RESIDENTIAL SUPPORT SERVICES PROVIDER IN NORTH CAROLINA

PROVIDING SAFE, SUPPORTIVE LIVING ENVIRONMENTS FOR INDIVIDUALS WITH DISABILITIES AND CHRONIC CONDITIONS

Residential Support Services in North Carolina help individuals with disabilities, mental health challenges, or chronic conditions live independently or semi-independently within community settings. These services include assistance with daily living, health monitoring, and community integration, fostering independence and quality of life. Residential 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 Residential 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 residential 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 Residential Support Services meet quality, safety, and person-centered care standards.

2. RESIDENTIAL SUPPORT SERVICES OVERVIEW

Residential Support Services are designed to provide individuals with disabilities the necessary support to live independently within residential settings, including group homes, supported apartments, or individual residences.

Approved providers may deliver:

• Personal Care Assistance: Assisting with bathing, dressing, grooming, and mobility.

• Daily Living Skills Training: Teaching cooking, cleaning, budgeting, and personal care.

• Health Monitoring: Managing medications and overseeing chronic conditions.

• Behavioral Support: Addressing behavioral challenges and promoting positive interactions.

• Social Integration: Encouraging community participation and relationship-building.

• Crisis Intervention: Managing behavioral or health-related emergencies.

• Household Management: Supporting meal planning, housekeeping, and maintenance.

• Transportation Support: Facilitating access to medical appointments and community activities.

• Safety Monitoring: Ensuring a safe and supportive living environment.

• Documentation: Maintaining records of services provided, individual progress, and care plans.

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 Residential Support provider via the NCTracks Provider Portal.

• Maintain general liability and professional liability insurance.

• Develop policies for residential care, personal support, and safety management.

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

4. NORTH CAROLINA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

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

Application and Documentation Submission:

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

Program Readiness Review:

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

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Residential 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

• Residential Support Policy & Procedure Manual including:

  • Personal care and daily living assistance protocols

  • Safety, crisis intervention, and emergency response procedures

  • Staff credentialing, background checks, and ongoing training records

  • Documentation standards for care tracking and Medicaid billing

  • HIPAA compliance, participant rights, and grievance handling

  • Quality assurance and compliance monitoring

  • Infection control and hygiene practices

6. STAFFING REQUIREMENTS

Role: Residential Program Director

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

Role: Direct Support Professionals (DSPs)

Requirements: High school diploma or GED; experience in personal care and residential support; background clearance.

Role: Residential Coordinators

Requirements: Experience in community integration, independent living support, and case management.

All staff must complete:

• Training in personal care, community integration, and client safety

• HIPAA compliance and participant rights education

• Annual competency evaluations and ongoing professional development

• Safety, emergency response, and behavior management training

• Documentation and record-keeping best practices

7. MEDICAID WAIVER PROGRAMS

Residential 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 Residential Support 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 RESIDENTIAL SUPPORT SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Residential Support Services in North Carolina, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for residential care and personal 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 residential support and compliance monitoring

• Collaboration with housing agencies, 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.