NC Medicaid Personal Care Services and Other Public Programs

If the Agency provides State Plan personal care services (PCS) paid by NC Medicaid, sets the provider requirements of NC Medicaid Clinical Coverage Policy 3L: enrollment, the Provider Interface, the on-line service plan and its deadlines, aide documentation, the conviction billing bar, the ban on inducements, cooperation with audits, the internal quality improvement program and its December 31 attestation, abuse reporting, and supervision and training. Refers to CAP/DA and block grant programs for their own requirements.

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About this policy

Policy number: NC-HC-BUS-03
Version: 1.0
Main rule: NC Medicaid Clinical Coverage Policy 3L, §6.0
Library: North Carolina home care · 50 policies
Category: Business
Sections: 23

In short

Medicaid personal care services follow a service plan built from the state assessment, plus the nurse's own plan of care.
Do the tasks on the service plan on the days shown. If a task is not done, write down why.
Never offer a client or family a gift or anything else to choose or stay with the Agency.
A registered nurse visits every client at least every 90 days.
Report any suspected abuse, neglect or exploitation of a Medicaid client right away.

What's inside

23 sections. The full text comes with the One-time Policy Pack.

Full text with a package

Terms of Reference
1. Purpose
2. Scope
3. Definitions
4. Policy Statement (NC Medicaid Clinical Coverage Policy 3L, §6.0)
5. Enrollment and Changes
6. Referrals and the Service Plan
7. Developing the Service Plan
8. Delivering and Documenting PCS
9. Staff Requirements and the Billing Bar
10. No Gifts or Inducements
11. Reviews and Audits
12. Internal Quality Improvement Program
13. Health, Welfare and Safety
14. Training and Orientation
15. Other Public Programs
16. Responsibilities
17. Records and Compliance Monitoring
18. Staff Training
19. References
20. Related Policies and Forms
21. Approval
22. Revision History

An inspector may ask

Show me the PCS service plan for this beneficiary, the date you accepted the referral, and the date the plan was validated.
Where is the separate plan of care your registered nurse developed for this beneficiary?

North Carolina home care

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Rules it follows

NC Medicaid Clinical Coverage Policy 3L, §6.0NC Medicaid Clinical Coverage Policy 3L, §6.1NC Medicaid Clinical Coverage Policy 3L, §6.1.3NC Medicaid Clinical Coverage Policy 3L, §6.1.4NC Medicaid Clinical Coverage Policy 3L, §6.1.5NC Medicaid Clinical Coverage Policy 3L, §6.1.6NC Medicaid Clinical Coverage Policy 3L, §5.4.5(c)NC Medicaid Clinical Coverage Policy 3L, §5.4.6NC Medicaid Clinical Coverage Policy 3L, §5.4.11NC Medicaid Clinical Coverage Policy 3L, §7.1-§7.10NC Medicaid Clinical Coverage Policy 3K-210A NCAC 13J .1107(g)10A NCAC 13J .1502(a)

Forms included

NC-HC-BUS-03-A Medicaid PCS Referral and Service Plan Checklist

Read a sample in full

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