Notice of Service Discharge — Agency Policy Statement

CONFIDENTIAL — FOR AUTHORIZED INTERNAL USE ONLY

Document Type: Agency Policy Statement — Formal Letter of Discharge

Date: April 24, 2026 | Issuing Agency: Comp Serv Health, LLC — North Carolina | Status: Active

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REASON 1: INABILITY TO STAFF — EVV SERVICE ADDRESS NOT UPDATED

A fundamental requirement for the lawful delivery of Medicaid-funded in-home services in North Carolina is that the authorized service address on file with the Electronic Visit Verification (EVV) system, NC Medicaid, and the applicable Managed Care Organization (MCO) accurately reflects the physical location where services are being rendered.

The agency has been made aware that the service address at which services were most recently provided does not correspond to the address currently documented in the EVV system, and that this change of address was not communicated to, or updated with, NC Medicaid or the applicable MCO by the family or guardian. As the agency cannot lawfully staff, deliver, or bill for services at an address that has not been properly authorized and updated through the required Medicaid and MCO channels, the agency is unable to continue service provision under the current circumstances.

Regulatory Basis: NC Medicaid EVV Requirements | 42 CFR §441.301 | NC Medicaid Clinical Coverage Policy 8D (Innovations Waiver) | NC DHHS EVV Policy

REASON 2: INAPPROPRIATE COMMUNICATION WITH STAFF — RISK & SAFETY CONCERN

The agency has documented a pattern of communication directed toward agency staff and administration that has been determined to be inappropriate, threatening, and/or harassing in nature. Verbal communications have included language that poses a risk to the safety, well-being, and professional dignity of agency personnel. This conduct has been documented internally and has been reviewed by agency administration and clinical leadership.

Regulatory Basis: 10A NCAC 27G .0204 (Staffing Requirements) | NC General Statute §95-130 (Workplace Safety) | Agency Zero Tolerance Policy

AGENCY TRANSITION OF CARE ACTIONS

1. Agency will contact the assigned MCO Care Coordinator directly to formally notify them of this discharge decision and effective date.

2. Agency will request that the MCO Care Coordinator initiate the formal process to discharge the individual from this provider in the MCO's provider management and EVV systems.

3. Agency will provide the MCO Care Coordinator and the family/guardian with a list of other qualified Medicaid-enrolled providers in the area who offer the same or comparable services.

4. Records Request: The individual's records may be requested in writing at compservhealth.com or by calling 888-751-3730. Records will be provided within 30 days per HIPAA requirements.

All future communications regarding this matter must be submitted in writing to agency administration. Verbal communications will not be accepted or acted upon.

Comp Serv Health, LLC | 888-751-3730 | compservhealth.com | drniang.compservhealth.com