Frequently Asked Questions

DHSR requires a facility to be licensed if the facility provides services to the mentally ill, developmentally disabled, or substance abusers for one or more minors or two or more adults. These services shall be day services offered to the same individual for a period of three hours or more for 24 hours or residential services provided for 24 consecutive hours or more. Facilities for individuals who are substance abusers include chemical dependency facilities.

North Carolina General Statute 122C-3(14)b-(16)

(14) "Facility" means any person at one location whose primary purpose is to provide services for the care, treatment, habilitation, or rehabilitation of the mentally ill, the developmentally disabled, or substance abusers, and includes:

  • A "licensable facility," which is a facility that provides services to individuals who are mentally ill, developmentally disabled, or substance abusers for one or more minors or two or more adults. These services shall be day services offered to the same individual for a period of three hours or more during a 24-hour period or residential services provided for 24 consecutive hours or more. Facilities for individuals who are substance abusers include chemical dependency facilities.
  • A "residential facility," a 24-hour facility that is not a hospital, including a group home.
  • g. A "24-hour facility", is a facility that provides a structured living environment and services for a period of 24 consecutive hours or more and includes hospitals that are facilities under this Chapter.

(16) "Habilitation" means training, care, and specialized therapies undertaken to assist a client in maintaining his current level of functioning or in achieving progress in developmental skills areas (if happening, you MUST be licensed).

 

When you have determined that the service you wish to provide does require a license, the following questions will help you pinpoint the service category that best fits your proposed program:

  • Do you want to provide a day or residential service?
  • Who do you want to work with?
    • People with mental illness, intellectual/developmentally disabilities or substance use disorders?
    • Adults or minors?
  • How do you expect to be paid for the services you provide?

Once you have answered these questions, review the 31 specific services (PDF, 87 KB) that DHSR licenses to determine the best service category for your program. You can find more specific information about each service category under Rules and Resources. Review Subchapter G. Scroll through the document to find the service category number.

When an application for an initial is received, the MHLC team will vet to ensure the paper components requested to submit with the application are accounted for and current.

The application is then sent to DHSR construction. Construction will send a standard acknowledgment letter stating, "You may expect your review in approximately 18-10 weeks. However, if areas require a code interpretation, there could be a delay. (If the facility is a day program, this step is skipped).

When the applicant has successfully completed the physical plant review (no plant review by DHSR construction if a day treatment program), the application is sent to the L&T team for the program review. The L&T team will schedule a time to begin the program review process within 5-10 days after being assigned the application.

We provide the applicant six months to successfully complete the program review of the application process; however, we are ready to license much sooner. Please understand that the amount of time it takes to process an application for the program review weighs heavily if the licensee is prepared and has all the necessary material completed for the application process.

An interpretation the NC Department of Insurance determined in June of 1998. that any child under the age of six residing in a licensed Home (MHL, FCH or Child Care etc.) is considered non-ambulatory and, as such must be considered as part of the home's licensed census, as the child will require attention in addition to the care the licensed clients of the home will also require, this would also apply for an aged or disabled family member that needs assistance residing the home.

Based on the above, this will give the Licensed AFL a capacity of four, which will exceed the maximum capacity allowed per the .5600F service category; this will also change how the home is classified under the North Carolina State Building Code as there would be occupants in the home that require verbal and physical assistance to evacuate the home in the event of a fire or other emergency event, which would require the installation of a 13D Sprinkler System and have the home reclassified as a Licensed Small Residential Care Facility per DHSR construction.

The facility must lower their licensed census to two with a child or disabled family member in residence.

A qualified professional or an associate professional must meet one of the criteria outlined in the staff definitions in 10A NCAC 27G .0104. If an individual meets the criteria for a QP or an AP, then they can market themselves as such. There may be further requirements for a QP or AP position from individual agencies or organizations.

10A NCAC 27G .0104 STAFF DEFINITIONS
The following credentials and qualifications apply to staff described in this Subchapter:

