Procedure to Establishing a Nursing Home
Purpose: This procedure describes the steps to establish nursing home beds in North Carolina. The Medical Care Commission is authorized to adopt, amend and repeal all rules necessary for the implementation of the Nursing Home Act (Chapter 131E, Article 6, part A of the N.C. General Statutes). Rules in Title 10A 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.
| Medical Facilities Planning Section | (919)855-3865 |
| Certificate of Need Section | (919) 855-3873 |
| Construction Section | (919) 855-3893 |
| Nursing Home Licensure & Certification Section, Raleigh Office | (919) 855-4520 |
Procedure Summary: In order to operate a nursing home or add nursing home beds to an existing home in North Carolina, an applicant first consults the State Medical Facilities Plan to determine if there is a demonstrated need for such a facility. They then obtain a certificate of need. They must get approval for the construction of the facility, and then apply for and obtain a license. If Medicare or Medicaid patients will be treated, steps to obtain certification are taken after the facility is in operation. Licenses are then renewed annually.
Procedures:
| Step | Process followed |
|---|---|
| 1.0 | Consult the State Medical Facilities Plan: Medical Facilities Planning Section |
| 1.1 | Applicants can learn the number of nursing home beds needed by reviewing the annual State Medical Facilities Plan, which is published each calendar year and which specifies in which areas of the state they will be needed. |
| 1.2 | Applicants can also find the certificate of need review schedule and deadline for submittal of applications for beds 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 schedule outlined in 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 | The Certificate of Need Section schedules a review for each of the counties in which there is a need. Applications will only be accepted for proposed beds within a county where a review has been scheduled. |
| 2.3 | 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. |
| 2.4 | The CON Section conducts a public hearing 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. |
| 2.5 | 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. |
| 2.6 | A certificate of need is issued 35 days after the date of approval unless a petition for a contested case hearing is filed. |
| 2.7 | After a certificate of need is issued, the applicant contacts the Construction Section and the NH Licensure & Certification Section 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, the review fee, and the 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; the inspections 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 may be 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 transmittal form (form 4086) to the NH Licensure & Certification Section for approval for occupancy. |
| 4.0 | Obtain a license: Nursing Home Licensure & Certification Section |
| 4.1 | At least three months before operation, the applicant contacts the NH Licensure & Certification Section for a licensure and Medicare/Medicaid certification (if applicable) application package. |
| 4.2 | The Section sends all forms and information necessary for licensure. |
| 4.3 | The applicant completes and returns all forms and license fees. |
| 4.4 | The applicant submits policies, procedures, checklists and other documents for the in-office review conducted by the section prior to licensure. |
| 4.5 | A state license is issued for a facility once the in-office review is completed and the Section has received approval for licensure by the Construction Section. |
| 5.0 | Obtain certification: Nursing Home Licensure & Certification Section |
| 5.1 | Facilities wishing to be certified for participation in the Medicaid/Medicare program must contact the Section for a certification package at least 3 months after operation. |
| 5.2 | The Section sends all forms and information necessary for certification. |
| 5.3 | The applicant completes and returns all forms. |
| 5.4 | The applicant contacts the fiscal intermediary for the CMS-855 form, completes the form and returns it to the fiscal intermediary. |
| 5.5 | After the facility is licensed and has residents, and after the Medicare Provider Enrollment form has been approved by the fiscal intermediary, the applicant contacts the Section to request, in writing, an initial certification survey. The applicant also contacts the Construction Section to request, in writing, an initial Life Safety Code survey. |
| 5.6 | The Construction Section conducts a survey to determine that the facility meets the Life Safety Code requirements, and the NH Licensure & Certification Section conducts the initial certification survey within three weeks of request. |
| 5.7 | 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. |
| 5.8 | The Section forwards all information to the Centers for Medicare and Medicaid Services (CMS) Regional Office in Atlanta for approval. |
| 5.9 | The Regional Office assigns the Medicare provider number and notifies the fiscal intermediary. |
| 6.0 | Maintain the state license: Nursing Home Licensure & Certification Section |
| 6.1 | At the end of each September, the Section sends out license renewal applications to all nursing homes. |
| 6.2 | The Section renews a license after receipt and approval of the application and license fee. |