To streamline processes for nursing facility admissions and the determination of long-term care financial eligibility, NC Medicaid created a new standardized PHP Notification of Nursing Facility Level of Care Form (NC Medicaid-2039) for PHPs and nursing facilities to communicate with local Departments of Social Services (DSS).
The standardized form includes all information a local DSS needs to begin the financial determination for long-term care as required by the Centers for Medicare and Medicaid Services (CMS). Once counties conduct the financial determination and establish the patient monthly liability (PML), the PML will be shared with health plans and allow payments to proceed to nursing facilities.
To further clarify how this process works, NC Medicaid created stakeholder-specific fact sheets for counties, for health plans, and for providers (including hospitals and nursing facilities). The fact sheets outline the information flow, timelines and requirements for the long-term care financial eligibility determination process.
NC Medicaid will host stakeholder webinars to answer questions in the coming weeks, more information will be forthcoming as these webinars are scheduled.
Contact
NC Medicaid Contact Center: 888-245-0179