NC Medicaid has received approval from the Centers for Medicare & Medicaid Services (CMS) on the 1915(i) State Plan Amendment (SPA), to start 1915(i) services for eligible NC Medicaid members as of July 1, 2023. 1915(i) services are home and community-based services (HCBS) which provide opportunities for Medicaid enrollees to receive services in their own home or community rather than institutions.
The approval of 1915(i) services will allow NC Medicaid to continue to offer Medicaid beneficiaries a comprehensive array of behavioral health, intellectual/developmental disability (I/DD) and traumatic brain injury (TBI) services in NC Medicaid Direct and in the Behavioral Health I/DD Tailored Plan when they launch. Additionally, this approval allows NC Medicaid to extend coverage of the current 1915(b)(3) services to additional populations.
The following services are available under the 1915(i) SPA:
- Community Living and Support focuses on skill practice/acquisition and provides supervision/assistance for activities. This service is available for members with an I/DD or TBI.
- Community Transition provides funds for adult members moving from an institutional setting into their own private residence. This service is available for members with an I/DD, serious mental illness (SMI), severe substance use disorder (SUD), or TBI.
- The Individual and Transitional Support service supports in acquiring, retaining and improving self-help, social and adapting skills to reside successfully in the community. This service is available for some members with a serious emotional disturbance (SED), SMI or severe SUD.
- Respite provides periodic or scheduled support and relief to the primary caregiver(s) from the responsibility and stress of caring for beneficiaries. This service is available for some members with I/DD, SED, severe SUD, and TBI.
- Supported Employment provides initial job development, train
Note: When provided in the home (not in a group home or congregate living setting), the Individual and Transitional Support service and Community Living and Support service are subject to Electronic Visit Verification (EVV). For more information on EVV and its requirements, please visit the NC Medicaid EVV webpage.
With the approval of the 1915(i) services, members currently receiving 1915(b)(3) services will begin the transition to 1915(i) services as early as July 1, 2023. Prior to receiving 1915(i) services, members must have a completed 1915(i) assessment performed by their TCM provider or care coordinator and have been deemed eligible for 1915(i) services.
1915(b)(3) services will continue to remain available for members who have not yet completed the 1915(i) assessment and been deemed eligible for 1915(i) services. This transition will take time as networks are expanded and members are engaged. NC Medicaid intends that individuals will maintain their services until they transition to 1915(i) services. Please note, that as NC Medicaid is transitioning members who currently receive 1915(b)(3) services, it will take time for providers in the community to build capacity to provide these much-needed services.
NC Medicaid is committed to a smooth transition from 1915(b)(3) services to 1915(i) services and has been working with Local Management Entity-Managed Care Organizations (LME-MCOs) to first prioritize the transition for members who currently receive 1915(b)(3) services and are transitioning to a Tailored Plan at Tailored Plan launch. The next priority for transition to 1915(i) services are other members currently receiving 1915(b)(3) services who are not transitioning to a Tailored Plan.
1915(i) services will be available through:
- NC Medicaid Direct through LME/MCOs
- Tribal Option through LME/MCOs
- All Tailored Plans (upon launch)
- The Children & Families Specialty Plan (upon launch)
NC Medicaid is aware that the expansion of the availability of Home and Community Based Services (HCBS) through the 1915(i) has been long awaited. As NC Medicaid focuses on the smooth transition of current members receiving 1915(b)(3) services, it’s important to understand that it will take time for providers in the community to build capacity to provide these much-needed services.
NC Medicaid is incredibly excited about the approval of the 1915(i) services and is looking forward to supporting the LME/MCOs, providers and members in working to make to make these services more available to all members who could benefit from them. In this transition the first priority remains a smooth transition to these services currently receiving services to avoid disruption in care.
Providers can find more information on the transition from 1915(i) services to 1915(b)(3) services in the Transition of 1915(b)(3) Benefits to 1915(i) fact sheet.
Contact
NCTracks Call Center: 800-688-6696