COMMUNITY TRANSITION SERVICES PROVIDER IN NORTH CAROLINA

FACILITATING SMOOTH TRANSITIONS FROM INSTITUTIONAL CARE TO COMMUNITY-BASED LIVING

Community Transition Services in North Carolina assist individuals moving from institutional settings, such as nursing homes or long-term care facilities, to community-based living arrangements. These services provide essential support during the transition, including housing assistance, personal care setup, and community integration. Community Transition 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 Transition 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 transition services targeting individuals with developmental disabilities and mental health needs.

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. COMMUNITY TRANSITION SERVICES OVERVIEW

Community Transition Services are designed to support individuals as they move from institutional care to community living, promoting independence and enhancing quality of life.

Approved providers may deliver:

• Housing Assistance: Securing affordable, accessible housing options.

• Household Setup: Purchasing essential items like furniture, bedding, and kitchenware.

• Utility Connection: Assisting with setting up utilities such as electricity, water, and internet.

• Personal Care Support: Arranging for in-home care services as needed.

• Skill Building: Teaching independent living skills, such as budgeting and home maintenance.

• Service Coordination: Connecting individuals to local resources, healthcare providers, and community programs.

• Transportation Planning: Assisting with setting up reliable community or personal transportation.

• Financial Planning: Helping manage budgeting, rent payments, and utility expenses.

• Documentation: Maintaining records of transition plans, support services, and outcomes.

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 Transition provider via the NCTracks Provider Portal.

• Maintain general liability and professional liability insurance.

• Develop policies for transition planning, community integration, and safety management.

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

4. NORTH CAROLINA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

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

Application and Documentation Submission:

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

Program Readiness Review:

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

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Community Transition 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 Transition Policy & Procedure Manual including:

  • Transition planning and independent living support procedures

  • Safety and emergency preparedness guidelines

  • Staff credentialing, background checks, and ongoing training records

  • Documentation standards for transition tracking and Medicaid billing

  • HIPAA compliance, participant rights, and grievance handling

  • Financial management support for transition expenses

  • Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Community Transition Program Director

Requirements: Bachelor’s or Master’s degree in social work, human services, or healthcare administration; experience in transitional care and community integration.

Role: Transition Coordinators

Requirements: Experience in care coordination, housing assistance, and community support; background clearance.

Role: Independent Living Specialists

Requirements: Experience in skills training, personal care support, and client advocacy.

All staff must complete:

• Training in transition planning, independent living support, and client interaction

• HIPAA compliance and participant rights education

• Annual competency evaluations and ongoing professional development

• Safety, emergency response, and housing assistance training

• Documentation and record-keeping best practices

7. MEDICAID WAIVER PROGRAMS

Community Transition 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 TRANSITION SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Community Transition Services in North Carolina, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for transition planning and independent living support

• Staff credentialing, training program templates, and compliance documentation

• Medicaid billing setup and audit-prepared financial management

• Branding, website development, and client outreach strategies

• Quality assurance systems for transition support and compliance monitoring

• Collaboration with housing providers, healthcare agencies, 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.