INDIVIDUAL GOODS AND SERVICES PROVIDER IN NORTH CAROLINA

Fatumata Kaba
Sep 15
4 min read

ENHANCING INDEPENDENCE AND QUALITY OF LIFE THROUGH PERSONALIZED SUPPORT ITEMS AND SERVICES

Individual Goods and Services in North Carolina assist individuals with disabilities or chronic conditions by providing essential items and services that support independence, well-being, and community integration. These services are tailored to meet unique needs and preferences, offering practical solutions to daily challenges. Individual Goods and 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 Individual Goods and 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 goods and 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 Individual Goods and Services meet quality, safety, and person-centered care standards.

2. INDIVIDUAL GOODS AND SERVICES OVERVIEW

Individual Goods and Services provide essential items and personalized support solutions that promote autonomy, safety, and enhanced quality of life.

Approved providers may deliver:

Adaptive Equipment: Items such as mobility aids, grab bars, and adaptive utensils.
Household Items: Safety devices, personal care products, and hygiene supplies.
Technology Assistance: Communication devices and sensory aids.
Home Modifications: Small adaptations to improve accessibility and safety.
Personal Assistance Items: Products that aid in daily living tasks, such as dressing aids.
Health and Safety Enhancements: Smoke detectors, alert systems, and medical alert devices.
Transportation-Related Goods: Wheelchair lifts, seatbelt extenders, and accessible vehicle modifications.
Recreational and Social Items: Adapted sports equipment or hobby supplies.
Training and Education Materials: Books, digital resources, and training tools related to independent living.
Documentation: Maintaining records of purchased items, assessments, and client usage.

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 Individual Goods and Services provider via the NCTracks Provider Portal.
Maintain general liability and professional liability insurance.
Develop policies for item procurement, customization, and client safety.
Ensure staff complete required background checks, health screenings, and training in adaptive goods management.

4. NORTH CAROLINA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application via the NCTracks Portal for Individual Goods and Services under HCBS waivers.

Application and Documentation Submission:

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

Program Readiness Review:

NCDHHS and DMH/DD/SAS evaluate provider readiness, including item selection standards, safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Individual Goods and 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
Individual Goods and Services Policy & Procedure Manual including:
- Needs assessment and item selection protocols
- Safety and quality assurance procedures for adaptive goods
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for item tracking and Medicaid billing
- HIPAA compliance, participant rights, and grievance handling
- Emergency response and safety verification protocols
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Program Director

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

Role: Goods and Services Specialists

Requirements: Experience in adaptive equipment selection, customer support, and community resource coordination.

Role: Procurement Coordinators

Requirements: Experience in purchasing, vendor management, and inventory tracking; background clearance.

All staff must complete:

Training in adaptive goods management, client safety, and product customization
HIPAA compliance and participant rights education
Annual competency evaluations and ongoing professional development
Safety, emergency response, and client interaction training
Documentation and record-keeping best practices

7. MEDICAID WAIVER PROGRAMS

Individual Goods and 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 INDIVIDUAL GOODS AND SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Individual Goods and Services in North Carolina, offering:

Scope of Work:

Business registration, Medicaid enrollment, and licensing assistance
Policy manual development for adaptive equipment and personal support items
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 item safety and compliance monitoring
Collaboration with healthcare providers, equipment vendors, and community organizations