Latest Medicaid Bulletin Applicable to Nursing Facilities

NC Medicaid is aware of cases outstanding since the NC Medicaid Managed Care launch (July 1, 2021) where the level of care approval was not received and financial eligibility was not determined, but claims were still paid to nursing facilities by the PHPs. To correct this issue, PHPs will be sending the level of care approval documentation for these cases to the NF. As applicable, the local DSSs will be reaching out to the NFs to request a copy of the level of care approval documentation so that financial eligibility can be determined for these cases.

To provide additional information on this issue, NC DHHS has prepared “Guidance for Nursing Facilities Admitting Beneficiaries Assigned to a Prepaid Health Plan”. This information can be read by clicking here.