Purpose: A Continuing Care Retirement Community (CCRC) has two options for obtaining nursing care beds: by competitive review in counties where there is a "need determination in the State Medical Facilities Plan" or by exemption pursuant to Policy NH-2, which allows nursing care beds solely for use by residents of the CCRC. This procedure describes the steps to establish nursing beds as part of a Continuing Care Retirement Community (CCRC) pursuant to Policy NH-2. The Continuing Care Industry in North Carolina is regulated by the Department of Insurance, Continuing Care Section. Nursing care beds in CCRCs are subject to the same statutes and rules as other nursing care facilities. The Medical Care Commission is authorized to adopt, amend and repeal all rules necessary for the implementation of the Nursing Home Act (Article 6, part A of the N.C. General Statutes). Rules in Title 10 of the North Carolina Administrative Code (10A NCAC 13D) apply.
Please be aware that there may be variations in the process since individual projects may have special circumstances. The flow chart is intended to be a general guide to aid the applicant in completing the overall project.
Contacts: For questions regarding any part of this process, please contact the appropriate sections of the N.C. Division of Health Service Regulation or the Department of Insurance:
| Certificate of Need Section | (919) 855-3873 |
| Construction Section | (919) 855-3893 |
| Insurance, Dept of; Continuing Care Section | (919) 733-5633 |
| Licensure; Nursing Home Branch, Raleigh Office | (919) 733-7461 |
| Licensure; Nursing Home Branch, Western Office | (828) 669-3373 |
| Medical Facilities Planning Section | (919) 855-3865 |
Procedure Summary: Policy NH-2 in the State Medical Facilities Plan allows nursing beds to be developed as part of a CCRC, under certain limited circumstances, in addition to the need determinations in the Plan. Applicants for nursing beds as part of a CCRC must consult the State Medical Facilities Plan to see if they comply with conditions for this exemption. The applicant must obtain a certificate of need for the nursing beds. The applicant must get approval for the construction of the facility, and then apply for and obtain a license. Policy NH-2 prohibits these beds from being certified for Medicaid. If Medicare patients will be treated, steps to obtain certification are taken after the facility is in operation. Licenses for the nursing facility are then renewed annually. (NOTE: A nursing unit cannot be established pursuant to Policy NH-2 unless the overall CCRC is also licensed by the Department of Insurance, Continuing Care Section.)
Procedures:
| Step | Process followed |
|---|---|
| 1.0 | Consult the State Medical Facilities Plan: Medical Facilities Planning Section |
| 1.1 | Applicants can learn the conditions of Policy NH-2 by reviewing the annual State Medical Facilities Plan, which is published each calendar year. |
| 1.2 | Applicants can also find the general certificate of need review schedule and deadline for submittal of applications for nursing beds pursuant to Policy NH-2 in the State Medical Facilities Plan. No one may develop new nursing home beds without a certificate of need. |
| 2.0 | Obtain a Certificate of Need: Certificate of Need Section |
| 2.1 | The applicant submits a certificate of need (CON) application for the proposed nursing home beds according to the provisions of the State Medical Facilities Plan. If the applicant is leasing the facility, both the prospective owner/lessor and the lessee of the home must submit a joint application. |
| 2.2 | Within 30 days of the beginning of the review period, written comments may be filed by any person, including the applicant regarding the proposals under review. |
| 2.3 | A public hearing is conducted by the CON Section within 30 to 50 days from the beginning of the review period. At this time the applicant is given the opportunity to respond to written comments submitted to the CON Section and inquiries made at the hearing. |
| 2.4 | A decision to approve or disapprove an application is made by the CON section within 150 days of the beginning of the designated review period. |
| 2.5 | A certificate of need is issued 35 days after the date of approval unless a petition for a contested case hearing is filed. |
| 2.6 | After a certificate of need is issued, the applicant contacts the Construction Section and the Nursing Home Branch about the respective requirements for the development of nursing home beds. |
| 3.0 | Obtain construction approval: Construction Section |
| 3.1 | The applicant sends two sets of floor plans and specifications to the Construction Section. |
| 3.2 | The Construction Section reviews the floor plans and writes the applicant with requirements or review comments and instructions. The Construction Section acts as the control point for distribution of plans and specifications to the Department of Insurance. Plans are generally reviewed in three stages: schematic, design development, and final working drawings. |
| 3.3 | Applicants and their designers work closely with local building officials and fire prevention officials as well as with the Construction Section to ensure the facility is code- and licensure-compliant, and, if certification for Medicare is desired, certification-compliant. |
| 3.4 | At least two weeks before construction is complete, the applicant sends a letter to the Construction Section requesting a final construction inspection with project information and local approvals. The facility must be ready with all systems operational and all construction completed by the final construction inspection date. The Construction Section does not do punchlist inspections; they are the responsibility of the designer, contractor, and owner. |
| 3.5 | The Construction Section sends a copy of the final inspection document list, inspects the facility for licensure and for certification, and reviews the required final documentation. This is usually a joint inspection effort to ensure that the building meets construction standards for both licensure and for Medicare/Medicaid certification. |
| 3.6 | If some minor deficiencies are found, the applicant submits a plan of correction. |
| 3.7 | When all items are acceptable, the Construction Section sends the construction approval transmittal form (form 4086) to the Nursing Home Branch. |
| 4.0 | Obtain a license: Nursing Home Branch |
| 4.1 | At least three months before operation, the applicant contacts the Nursing Home Branch for a license and certification application package. |
| 4.2 | The Branch sends all forms and information necessary for licensure. |
| 4.3 | The applicant completes and returns all forms. |
| 4.4 | The applicant requests to be licensed. If the applicant is planning to participate in the Medicare program, an on-site licensing survey by the Branch will not be conducted, because a certification survey follows (see step 5.3). |
| 4.5 | The Branch reviews the applicant’s policies, procedures and checklists. |
| 4.6 | If the facility chooses not to participate in the Medicare program, the Branch schedules a licensing survey within 3 weeks of the request. The Branch completes their licensing survey and issues a state license if the facility is acceptable for licensure. |
| 5.0 | Obtain certification: Nursing Home Branch |
| 5.1 | Facilities wishing to be certified for participation in the Medicare program must contact the Branch for a certification package. |
| 5.2 | After the facility is licensed and has residents, and after the certification package has been approved by the Branch and the fiscal intermediary, the applicant contacts the Construction Section and the Branch to request, in writing, an initial certification survey. |
| 5.3 | After the Construction Section has determined that the facility meets the Life Safety Code requirements, the Nursing Home Branch conducts the initial certification survey within three weeks of request. |
| 5.4 | Certification is completed if all programs are acceptable. The certification date will be one of the following: the last date of either the certification initial survey or the Life Safety Code survey or the last date of an acceptable plan of correction from either of these surveys. |
| 5.5 | The Branch forwards all information to the Atlanta Health Care Finance Administration (HCFA) Regional Office for approval. |
| 5.6 | The Regional Office assigns the Medicare provider number and notifies the fiscal intermediary. |
| 6.0 | Maintain the state license: Nursing Home Branch |
| 6.1 | At the end of each September, the Nursing Home Branch sends out license renewal applications to all nursing homes. |
| 6.2 | The Branch renews a license after receipt and approval of the application. |
This page last updated on August 3, 2007.