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State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L

North CarolinasubregulatoryNC Department of Health and Human Services, Division of Health Benefits (NC Medicaid)· effective 2026-01-01

What this rule requires your agency to do

  • 1Providers shall ensure criminal background checks are conducted on all in-home aides before hire; aides must not be listed with a substantiated finding on the NC Health Care Registry (G.S. 131E-256); and shall not bill for PCS provided by individuals with the disqualifying convictions/findings enumerated in Sec. 6.0 and 7.10.c. Providers shall also submit an annual CQI compliance attestation to NC Medicaid by December 31 (Sec. 7.7.e).(State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L)
  • 2The in-home PCS provider shall ensure a qualified RN Nurse Supervisor conducts a supervisory visit to each beneficiary's primary private residence every 90 calendar days (7-day grace), with two of the visits within 365 days conducted while the aide is scheduled present, performing the confirmations and record validations listed in Sec. 7.10.b.(State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L)
  • 3Aide personnel records must document training in, at minimum: beneficiary rights; confidentiality/privacy; personal care skills for the five ADLs; documentation/reporting of accidents and incidents; recognizing and reporting abuse and neglect; and infection control (Sec. 6.1.2). Aides serving Session Law 2013-306 beneficiaries need training/experience in irreversible-memory-dysfunction (Alzheimer's-type) care, with attestation NC Medicaid-3085 (Sec. 6.1.2.d).(State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L)
  • 4Providers subject to EVV shall (effective Jan 1, 2021) use an EVV solution capturing six Cures Act components (type of service, individual receiving, date, location, individual providing, start/end time); inform beneficiaries in writing in each file; and train staff initially and at least annually with written documentation in each employee file (Sec. 7.4.1, 7.4.2).(State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L)
  • 5Providers shall enroll in and use the Provider Interface, develop and validate an on-line PCS service plan within seven business days of accepting a CIAE referral, and obtain the beneficiary's written signed consent within 14 business days of the validated plan (Sec. 6.1.3, 6.1.4).(State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L)
  • 6Providers must be a home care agency licensed by DHSR to operate in the county/counties where PCS is provided (Sec. 6.1). PCS aides shall be high school graduates or equivalent, or 18 years of age or older (Sec. 6.1.1).(State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L)
  • 7Providers shall obtain prior approval before rendering PCS; approved hours are based on an independent CIAE assessment of the five qualifying ADLs (Sec. 5.1, 5.2). Monthly limits: up to 60 hours/month for beneficiaries under 21; up to 80 hours/month for beneficiaries 18 and older (Sec. 5.3.1).(State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L)
  • 8Providers shall maintain aide documentation showing all service-plan tasks are performed at the indicated frequency and days, recording date of service, tasks provided, aide identity, and all deviations from the plan (Sec. 6.1.5).(State Plan Personal Care Services (PCS) in In-Home Settings, Clinical Coverage Policy No. 3L)

Applies to: Licensed home care agencies enrolled as NC Medicaid PCS providers; paraprofessional aides employed by those agencies; RN nurse supervisors; NC Medicaid beneficiaries seeking in-home PCS.

Governs Medicaid coverage of hands-on assistance with the five qualifying ADLs (bathing, dressing, mobility, toileting, eating) delivered in a beneficiary's private residence by paraprofessional aides of DHSR-licensed home care agencies. Sets prior-approval, independent-assessment, aide qualification/training, documentation, EVV, supervision, background-check, and quality-improvement obligations. Amended effective January 1, 2026.

Regulatory information, not legal advice — always confirm against the cited official source. Verification reduces error; it does not certify compliance.