  1. "Associate Professional (AP)" within the mental health, developmental disabilities and substance abuse services (mh/dd/sas) system of care means an individual who is a:
    1. graduate of a college or university with a masters degree in a human service field with less than one year of full-time, post-graduate degree accumulated mh/dd/sa experience with the population served, or a substance abuse professional with less than one year of full-time, post-graduate degree accumulated supervised experience in alcoholism and drug abuse counseling. Supervision shall be provided by a qualified professional with the population served until the individual meets one year of experience. The supervisor and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually; or
    2. graduate of a college or university with a bachelor's degree in a human service field with less than two years of full-time, post-bachelor's degree accumulated mh/dd/sa experience with the population served, or a substance abuse professional with less than two years of full-time, post-bachelor's degree accumulated supervised experience in alcoholism and drug abuse counseling. Supervision shall be provided by a qualified professional with the population served until the individual meets two years of experience. The supervisor and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually; or
    3. graduate of a college or university with a bachelor's degree in a field other than human services with less than four years of full-time, post-bachelor's degree accumulated mh/dd/sa experience with the population served, or a substance abuse professional with less than four years of full-time, post-bachelor's degree accumulated supervised experience in alcoholism and drug abuse counseling. Supervision shall be provided by a qualified professional with the population served until the individual meets four years of experience. The supervisor and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually; or
    4. registered nurse who is licensed to practice in the State of North Carolina by the North Carolina Board of Nursing with less than four years of full-time accumulated experience in mh/dd/sa with the population served. Supervision shall be provided by a qualified professional with the population served until the individual meets four years of experience. The supervisor and the employee shall develop an individualized supervision plan upon hiring. The parties shall review the plan annually.
  1. "Qualified professional" means, within the mh/dd/sas system of care:
    1. an individual who holds a license, provisional license, certificate, registration or permit issued by the governing board regulating a human service profession, except a registered nurse who is licensed to practice in the State of North Carolina by the North Carolina Board of Nursing who also has four years of full-time accumulated experience in mh/dd/sa with the population served;
    2. a graduate of a college or university with a Masters degree in a human service field and has one year of full-time, pre- or post-graduate degree accumulated supervised mh/dd/sa experience with the population served, or a substance abuse professional who has one year of full-time, pre- or post-graduate degree accumulated supervised experience in alcoholism and drug abuse counseling;
    3. a graduate of a college or university with a bachelor's degree in a human service field and has two years of full-time, pre- or post-bachelor's degree accumulated supervised mh/dd/sa experience with the population served, or a substance abuse professional who has two years of full-time, pre- or post-bachelor's degree accumulated supervised experience in alcoholism and drug abuse counseling; or
    4. a graduate of a college or university with a bachelor's degree in a field other than human services and has four years of full-time, pre- or post-bachelor's degree accumulated supervised mh/dd/sa experience with the population served, or a substance abuse professional who has four years of full-time, pre- or post-bachelor's degree accumulated supervised experience in alcoholism and drug abuse counseling.

DHSR does not assist with funding for facilities. Prospective providers should determine their funding source prior to applying for a mental health license with DHSR. If your plan includes being reimbursed with state dollars or Medicaid dollars, you will need to have a contract with an LME/MCO, and must contact the LME/MCO you wish to work with (generally the LME/MCO for your region) to find out the process for contracting with them.

Local Management Entity/Managed Care Organizations Directory

In order to be paid with Medicaid or state funds for providing a service, there may be additional staffing, training, or treatment requirements, for that particular service. These additional requirements are called "clinical coverage policies" for Medicaid funds, and "service definitions" for state funds. You may wish to research the service definition or clinical coverage policy that matches your service before you contact your LME/MCO.

DMH/DD/SAS web page with state funded service definitions

NC Medicaid web page that includes links to Clinical Coverage Policies for Medicaid Reimbursement.

Private Pay
If a prospective provider does not wish to take advantage of public dollars as a funding source (i.e. Medicaid, state, county funds), then the provider does not need to have a contract with the local LME/MCO and can just bill prospective clients.

Yes. Serving most clients without first obtaining a license is a violation of the law. Specifically, North Carolina General Statute 122C-28 states: “Operating a licensable facility without a license is a Class H felony, including a fine of one thousand dollars ($1,000) per day that the facility is in operation in violation of this Article.”

Yes. All staff must be trained and competent to provide services to the clients the facility serves.

Staff training should be provided by a person who is competent in the area in which staff need training. Training in medication administration, for example, must be conducted by a licensed registered nurse, pharmacist, or other legally qualified person as per 10A NCAC 27G .0209(c)(3). Training in client rights, including restrictive interventions, must be conducted by a person trained to train others. Your qualified professional may be a resource for assisting, developing or performing some of the required training. Your LME-MCO may also be a resource for training resources.

Yes, staff must be in place and the facility must be completely furnished and ready to open before an initial license is issued.

Mental Health Licensure requires the licensee to develop written policies and procedures. The Applicant’s policies and procedures manual must be submitted to the Licensure & Training Consultant at the first review. Policies and procedures manual helps align the missions and goals of the organization, the applicable laws and rules, and the processes by which the work is to be done. It serves as a consistent source for organizational policy, which are the overall regulations that govern the business, and the procedures that define how those policies will be implemented. Therefore, writing them well will help keep the organization on path and ensure that standard procedures are being conducted the same way by all staff.

