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NC Department of Health and Human Services
NC Division of
Medical Assistance

Home Office Supporting Nursing Facilities Cost Reports

If you are a Home Office or Related Party Organization supporting Nursing Facilities providing Long Term Skilled Nursing Care (SNC) and/or Intermediate Nursing Care (INC), you are required to report financial information to DMA.

Contact Information:

Michael D'Alessio

Home Office Cost Reporting will use the CMS 287 cost reporting form plus NC Medicaid Supplemental Schedules.

IMPORTANT NOTICE: If the provider has a home office, they must file the CMS 287 (Home Office) cost reporting forms pursuant to CMS Publication 15, Section 3903. We do not have the software at this point to read it; therefore, providers must file a hardcopy.

If the provider has a related organization which does not fall subject to CMS 287 requirements, they must complete Worksheet A-8-1 in accordance with Medicare cost reporting principles. We will audit this accordingly and request supplemental information to ensure that only actual cost is reported and profit has been removed.

If the provider has related organization / home office costs in the CMS cost reporting schedules, the provider must submit a hardcopy of the provider’s related organization / home office cost report.

All providers will use the CMS cost reporting forms plus NC Medicaid Supplemental Schedules as shown below.

For FYE 2015, nursing facility providers will file full 12 month cost reports using the CMS 2540-10 cost reporting forms plus the NC Medicaid Supplemental Schedules and the cost report period will be the provider's normal fiscal year end as registered with Medicare.

You will need to download the “SNF 2015 Instructions_Version 5” document as it contains specific DMA requirements that must be followed when preparing the “NC NF Supplemental Cost Report 2015 – Version 5” Excel cost reporting forms.

The free Adobe Acrobat Reader is required to view and print PDF files.

Home Office/Related Organization with a 2015 FYE on or before 12/31/2015

For questions directly related to the new NC NF Medicaid Supplemental Cost Report Schedules, you may download the (pdf) file using the following link - NC NF Medicaid Supplemental Cost Report FAQS (PDF, 19KB)

State-Owned Nursing Facility FYE 06/30/2015

  • State Owned / Operated Skilled Nursing Facility providers shall file annual Medicaid cost reports with DMA using the CMS 2540 cost reporting schedules. Cost reports shall be filed within five (5) months after the provider's fiscal year end.
  • State Owned / Operated Provider Based Nursing Facilities shall file annual Medicaid cost reports with DMA using the CMS 2552 cost reporting schedules. Cost reports shall be filed withing five (5) months after the provider's fiscal year end or 37 days from the date of the hospital's PS&R, whichever is later

Established Cost Limitations

Nursing facility cost reports for fiscal year 2015

The cost limitations for FY 2015 are as follows:

  1. Director's Fees: $2,400 annually or $200 per meeting
  2. Owner or Administrator Salary:
    $57,097 (1-50 beds)
    $69,336 (51-99 beds)
    $73,414 (100-149 beds)
    $79,006 (150-199 beds)
    $89,724 (200-249 beds) Ready NC Connect NC