• Proof of general and professional liability insurance

• Community Living and Support Policy & Procedure Manual including:

  • Daily living assistance and community integration procedures

  • Behavioral support and self-advocacy training guidelines

  • Staff credentialing, background checks, and ongoing training records

  • Documentation standards for service tracking and Medicaid billing

  • HIPAA compliance, participant rights, and grievance handling

  • Safety and emergency response protocols

  • Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Community Living Program Director

Requirements: Bachelor’s or Master’s degree in social work, human services, or healthcare administration; experience in community support program management.

Role: Community Support Specialists

Requirements: High school diploma or GED; experience in direct care, community support, or habilitation; background clearance.

Role: Personal Care Aides (PCAs)

Requirements: Completion of an approved PCA training program; experience in personal care and community engagement; background clearance.

All staff must complete:

• Training in independent living, personal care, and client interaction

• HIPAA compliance and participant rights education

• Annual competency evaluations and ongoing professional development

• Safety, emergency response, and behavioral support training

• Documentation and record-keeping best practices

7. MEDICAID WAIVER PROGRAMS

Community Living and Support Services are available under the following North Carolina Medicaid Waivers:

• Innovations Waiver

• Community Alternatives Program for Disabled Adults (CAP/DA)

• Community Alternatives Program for Children (CAP/C)

• Traumatic Brain Injury (TBI) Waiver

• Home and Community-Based Services (HCBS) Waiver

8. TIMELINE TO LAUNCH

Phase: Business Formation and Compliance Preparation

Timeline: 1–2 months

Phase: Staff Hiring, Credentialing, and Program Development

Timeline: 2–3 months

Phase: North Carolina Medicaid Provider Enrollment and Readiness Review

Timeline: 60–90 days

Phase: Medicaid Billing Setup and Service Launch

Timeline: 30–45 days

9. CONTACT INFORMATION

North Carolina Department of Health and Human Services (NCDHHS)Website: https://www.ncdhhs.gov/

NCTracks Provider Enrollment Portal

Website: https://www.nctracks.nc.gov/

North Carolina Division of Health Benefits (NC Medicaid)

Website: https://medicaid.ncdhhs.gov/

North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH/DD/SAS)

Website: https://www.ncdhhs.gov/divisions/mhddsas

Centers for Medicare & Medicaid Services (CMS)

Website: https://www.cms.gov/

WAIVER CONSULTING GROUP’S START-UP ASSISTANCE SERVICE — NORTH CAROLINA COMMUNITY LIVING AND SUPPORT SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Community Living and Support Services in North Carolina, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for community integration and client support

• Staff credentialing, training program templates, and compliance documentation

• Medicaid billing setup and audit-prepared financial management

• Branding, website development, and community outreach strategies

• Quality assurance systems for community support and compliance monitoring

• Collaboration with healthcare providers and community organizations

Continue To Our Client Portal To Get Started

Our Client Portal offers a wealth of resources that you can explore related to various programs and state requirements.