Why Separate Policies and Procedures:
Policies reflect governing rules and are general in nature. Procedures indicate the specific implementation of a given policy. Policies adapt to changes in governmental statutes. Procedures, in addition to adapting to changes in policies, should also evolve with new tools and methods of treatment. This separation will ultimately serve to distinguish what is based on rules and what are the existing standards of practice.

Where to Begin:
You must begin by assembling all applicable North Carolina General Statute 122C and the 10A NCAC North Carolina Administrative Code (mental health licensure rules) for the type of license or designation sought. All applicable Rules become the foundation of your new policy and procedure manual. In the absence of all else, these things must be satisfied. The key to writing strong procedures and policies is to make the documents rigid enough to clearly indicate the rules of the organization, but flexible enough to be able to be followed easily and without significant deviation.

Rules:
The following rules are essential for all licensed mental health facilities to help formulate the required Operations and Management Policies, Guidelines and Procedures:

10A NCAC Chapter 13 N.C. Medical Care Commission
Subchapter O Health Care Personnel Registry
.0101 Definitions
.0102 Investigating and Reporting Health Care Personnel

10A NCAC Chapter 26 Mental Health, General
Subchapter C
Designation of Facilities for the Custody and Treatment of Involuntary Clients

10A NCAC Chapter 27 Mental Health, Community Facilities and Services
Subchapter CProcedures and General Information
Subchapter DGeneral Rights
Subchapter ETreatment or Habilitation Rights
Subchapter F24-Hour Facilities
Subchapter GRules for Mental Health, Developmental Disabilities, and Substance Abuse Facilities and Services

There is no standard template. However, you will find information on our list of required materials.

Developing and maintaining a written emergency plan- specifically policies & procedures which prepare, train and require practice to ensure health, safety and welfare (shelter-in-place, lockdown and shelter-out), including maintaining (specific) information which will protect people served and staff during emergencies.

Developing and implementing plans, procedures and backup plans that include ways to globally communicate with people served and staff's families and community agencies before, during and after an emergency.

Special needs - a plan focused on people served and staff with special needs or chronic medical issues and requirements (such as transportation, food, etc.) before, during and after an emergency.

Recovery - A plan of action for recovery that includes the protection of information and assets to allow for a continuum of care for children and families.

Some counties use Emergency plans submitted through the NCDPS Risk Management Portal with the State of North Carolina. https://rmp.nc.gov/Portal/#

Type of Facility Number of Beds Base Fee Per Bed Fee
Non-ICF/IID Facilities 6 or less $350.00 $0
Non-ICF/IID Facilities 7 or more $525.00 $19.00
ICF/IID Facilities 6 or less $900.00 $0
ICF/IID Facilities 7 or more $850.00 $19.00
Non- Residential Facilities N/A $265.00 N/A

It depends on if the initial is a day or residential:

Residential

Sanitation and fire are required for all residential.

Day Program

Must submit the following

  • Current local Fire Marshal's Inspection Report for the building.
  • Current local Sanitation Inspection report if serving any food.

If a facility prepares food for sale or as part of a fee, it must have a permit, including sanitation inspections. The State considers food preparation to include the portioning of food.

If a facility serves commercially pre-packaged foods or foods that were individually packaged w/in a permitted restaurant w/o any extra handling, then no permit or inspection is needed. However, if the facility prepares or portions out the food in any way, then a permit & inspection are required.

  • Examples:
    • Individual boxes of nuggets from a restaurant are handed to the end consumer (no permit/inspection) versus getting a platter of nuggets from a restaurant & giving a portion to each consumer (permit/inspection).
    • The individual sub is made & packaged at a restaurant and handed to the end consumer (no permit/inspection) VS Getting a sub from a restaurant & cutting it into portions to give to consumers (permit/inspection).
    • Handing a slice of pizza boxed at a restaurant to the end consumer (no permit/inspection) VS Getting a whole pizza & putting a slice on a plate for the consumer (permit/inspection).
    • Giving commercially packaged sliced apples to a consumer (no permit/inspection) VS Slicing an apple for them (permit/inspection).
    • Commercially packaged, pre-cooked item handed to a consumer for them to open & re-heat themselves (no permit/inspection) VS Opening & re-heating a commercially packaged, pre-cooked item for a consumer (permit/inspection).

Take the completed service categories section in the licensure application to your zoning, building and/or fire officials. Providers of day, outpatient and residential need zoning approval. Twenty-four hour residential services must present completed application to their LME-MCO to request a letter of support.

Yes. If you provide residential services for handicapped clients, you need to provide proper accommodations. Contact your local building official for information.

No. You need to review the physical plant requirements in 10A NCAC 27G Section .0300 to verify the facility meets the construction, space and other physical plant requirements for the clients to be served. You may, however, contact the DHSR Construction Section for specific questions.

