SPECIALIZED THERAPIES SERVICES PROVIDER IN NORTH CAROLINA

DELIVERING TARGETED THERAPEUTIC INTERVENTIONS TO ENHANCE PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING

Specialized Therapies Services in North Carolina provide targeted therapeutic interventions for individuals with disabilities, chronic conditions, or mental health challenges. These services include a range of therapies tailored to meet unique needs, focusing on improving function, independence, and quality of life. Specialized Therapies 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 Specialized Therapies 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 specialized therapies targeting individuals with developmental disabilities and mental health needs.

Agency: Centers for Medicare & Medicaid Services (CMS)

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

2. SPECIALIZED THERAPIES SERVICES OVERVIEW

Specialized Therapies address specific physical, developmental, behavioral, and emotional challenges through targeted therapeutic techniques.

Approved providers may deliver:

• Physical Therapy (PT): Enhancing mobility, strength, and coordination through exercises and interventions.

• Occupational Therapy (OT): Supporting daily living skills and adaptive techniques for independence.

• Speech and Language Therapy (SLT): Addressing communication disorders and dysphagia (swallowing difficulties).

• Behavioral Therapy: Implementing strategies to manage challenging behaviors and enhance social skills.

• Music and Art Therapy: Promoting self-expression and emotional healing through creative outlets.

• Recreational Therapy: Encouraging physical activity and community participation.

• Sensory Integration Therapy: Helping individuals process sensory information effectively.

• Cognitive Behavioral Therapy (CBT): Addressing thought patterns and behaviors to improve mental health.

• Trauma-Informed Therapy: Providing support for individuals impacted by trauma or abuse.

• Documentation: Maintaining detailed records of therapy sessions, progress tracking, and treatment 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 Specialized Therapies provider via the NCTracks Provider Portal.

• Maintain general liability and professional liability insurance.

• Develop policies for therapy delivery, safety protocols, and client interaction.

• Ensure therapists hold valid state licenses and complete required background checks.

4. NORTH CAROLINA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

• Complete the Provider Enrollment Application via the NCTracks Portal for Specialized Therapies under HCBS waivers.

Application and Documentation Submission:

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

Program Readiness Review:

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

Approval & Medicaid Enrollment:

• Upon approval, providers are authorized to bill Medicaid for Specialized Therapies 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

• Specialized Therapies Policy & Procedure Manual including:

  • Therapy planning and individualized care procedures

  • Safety protocols for therapeutic interventions

  • Staff credentialing, background checks, and ongoing training records

  • Documentation standards for therapy tracking and Medicaid billing

  • HIPAA compliance, participant rights, and grievance handling

  • Quality assurance and compliance monitoring

  • Emergency response and client safety protocols

6. STAFFING REQUIREMENTS

Role: Specialized Therapies Program Director

Requirements: Licensed therapist (PT, OT, SLP, or behavioral therapist) with a Master's or Doctorate in a relevant field; experience in clinical supervision and program management.

Role: Physical Therapists (PT)

Requirements: Doctorate in Physical Therapy (DPT); North Carolina state license; CPR certification.

Role: Occupational Therapists (OT)

Requirements: Master’s degree in Occupational Therapy; state licensure; experience in rehabilitation and adaptive techniques.

Role: Speech-Language Pathologists (SLP)

Requirements: Master’s degree in Speech-Language Pathology; ASHA certification; state licensure.

Role: Behavioral Therapists

Requirements: Certification as a Board Certified Behavior Analyst (BCBA); experience in applied behavior analysis.

Role: Creative Arts Therapists (Music/Art)

Requirements: Certification from the appropriate therapy board; experience in creative therapeutic interventions.

All staff must complete:

• Training in therapy techniques, client safety, and patient interaction

• HIPAA compliance and participant rights education

• Annual competency evaluations and ongoing professional development

• Safety, emergency response, and therapy-specific training

• Documentation and record-keeping best practices

7. MEDICAID WAIVER PROGRAMS

Specialized Therapies 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 Specialized Therapy 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 SPECIALIZED THERAPIES SERVICES PROVIDER

WCG supports agencies in launching Medicaid-compliant Specialized Therapies Services in North Carolina, offering:

Scope of Work:

• Business registration, Medicaid enrollment, and licensing assistance

• Policy manual development for therapeutic practices and client safety

• 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 therapeutic care and compliance monitoring

• Collaboration with healthcare providers and therapy specialists

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.