{"data":{"id":"us-nc/n.c.-gen.-stat.-108c-3","jurisdiction":"us-nc","citation":"N.C. Gen. Stat. § 108C-3","heading":"Medicaid provider screening.","body":"(a)\tProvider Screening. - The Department shall conduct provider screening of Medicaid providers in accordance with applicable State or federal law or regulation.\n(b)\tEnrollment Screening. - The Department must screen all initial provider applications for enrollment in Medicaid, including applications for a new practice location, and all revalidation requests based on the Department's assessment of risk and assignment of the provider to a categorical risk level of limited, moderate, or high. If a provider could fit within more than one risk level described in this section, the highest level of screening is applicable.\n(c)\tLimited Categorical Risk Provider Types. - All of the following provider types are designated as limited categorical risk:\n(1)\tAmbulatory surgical centers.\n(1a)\tBehavioral health and intellectual and developmental disability provider agencies that are nationally accredited by an entity approved by the Secretary, unless they meet the description in subdivision (g)(15) of this section.\n(2)\tEnd-stage renal disease facilities.\n(3)\tFederally qualified health centers.\n(4)\tHealth programs operated by an Indian Health Program, as defined in section 4(12) of the Indian Health Care Improvement Act, or an urban Indian organization, as defined in section 4(29) of the Indian Health Care Improvement Act, that receives funding from the Indian Health Service pursuant to Title V of the Indian Health Care Improvement Act.\n(5)\tHistocompatibility laboratories.\n(6)\tHospitals, including critical access hospitals, Department of Veterans Affairs Hospitals, and other State or federally owned hospital facilities.\n(6a)\tLicensed outpatient behavioral health providers.\n(7)\tLocal Education Agencies.\n(8)\tMammography screening centers.\n(9)\tMass immunization roster billers.\n(10)\tNursing facilities, including Intermediate Care Facilities for Individuals with Intellectual Disabilities, that are not skilled nursing facilities.\n(10a)\tSkilled nursing facilities that are limited categorical risk under subsection (k) of this section.\n(11)\tOrgan procurement organizations.\n(12)\tPhysician or nonphysician practitioners, including nurse practitioners, CRNAs, physician assistants, physician extenders, occupational therapists, speech/language pathologists, chiropractors, and audiologists; optometrists; dentists and orthodontists; and medical groups or clinics.\n(13)\tRadiation therapy centers.\n(14)\tRural health clinics.\n(15)\tHearing aid dealers.\n(16)\tRepealed by Session Laws 2025-27, s. 2.3(b), effective January 1, 2024.\n(17)\tReligious nonmedical health care institutions.\n(18)\tRegistered dieticians.\n(19)\tClearinghouses, billing agents, and alternate payees.\n(20)\tLocal health departments.\n(d)\tLimited Categorical Risk Screenings. - When the Department designates a provider as a limited categorical level of risk, the Department shall conduct the applicable screening functions required by federal law.\n(e)\tModerate Categorical Risk Provider Types. - All of the following provider types are designated as moderate categorical risk:\n(1)\tAmbulance services.\n(2)\tComprehensive outpatient rehabilitation facilities.\n(3)\tRepealed by Session Laws 2018-5, s. 11H.12(a), effective June 12, 2018.\n(4)\tRepealed by Session Laws 2013-378, s. 6, effective October 1, 2013.\n(5)\tRevalidating hospice organizations, unless they meet the description in subdivisions (g)(14) and (g)(15) of this section.\n(6)\tIndependent clinical laboratories.\n(7)\tIndependent diagnostic testing facilities.\n(8)\tPharmacy services.\n(9)\tPhysical therapists enrolling as individuals or as group practices.\n(10)\tRevalidating adult care homes delivering Medicaid-reimbursed services, unless they meet the description in subdivision (g)(15) of this section.\n(11)\tRevalidating agencies providing durable medical equipment, including orthotics and prosthetics, unless they meet the description in subdivision (g)(15) of this section.\n(12)\tRevalidating agencies providing nonbehavioral health home- or community-based services pursuant to waivers authorized by the federal Centers for Medicare and Medicaid Services under 42 U.S.C. § 1396n(c), unless they meet the description in subdivision (g)(15) of this section.\n(13)\tRevalidating agencies providing private duty nursing, home health, personal care services or in-home care services, or home infusion, unless they meet the description in subdivision (g)(15) of this section.\n(14)\tNonemergency medical transportation.\n(15)\tSkilled nursing facilities that are moderate categorical risk under subsection (k) of this section.\n(16)\tPortable X-ray suppliers.\n(f)\tModerate Categorical Risk Screenings. - When the Department designates a provider as a moderate categorical level of risk, the Department shall conduct the applicable screening functions required by federal law and regulation.