  • Policy and procedures comply with the rule. (When submitting the P&P submit in ONE PDF)
  • The policies and procedures worksheet is completed

Ensure when submitting information, staff records the agency follows the format (and numbering) of the required materials worksheet.

  • John Doe
  • John's signed job description
  • John HCPR (90 days)
  • John's criminal background check (180 days)

The KEY to a more efficient review Is ORGANZATION and submitting the correct documentation.

Physical plant requirements are listed in the initial application packet. No DHSR construction fees are required for a day facility.

Application

  • Take the completed application (pages 9-14) to your local zoning office and obtain zoning approval.
  • Attach the zoning approval letter to the application.
  • Preliminary program approval letter is required from the State Opioid Treatment Authority (SOTA) for all service category 3600 facilities.
  • Submit all items listed in Requirements for Day Programs box on page 8, including approved:
    • Fire Marshal,
    • Sanitation and
    • Building Officials inspection reports as required.
  • Include initial licensure fee upon submitting all items.
  • Write a letter briefly describing the services to be offered by the facility.
  • Develop written policies and procedures for your service but do not submit them with the application.
  • Day Programs for children and adolescents cannot be in a building classified as a Business Occupancy. These programs are required to meet either Group E-Educational Occupancy or Group I-4 - Child Daycare Occupancy under the NCSBC.

24-hour residential applicants must contact the LME-MCO in the catchment area to verify/review if there is a need for the particular twenty-four hour residential service (see 10A NCAC 27G .0406). The LME-MCO will issue the letter of support which needs to be enclosed with the initial licensure application or a change application if changing service category.

All licenses expire at the end of the calendar year. A renewal application must be submitted through DHSR's online Enterprise System.

If there is a change of ownership to a new provider under the current Innovations Waiver, as long as the facility was licensed for five or six beds prior to 6/5/2011, the new owner can continue to be licensed for five or six beds and serve Innovation Waiver consumers in those beds.

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. If you have questions or need additional information regarding the NPI number, call the toll free number 1-800-465-3203 or visit the NPI website.

Program Code

10 NCAC 27G

Facility Type/Service Category

Day/24-Hour/ Periodic

.1100

Partial Hospitalization for individuals who are acutely mentally ill

Day

.1200

Psychosocial Rehab for individuals with Severe and Persistent Mental Illness

Day

.1300

Residential Treatment for Children or Adolescents

24- Hour

.1400

Day Treatment for Children and Adolescents with Emotional or Behavioral Disturbances

Day

.1700

Residential Treatment Staff Secure for Children or Adolescents

24- Hour

.1800

Intensive Residential Treatment for Children or Adolescents

24- Hour

.1900

Psychiatric Residential Treatment for Children and Adolescents

24- Hour

.2100

Specialized Community Residential Centers for Individuals with Developmental Disabilities

24- Hour

.2200

Before/After School and Summer Developmental Day Services for Children with or at Risk for Developmental Delays, Developmental Disabilities, or Atypical Development

Day

.2300

Adult Developmental and Vocational Program for Individuals with Developmental Disabilities

Day

.2400

Developmental Day Services for Children with or at Risk for Developmental Delays, Developmental Disabilities or Atypical Development

Day

.3100

Nonhospital Medical Detoxification for Individuals who are Substance Abusers

24- Hour

.3200

Social Setting Detoxification for Substance Abusers

24- Hour

.3300

Outpatient Detoxification for Substance Abuse

Periodic

.3400

Residential Treatment/Rehabilitation for Individuals with Substance Abuse Disorders

24- Hour

.3600

Outpatient Opioid Treatment

Periodic

.3700

Day Treatment Facilities for Individuals with Substance Abuse Disorders

Day

.4100

Residential Recovery Programs for Individuals with Substance Abuse Disorders and their Children

24- Hour

.4300

Therapeutic Community

24- Hour

.4400

Substance Abuse Intensive Outpatient Program (SAIOP)

Periodic

.4500

Substance Abuse Comprehensive Outpatient Treatment Program (SACOT)

Periodic

.5000

Facility Based Crisis Services for Individuals of All Disability Groups

24- Hour

.5100

Community Respite Services for Individuals of All Disability Groups

24- Hour

.5200

Residential Therapeutic (Habilitative) Camps for Children and Adolescents of All Disability Groups

24- Hour

.5400

Day Activity for Individuals of All Disability Groups

Day

.5500

Sheltered Workshops for Individuals of All Disability Groups

Day

.5600

Supervised Living for Individuals of All Disability Groups

24- Hour

.6000

Inpatient Hospital Treatment for Individuals who have Mental Illness or Substance Abuse Disorders

24- Hour