SPECIAL BULLETIN COVID-19 #144: COVID-Nursing Facility Response Site Criteria Revised

Friday, December 18, 2020

Note: This bulletin revises the COVID-Response Site criteria established in SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients. Special Bulletin #82 otherwise remains in effect as written. 

Under Special Bulletin #82, NC Medicaid established its reimbursement methodology for “COVID-Response sites,” defined as a Medicaid enrolled nursing home “accepting a COVID+ resident discharged from an acute health care setting.” This reimbursement methodology ensured that COVID-Response sites “receive the same assistance as a Skilled Nursing Facility (SNF) with an Outbreak.” 

Under its Criteria for Reimbursement at the Additional COVID-19 Per Diem Rate section, Special Bulletin #82 established that to be a COVID-Response site, a nursing facility:

must have identified itself to NC Medicaid as a COVID-Response site. A COVID-Response site must not have or had an open Corrective Action Plan with any DHHS division for infection control-related deficiencies at any point on or after April 1, 2020.
This bulletin revises this previously established criteria.

This bulletin revises this previously established criteria.

Revision to COVID-Response Site Criteria Established under Special Bulletin #82

NC Medicaid will apply the following amended criteria when reviewing any COVID-Response Site designation request received on or after Dec. 1, 2020:

  • A facility must request COVID-Response Site status.
  • A facility must not have received any harm or immediate jeopardy-level deficiencies within the six months prior to seeking COVID-Response Site status. This replaces the deficiency criteria established in Special Bulletin #82.
  • A facility must participate in an Infection Control and Response (ICAR) assessment conducted by the UNC Statewide Program for Infection Control and Epidemiology (SPICE) prior to NC Medicaid activating the COVID-Response Site rate.
  • If a facility meets all criteria established above, NC Medicaid will retroactively activate the facility’s COVID-Response Site rate on the first of the facility’s application month.

Facility Outbreak Status and Response Site Designation

A facility with a COVID-19 outbreak, as indicated in NCDHHS COVID-19 Ongoing Outbreaks in Congregate Living Settings Updates, does not have COVID-Response Site status. NC Medicaid, in conjunction with the Division of Public Health and  local health departments, will verify the  current outbreak status of every facility applying or approved to serve as a COVID-Response Site.

If a facility requesting Response Site status is currently experiencing an outbreak, NC Medicaid will suspend its review until the outbreak is over.  After the outbreak has concluded, NC Medicaid will verify that the facility’s response during the outbreak was appropriate before activating or reactivating the facility’s COVID-Response Site status and rate.

Individual Arrangements between Nursing Facilities and Acute Care Settings

NC Medicaid does not take a position on individual arrangements for the transfer and discharge of COVID-19 positive patients from an acute care setting to a nursing facility. The scope of this bulletin and Special Bulletin #82 is limited to the criteria used to authorize COVID-specific Medicaid reimbursement for serving COVID positive Medicaid beneficiaries.  

Other COVID- Response Site Requirements in Special Bulletin #82 Remain in Effect

Rate structure, billing criteria and reporting requirements for COVID-Response Sites established in Special Bulletin #82 remain in effect.

For Additional Information

  • Please review Special Bulletin #82
  • Please see Reporting Requirements under Information for Nursing Facilities and Adult Care Homes COVID-19 Status Reporting Template Established in SPECIAL BULLETIN COVID-19 #82: Required Reporting to Maintain Retroactive Targeted Rate Increases for Skilled Nursing Facilities (SNFs) and Adult Care Homes (ACHs) Serving COVID-positive Patients on NC Medicaid’s COVID-19 Guidance: Status Reporting for Reimbursement page.
  • To request Response Site status, please email Medicaid.ProviderReimbursement@dhhs.nc.gov

Contact

Medicaid Contact Center: 888-245-0179