SECTION .0700 - LICENSED NURSING HOME SERVICES
10A NCAC 41A .0701 MEDICAL ELIGIBILITY FOR LICENSED NURSING HOME SERVICES
(a) A patient shall be medically eligible for reimbursement for up to 60 days per year, beginning the first day of financial eligibility, for treatment and convalescence services at a contract nursing home if the tuberculosis control branch finds that the following criteria are met:
(1) The applicant must have active pulmonary or disseminated tuberculosis associated with incapacitation or significant debilitation which requires a SNF or ICF level of care. To aid in making this determination, the referring physician shall provide a treatment plan and project a length of stay for the patient at the nursing home.
(2) The applicant must have positive bacteriology for tuberculosis. The positive bacteriology (AFB) must have been obtained within the preceding 14 days.
(3) The applicant must not be in need of an acute level of hospital care for any condition.
(4) The applicant must be 16 years of age or over.
(5) The applicant must be referred by a licensed physician who has first‑hand knowledge of the applicant's mental and physical condition. The referring physician must furnish a summary of the applicant's physical and mental condition and known infirmities, and specific details of treatment and medication the applicant is taking with recommendations as to dosage, frequency and duration. This summary must include all known allergies as well as anti‑tuberculosis and all other medications that the patient is taking. In addition, dietary needs, pertinent x‑rays, and copies of laboratory reports must be forwarded, either with the patient, if accepted for admission, or in advance.
(6) The head of the Tuberculosis Control Branch may make exceptions to the criteria contained in (1) through (5) of this Paragraph upon a determination that a patient could be best treated for a tuberculosis condition at a licensed nursing home.
(b) If the head of the Tuberculosis Control Branch determines that additional treatment or convalescent care at a licensed nursing home is medically necessary because of the tuberculosis condition, the head of the Branch may extend medical eligibility for more than 60 days per year.
(c) The medical care payments described in this Rule are available only for services provided at a licensed nursing home which has contracted with the tuberculosis program for these services. Further payment limitations are found in 10A NCAC 45A .0300.
History Note: Authority G.S. 130A‑177;
Eff. October 1, 1985;
Amended Eff. September 1, 1990.