Section 1902(kk)(1) of the Social Security Act, for provider types that exist in both Medicare and Medicaid, requires the State Medicaid Agency (SMA) to assign providers to the same or higher risk category applicable under Medicare in accordance with 42 CFR § 424.518. As a result, NC Medicaid has updated the categorial risk level assignments for organizations enrolling as Skilled Nursing Facilities, Hospice Organizations, and Portable X-ray Suppliers to be compliant with federal regulations.
What Changed
Skilled Nursing Facilities (SNFs)
Effective Jan. 1, 2023: Newly enrolling SNFs or undergoing a change in ownership moved from limited categorical risk level to high risk. SNFs who are revalidating have moved from limited risk to moderate risk.
Hospice Organizations
- Effective Jan. 1, 2024: Newly enrolling Hospice Organizations or undergoing a change in ownership have moved from moderate risk to high risk.
- Hospice Organizations, who are revalidating, will remain in the moderate risk category.
Portable X-ray Suppliers
Portable X-ray Suppliers have moved from limited risk to moderate risk.
What This Means for Providers
- Providers newly enrolled in these taxonomies since the effective dates above now require a site visit if one has not been conducted by Medicare or NC Medicaid in the past five years.
- Providers classified as high risk will require:
- A site visit (if one has not been conducted by Medicare or NC Medicaid in the past five years.
- A Fingerprint-based Criminal Background Checks (FCBC) of individual owners, if FCBC has not been initiated by NC Medicaid in the past five years.
Due to these changes, Skilled Nursing Facilities, Hospice organizations and Portable x-ray suppliers are required to pay a federal fee per application, if not paid to Medicare within the past five years, to offset the cost of conducting the required enrollment screenings.
Contact
NCTracks Call Center: 800-688-6696
Provider Ombudsman: 866-304-7062