How Do I Get Services?

Individuals may contact Restorative Care Services directly or be referred by a family member, legal guardian, healthcare provider, school, hospital, Department of Social Services, court professional, probation or parole officer, care manager, health plan, or community agency.

To get started, you may:

• Submit a referral form through our website.

• Call our office to speak with a team member who can explain the referral and intake process.

After receiving the referral, our staff will review the information and contact the individual or authorized representative to discuss the next steps. Acceptance and scheduling depend on clinical needs, service eligibility, insurance authorization, provider availability, and our participation with the individual’s health plan.

Do I Need a Referral From a Doctor?

A doctor’s referral may not be required to contact us or request outpatient services. However, insurance requirements vary, and certain services may require an assessment, service order, recommendation, or prior authorization before treatment can begin. Our staff can help explain the requirements that apply to the requested service.

What Ages Do You Serve?

We provide outpatient behavioral health services to children, adolescents, and adults. Age and eligibility requirements may vary depending on the specific service and funding source.

What Services Do You Provide?

Restorative Care Services offers:

• Outpatient therapy

• Group therapy

• Comprehensive Clinical Assessments (CCAs)

• 1915(i) Respite Services

What Is a Comprehensive Clinical Assessment?

A Comprehensive Clinical Assessment, commonly called a CCA, is an evaluation completed by a licensed clinician. It helps identify an individual’s behavioral health needs, strengths, symptoms, level of functioning, possible diagnoses, and recommended services.

Does Everyone Need a CCA Before Starting Therapy?

An assessment is generally needed to determine the individual’s treatment needs and establish appropriate recommendations. Whether a new CCA is required may depend on the person’s circumstances, existing records, insurance requirements, and the date and completeness of any previous assessment.

What Happens After the CCA?

The clinician will review the assessment findings and recommend services based on the individual’s needs. Recommendations may include outpatient therapy, group therapy, another level of care, or referrals to other community providers. Completing a CCA does not guarantee admission into a particular service.

Do You Provide Individual, Family, and Group Therapy?

Available treatment may include individual, family, or group therapy based on clinical recommendations, current program availability, and insurance authorization. Please contact our office to learn which services are currently accepting referrals.

1915(i) Respite Questions

What is 1915(i) Respite?

1915(i) Respite provides periodic support and temporary relief to a primary caregiver who lives with and is principally responsible for supervising and caring for an eligible individual. The service allows caregivers to take planned breaks or attend to certain planned or unexpected events while the individual receives appropriate support.

Where Can Respite Be Provided?

Depending on the individual’s approved service plan, respite may be provided in or outside the home in an authorized community-based setting.

When Are Respite Services Available?

Depending on the individual’s assessed needs, approved service plan, authorization, and staff availability, respite may be provided during the day, overnight, on weekends, or in response to certain family emergencies.

Emergency respite addresses an unexpected family or caregiver need. It is not a substitute for behavioral health crisis services or emergency medical care.

Who May Qualify for 1915(i) Respite?

The service may be available to qualifying NC Medicaid beneficiaries who:

• Are ages 3 through 21 and have a qualifying serious emotional disturbance or severe substance use disorder; or

• Are age 3 or older and have a qualifying intellectual or developmental disability or traumatic brain injury.

Additional clinical, functional, caregiving, assessment, and authorization requirements apply. Having a diagnosis or being enrolled in NC Medicaid does not automatically establish eligibility.

Which Medicaid Programs May Cover 1915(i) Services?

Depending on the person’s eligibility, 1915(i) services may be available through:

• A Behavioral Health and I/DD Tailored Plan

• NC Medicaid Direct

• The Eastern Band of Cherokee Indians Tribal Option

• The Children and Families Specialty Plan, managed by Healthy Blue Care Together

Coverage does not necessarily mean that Restorative Care Services participates in every plan or is authorized to provide services to every member. Please contact our office and the member’s health plan to verify eligibility, authorization, and provider-network participation.

Who Is Not Eligible for 1915(i) Respite?

1915(i) services are generally unavailable to members enrolled in a Standard Plan. Participation in certain Medicaid waiver programs, residential services, or other overlapping services may also affect eligibility. The member’s health plan or care coordinator should verify eligibility based on the person’s specific circumstances.

How Do I Request a 1915(i) Assessment?

First, the individual must have NC Medicaid. To apply, visit the NC Medicaid application website or call the NC Medicaid Contact Center at 1-888-245-0179.

If the individual already has Medicaid, contact the Member and Recipient Service Line listed on the Medicaid health plan ID card and request a 1915(i) assessment. Individuals who have a Tailored Care Manager or Care Coordinator may contact that person for assistance.

Trillium Health Resources members may call 1-877-685-2415. TTY users may call 711.

Can Restorative Care Services Complete the 1915(i) Assessment?

The required 1915(i) eligibility assessment is generally coordinated through the individual’s Tailored Care Manager, Care Coordinator, or health plan. Restorative Care Services may accept a referral after the individual is determined eligible, respite is included in the approved service plan, and the service is authorized.

Does a Referral Guarantee Respite Services?

No. A referral does not guarantee eligibility, authorization, or immediate availability. The individual must meet NC Medicaid requirements, complete the required assessment process, have respite included in the approved service plan, and receive authorization before services begin.