A "nursing facility" is an institution or a distinct part of an institution, other than an intermediate care facility for individuals with intellectual disabilities, that is certified by Medicaid to provide nursing facility level of care servcies.
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.
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Coverage and Requirements
- Clinical Coverage Policy 2B-1, Nursing Facilities
- Clinical Coverage Policy 2B-2, Geropsychiatric Units in Nursing Facilities
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
- Facility name
- Facility address
Following the logic in Section Q, information about who (if anyone) assisted the resident in completing Section Q:
- Significant other
- Legally authorized representative
- 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.
- North Carolina Level I Screening Form for Nursing Facility Admissions
- Nursing Facility Capital Data Survey (Fair Rental Value)
- Nursing Facility Cost Report Software Package (DMA-4082)
- Nursing Facility Hearing Request Form (DMA-9051)
- Nursing Facility Notice of Transfer/Discharge (DMA-9050)
- Ventilator Physician's Order Form
Medical Assistance Clinical Section