\n(g)\tHigh Categorical Risk Provider Types. - All of the following provider types are designated as high categorical risk:\n(1)\tProspective, or newly enrolling, adult care homes delivering Medicaid-reimbursed services.\n(2)\tAgencies providing behavioral health services, excluding (i) behavioral health and intellectual and developmental disability provider agencies that are nationally accredited by an entity approved by the Secretary and (ii) licensed outpatient behavioral health providers.\n(3)\tRepealed by Session Laws 2018-5, s. 11H.12(a), effective June 12, 2018.\n(4)\tProspective, or newly enrolling, agencies providing durable medical equipment, including, but not limited to, orthotics and prosthetics.\n(5)\tAgencies providing HIV case management.\n(6)\tProspective, or newly enrolling, agencies providing nonbehavioral health home- or community-based services pursuant to waivers authorized by the federal Centers for Medicare and Medicaid Services under 42 U.S.C. § 1396n(c).\n(7)\tProspective, or newly enrolling, agencies providing personal care services or in-home care services.\n(8)\tProspective, or newly enrolling, agencies providing private duty nursing, home health, or home infusion.\n(9)\tProviders against which the Department has imposed a payment suspension based upon a credible allegation of fraud in accordance with 42 C.F.R. § 455.23 within the previous 12-month period. The Department shall return the provider to its original risk category not later than 12 months after the cessation of the payment suspension.\n(10)\tProviders that were excluded, or whose owners, operators, or managing employees were excluded, by the U.S. Department of Health and Human Services Office of Inspector General, the Medicare program, or another state's Medicaid or Children's Health Insurance Program within the previous 10 years.\n(11)\tProviders that have incurred a Medicaid final overpayment, assessment, or fine to the Department in excess of twenty percent (20%) of the provider's payments received from Medicaid in the previous 12-month period. The Department shall return the provider to its original risk category not later than 12 months after the completion of the provider's repayment of the final overpayment, assessment, or fine.\n(12)\tProviders whose owners, operators, or managing employees were convicted of a disqualifying offense pursuant to G.S. 108C-4 but were granted an exemption by the Department within the previous 10 years.\n(13)\tSkilled nursing facilities that are high categorical risk under subsection (k) of this section.\n(14)\tProspective, or newly enrolling, hospice organizations and revalidating hospice organizations undergoing a change in ownership.\n(15)\tThe following revalidating providers (i) that are revalidating for the first time since newly enrolling and (ii) for which fingerprinting requirements, as a newly enrolling provider, were waived due to a national, state, or local emergency:\na.\tOpioid treatment programs that have not been fully and continuously certified by the Substance Abuse and Mental Health Services Administration since October 23, 2018.\nb.\tAgencies providing durable medical equipment, including orthotics and prosthetics.\nc.\tAdult care homes delivering Medicaid-reimbursed services.\nd.\tAgencies providing private duty nursing, home health, personal care services, or in-home care services, or home infusion.\ne.\tHospice organizations.\n(h)\tHigh Categorical Risk Screenings. - When the Department designates a provider as a high categorical level of risk, the Department shall conduct the applicable screening functions required by federal law and regulation.\n(i)\tDually-Enrolled Providers. - For providers dually enrolled in the federal Medicare program and Medicaid, the Department may rely on the results of the provider screening performed by Medicare contractors.\n(j)\tOut-of-State Providers. - For out-of-state providers, the Department may rely on the results of the provider screening performed by the Medicaid agencies or Children's Health Insurance Program agencies of other states.\n(k)\tSkilled Nursing Facilities. - The categorial risk level for provider screening of skilled nursing facilities is the categorical risk level required by federal law or regulation. If federal law or regulation does not require a particular categorical risk level, skilled nursing facilities are limited categorical risk. (2011-399, s. 1; 2013-378, s. 6; 2016-94, s. 12H.3(a); 2018-5, s. 11H.12(a); 2022-74, s. 9D.15(z); 2025-27, s. 2.3(a), (b).)","path":["Chapter 108C. Medicaid Provider Requirements."],"source_url":"https://www.ncleg.gov/EnactedLegislation/Statutes/HTML/BySection/Chapter_108C/GS_108C-3.html","current_through":"S.L. 2026-30","vintage":"","retrieved_at":"2026-08-27T18:16:32Z","sha256":"50adc1cd4a7ccc4370879ebf8c34692b210e511fcd4e07333490856496a819d2","source_id":"us-nc","stale":false,"prev":"us-nc/n.c.-gen.-stat.-108c-2.1","next":"us-nc/n.c.-gen.-stat.-108c-4"},"notice":"GroundRules: Original legal text. Not legal advice."}