Adult Care Homes

An adult care home (ACH) provides room, board and supervision to people who require assistance with daily living activities, bridging the gap between independent living and nursing facility care. Adult care homes are not substituted for nursing facilities, but rather another level of care appropriate for those who need assistance with bathing, dressing, ambulation, eating, toileting, and/or medication administration.

Adult care homes are assisted living facilities licensed by the Division of Health Service Regulation and enrolled by NC Medicaid as a provider of basic or enhanced personal care services and non-emergency medical transportation.

Adult care homes for two to six beds are called family care homes. Nursing facilities and hospitals may have designated adult care home beds.

Fee Schedules  (NOTE: There is only one fee schedule for both adult care homes and personal care services since the program was consolidated. Once on the PCS fee schedule page, you will see the rates broken down by modifier; this includes adult care homes (modifier HC).)

 

Payment Methodology Study

The NC General Assembly has issued a Senate Bill (SB) to look at the current payment process for NC Adult Care homes.  The Session Law 2019-240 SB 537 required the NC Medicaid Program to look at the managed care delivery system and establish a work group to evaluate reimbursement options for services provided by adult care homes.  A legislative report will be prepared for the General Assembly on the various alternative payment models available under the State’s 1115 Medicaid Waiver, and a look at best practices across states. This fact-finding legislation will provide a summary of the findings for current payment system(s).

 

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