Forms & Applications

Relatives as Direct Support Employee (RADSE) Forms:

The Western Regional Partnership (WRP), an initiative established by CenterPoint Human Services (CenterPoint), Partners Behavioral Health Management (Partners), and Smoky Mountain LME/MCO (Smoky), continues to make progress toward the consolidation goals outlined in the Division of Health and Human Services (DHHS) Medicaid Reform Plan.

NC Innovations requires that LME/MCOs review requests for relatives or legally responsible persons (LRPs) to be direct support employees. The WRP has standardized the request process by developing standardized electronic forms and submission methods for relative/LRPs as direct service employee (RADSE) review requests. The standardized Part A, B, and C forms are available at each WRP member website.

Electronic submission is required and the submission email addresses for the appropriate WRP member are indicated on each form (for CenterPoint – RADSE@cphs.org).

Any provider that wishes to immediately begin electronic submission of applications is encouraged to do so. However, effective December 1, 2014, providers are required to submit RADSE applications via electronic submission. No other submissions will be accepted after 12/1/2014.

Please direct any questions to RADSE@cphs.org.

Submission Instructions: Select the appropriate form below to download. Make sure editing is enabled and complete the form. Save the completed form to your computer, then select the correct WRP member’s email to open a new email window. Attach the completed form to the email and send!

Various Provider Forms:

Involuntary Commitment Forms:

Consumers:

Provider Medicaid Enrollment:

Contracting:

Provider Monitoring

Plans of Correction

State Regulations

Service Definitions

Incident Reporting