N.C. Medicaid Clinical Coverage Policy No. 3D § 5.2.2.4

The hospice provider is responsible for ensuring that the long-term care

prior approval process has been completed and that the Medicaid

beneficiary is approved for nursing facility or ICF/IID level of care. This

process can be completed by the hospice or through arrangement with the

facility, hospital discharge planner, physician, or other sources. A hospice

Medicaid beneficiary in a nursing or ICF/IID facility shall meet the same

level of care requirements as other Medicaid nursing facility beneficiaries.

The hospice provider shall retain a copy of the NC Medicaid Long Term

Care Form FL-2 or IID-2, as applicable, in the Medicaid beneficiary’s

records on site at the hospice provider.

Note: Hospice agencies verify the nursing facility or ICF/IID level of care

long-term care approval in NC Tracks to ensure the approval was

obtained prior to seeking reimbursement. Hospice providers should

provide documentation referencing place of origin verifying the FL-2 or

IID-2 in beneficiary medical records.