Nursing Facilities

A "nursing facility" is an institution or a distinct part of an institution (other than an intermediate care facility for individuals with intellectual disabilities) certified by Medicaid to provide nursing facility level of care services.

Nursing facilities provide daily licensed nursing care, but do not require the degree of medical consultation and support services available in an acute care hospital. A nursing facility receiving Medicaid funding must be licensed by the NC Division of Health Service Regulation (DHSR) and comply with state and federal rules and regulations. DHSR has published results of recent surveys conducted in Skilled Nursing Facilities within the State of North Carolina.

Nursing Facility Webinars and Fact Sheets

• Skilled Nursing Facility Process - Provider Training - Nov. 3, 2022
• NC Medicaid Managed Care/Nursing Facility - Provider Process - Oct. 17, 2022
• NC Medicaid Managed Care/Nursing Facility - PHP Process - Oct. 17, 2022
• NC Medicaid Direct and NC Medicaid Managed Care/Nursing Facility - Local DSS Process - Oct. 17, 2022

Financials and Forms

• Fee Schedule
• Fee Schedule - Frequently Asked Questions
• Cost Reports and Assessments
• Nursing Facility Forms

Coverage and Requirements

• Clinical Coverage Policy 2B-1, Nursing Facilities
• Clinical Coverage Policy 2B-2, Geropsychiatric Units in Nursing Facilities

Annual Survey Results

Annual Skilled Nursing Facility Survey Results

MDS 3.0 Section Q Referral Process

Required under MDS 3.0 Section Q, facilities will make a referral when a person residing in a nursing facility indicates under Section Q an interest in speaking with someone about the possibility of returning to the community.

Submit Section Q referrals at 1-866-271-4894.

Provide the following information:

• Resident’s name and phone contact information
• Name of referring facility’s contact, including:
  • Staff contact name
  • Phone
  • Email
  • Facility name
  • Facility address
  • County

Following the logic in Section Q, information about who (if anyone) assisted the resident in completing Section Q:

• Family
• Significant other
• Guardian
• Legally authorized representative
• Other
• Pay source/number
• Date of admission
• Date of birth

A facility will receive written confirmation that the referral was made and forwarded to the appropriate entities. The MDS 3.0 Section Q referral process does not otherwise change a facility’s discharge planning responsibilities.

Local Contact Agency

The Local Contact Agency (LCA) is a local, community organization that has been designated by the Office of Long-term Services and Supports as an LCA.

• LCAs are responsible for contacting referred residents and providing information about community support options.
• The LCA will coordinate these face-to-face conversations with the person residing in the facility, the facility point of contact and as appropriate, family members or other supports.

Contacts

NC Medicaid Clinical Section
Phone: 919-855-4340
Fax: 919-733-2796