Nursing Facility Cost Assessment

Effective retroactively to Nov. 1, 2022, NC Medicaid is modifying the structure of the existing provider assessment on SNFs. Consistent with current Centers for Medicare and Medicaid Services (CMS)-approved state authority, this modification will allow NC Medicaid to reinvest additional provider tax collections and associated federal matching dollars into an increase in Medicaid SNF-specific per diem rates. The revised SNF provider assessment program is structured:

  1. The per diem assessments are imposed on non-Medicare patient days as allowed for under 42 CFR 433.68(d).
  2. The assessments imposed on nursing facilities will be calculated as follows:
    • Continuing Care Retirement Centers and Tribal Facilities will be assessed at a uniform per diem rate equal to $0.00 per non-Medicare day.
    • Nursing facilities with a total annual census greater than 42,000 will be assessed at uniform per diem rate equal to $8.64 per non-Medicare day.
    • All other nursing facilities that do not meet the criteria of (a) or (b) above will be assessed at a uniform per diem rate equal to $26.74 per non-Medicare day.

Between April 1, 2012, and October 31, 2022, the following cost assessment rates applied to enrolled nursing facility providers:

  • $13.68 for 48,000 or fewer total patient days per year
  • $7.18 for more than 48,000 total patient days per year

Provider assessments are due 15 days after the last date of the previous month. Please note CCRC's (Continuing Care Retirement Community) Facility Fee Assessment is zero.

Failure to provide accurate and timely reporting of days and payment of assessment will result in a 10% reduction in facility rates for Medicaid participating facilities and recoupment. (10A NCAC 22G.0109)

NC Medicaid is allowed to withhold up to 100% of the facility’s payments until the liability is satisfied. Please note this reduction does not have a recoupment policy and stays in effect until assessments become current.

Assessment Worksheet Instructions

Days Adjustment Calculation  


NC Medicaid Finance Section
Stacey Crute
Phone: 919-527-7169
Fax: 919-716-0600