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NC Department of Health and Human Services
NC Division of
Medical Assistance
 
 

Nursing Facilities

DMA Clinical Policy and Programs
Phone Number 919-855-4340
Fax 919-733-2796

A nursing facility is an institution, or a distinct part of an institution, other than an intermediate care facility for the mentally retarded (ICF/MR), that is certified by Medicaid to provide nursing facility level of care services.  Nursing facility care provides daily licensed nursing care but does 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.

For service requirements, coverage criteria, and limitations refer to

Medicaid Bulletins

For changes and updates to coverage criteria, billing information, and other program requirements refer to the N.C. Medicaid general and special bulletins.

MDS 3.0 Section Q Referral Process in North Carolina

As is required under MDS 3.0, 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.  

Effective October 1, 2010, nursing facilities can call 1-866-271-4894 (9:00 a.m. through 5:00 p.m., Monday through Friday) to submit Section Q referrals to trained call-center staff.  

When submitting the referral, facilities will need to provide the following information:

  • Resident’s name and phone contact information
  • Name of referring facility’s contact, including:
    • Name of staff contact
    • Phone
    • Email
    • Name of facility
    • 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 Local Contact Agency
Call center staff will forward the facility’s referral to the appropriate local agency for a face-to-face follow up meeting with the interested person.  

The Local Contact Agency (LCA) is a local, community organization that has been designated by the Office of Longterm 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. 

Importantly, the MDS 3.0 Section Q referral process does not otherwise change a facility’s discharge planning responsibilities.

Case Mix Reimbursement Information

Nursing Facility Forms

To see forms that apply to all providers, please visit our Provider Forms page.

Nursing Facility Rates

Nursing Facility Cost Report Information

 

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