This bulletin serves to remind providers of mental health, Intellectual and Developmental Disabilities (I/DD) and Substance Use Disorder (SUD) services that achievement of national accreditation is required per NC Gen Stat § 122C-81 (2023), Medicaid clinical coverage policies, the North Carolina Medicaid State Plan and Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMHDDSUS) State-funded Service Definitions. The requirement for a provider to achieve national accreditation can either be one or three years after initial NCTracks Medicaid provider enrollment, except for providers of Innovation Waiver services.
Providers of select I/DD services included in Clinical Coverage Policy 8-P, North Carolina Innovations must be nationally accredited at the time of enrolling in Medicaid via NCTracks. Mental health, I/DD and SUD providers should refer to relevant clinical coverage policies to determine the specific timeframe allowed to achieve national accreditation.
[Providers are advised to initiate the process of obtaining national accreditation if the requirement has not been met or not already in progress. Beginning Jan. 25, 2026, NCTracks will institute monitoring efforts to verify provider compliance with NC Gen Stat § 122C-81 (2023) and clinical coverage policy requirements.]
Resources
- NC Medicaid Behavioral Health clinical coverage policies may be accessed at Program Specific Clinical Coverage Policies | NC Medicaid.
- DMHDDSUS State Funded Services coverage policies may be accessed at NC DMH/DD/SUS: Service Definitions.
Contact
Phone: Provider Ombudsman: 866-304-7062
Email: Medicaid.ProviderOmbudsman@dhhs.nc.gov