HOME HEALTH CARE SERVICES PROVIDER IN NORTH CAROLINA

Fatumata Kaba
Sep 15
4 min read

DELIVERING COMPREHENSIVE MEDICAL AND PERSONAL CARE IN THE COMFORT OF HOME

Home Health Care Services in North Carolina provide medical and personal care to individuals in their homes, allowing them to manage chronic conditions, recover from illness, or maintain independence. These services are essential for individuals who prefer to receive care at home rather than in a healthcare facility. Home Health Care Services are authorized under North Carolina Medicaid Home and Community-Based Services (HCBS) Waiver programs.

1. GOVERNING AGENCIES

Agency: North Carolina Department of Health and Human Services (NCDHHS)

Role: Administers Medicaid waiver funding for Home Health Care Services and oversees provider enrollment, service authorization, and reimbursement.

Agency: North Carolina Division of Health Benefits (NC Medicaid)

Role: Manages Medicaid waiver services and oversees Medicaid provider participation.

Agency: North Carolina Division of Health Service Regulation (DHSR)

Role: Regulates home health agency licensing and compliance with state regulations.

Agency: Centers for Medicare & Medicaid Services (CMS)

Role: Provides federal oversight to ensure Medicaid-funded Home Health Care Services meet quality, safety, and person-centered care standards.

2. HOME HEALTH CARE SERVICES OVERVIEW

Home Health Care Services involve a range of medical and non-medical care delivered directly in the individual's home. These services help maintain health, manage chronic conditions, and support recovery from illness or surgery.

Approved providers may deliver:

Skilled Nursing Care: Administering medication, wound care, and chronic disease management.
Physical Therapy: Improving mobility, strength, and coordination through rehabilitative exercises.
Occupational Therapy: Enhancing daily living skills and promoting independence.
Speech Therapy: Assisting with communication and swallowing disorders.
Home Health Aide Support: Personal care, hygiene assistance, and mobility support.
Medical Social Services: Providing counseling and resource coordination for healthcare access.
Medication Management: Ensuring proper administration and monitoring of medications.
Chronic Condition Monitoring: Tracking vital signs and managing health changes.
Post-Hospitalization Care: Supporting recovery at home after hospital discharge.
Documentation: Maintaining detailed care plans, progress notes, and patient assessments.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Register the business entity with the North Carolina Secretary of State.
Obtain EIN from the IRS and NPI (Type 2).
Enroll as a Medicaid Waiver Home Health Care provider via the NCTracks Provider Portal.
Obtain licensure as a Home Care Agency from the North Carolina Division of Health Service Regulation (DHSR).
Maintain general liability and professional liability insurance.
Develop policies for medical care, safety protocols, and patient support.
Ensure staff complete required background checks, health screenings, and professional licensure verifications.

4. NORTH CAROLINA PROVIDER ENROLLMENT PROCESS

Initial Interest and Application:

Complete the Provider Enrollment Application via the NCTracks Portal for Home Health Care Services under HCBS waivers.

Application and Documentation Submission:

Submit Articles of Incorporation, proof of EIN/NPI, insurance certificates, healthcare policies, and staff licensure documentation.

Program Readiness Review:

NCDHHS and DHSR evaluate provider readiness, including clinical protocols, safety measures, and staff qualifications.

Approval & Medicaid Enrollment:

Upon approval, providers are authorized to bill Medicaid for Home Health Care Services using designated billing codes.

5. REQUIRED DOCUMENTATION

Articles of Incorporation or Business License (North Carolina Secretary of State)
IRS EIN confirmation
NPI confirmation
Proof of general and professional liability insurance
Home Health Care Policy & Procedure Manual including:
- Medical care protocols and medication management guidelines
- Safety, infection control, and hygiene standards
- Staff credentialing, background checks, and ongoing training records
- Documentation standards for care tracking and Medicaid billing
- HIPAA compliance, patient rights, and grievance handling
- Emergency response and patient safety protocols
- Quality assurance and compliance monitoring

6. STAFFING REQUIREMENTS

Role: Home Health Program Director

Requirements: Registered Nurse (RN) license, Bachelor’s or Master’s in Nursing or Healthcare Administration; experience in clinical supervision and home health care.

Role: Registered Nurses (RNs)

Requirements: Active RN license; experience in home health care; CPR and BLS certifications.

Role: Licensed Practical Nurses (LPNs)

Requirements: State licensure; experience in patient care and medication administration.

Role: Home Health Aides (HHAs)

Requirements: Certified HHA training program completion; experience in personal care assistance.

Role: Physical/Occupational/Speech Therapists

Requirements: Appropriate licensure and certification in therapy specialties.

All staff must complete: