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

Adult Care Homes

NOTE: INFORMATION ON THIS PAGE EXPIRED ON DECEMBER 31, 2012. FOR INQUIRES REGARDING THIS SERVICE PLEASE VISIT THE PERSONAL CARE SERVICES PAGE AT http://www.ncdhhs.gov/dma/pcs/pas.html OR CALL 919-855-4340.

 

DMA Clinical Policy and Programs
Phone Number 919-855-4340
Fax 919-715-2372

An adult care home (ACH) provides room and board and 24-hour supervision and services for people needing assistance with activities of daily living (ADLs) and some health care needs due to normal aging, a chronic illness, a cognitive disorder, or a disability.  Adult care homes bridge the gap between independent living and nursing facility care that provides medical and nursing care in addition to help with ADLs.  The adult care home is not a substitute for the nursing facility, but rather another level of care appropriate for those who cannot live by themselves and need assistance with bathing, dressing, ambulation, eating, toileting, and/or medication administration.

Adult care homes are assisted living facilities licensed by the Division of Health Service Regulation and enrolled by the Division of Medical Assistance as a provider of basic or enhanced personal care services and non-emergency medical transportation.  Adult care homes for 2 to 6 beds are called family care homes. Nursing facilities and hospitals may have designated adult care home beds.

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.

Adult Care Home IMD Evaluation Page

ACH Financial Information

Cost Reports

ACH Forms

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

Effective October 1, 2013, all PCS referral/request forms were consolidated into the DMA 3051 Personal Care Services (PCS) Request for Services Form. With the implementation of DMA 3051, the following forms are no longer used:

  • DMA 3041 New Referral Request Form - Home Care Agency
  • DMA 3068 New Referral Request Form - Licensed Residential Facility
  • DMA 3042 Change of Status Request Form - Home Care Agency
  • DMA 3069 Change of Status Request Form - Licensed Residential Facility
  • DMA 3043 Change of Provider Request Form - Home Care Agency
  • DMA 3070 Change of Provider Request Form - Licensed Residential Facility

Below are all the currently used Adult Care Home forms: