North Carolina

The grounds, as North Carolina describes them

N.C.G.S. § 131E-117(15), "Declaration of patient's rights" (North Carolina General Assembly (PDF), no date stated on the document, retrieved 2026-09-13), states the patient's right:

"To not be transferred or discharged from a facility except for medical" "reasons, the patient's own or other patients' welfare, nonpayment for the stay," "or when the transfer or discharge is mandated under Title XVIII (Medicare)" "or Title XIX (Medicaid) of the Social Security Act."

Separately, NC Medicaid's prescribed notice form, NC Medicaid-9050 (6/2026), states its own six-reason list under federal rather than state authority: "Under federal law 42 CFR §483.15, you may only be transferred or discharged from this nursing facility for one of the following" "reasons:" —

"It is necessary for your welfare and your needs cannot be met in this facility;"

"Your health has improved sufficiently so that you no longer need the services provided by this facility;"

"The safety of individuals in this facility is endangered due to the clinical or behavioral status of the resident;"

"The health of individuals in this facility would otherwise be endangered;"

"You have failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at this" "facility; or"

"The facility ceases to operate."

The two lists are shown as published, reconciled nowhere: the statute states its own four-part ground under state law, and the document a resident actually receives states the federal six-part enumeration instead. The federal enumeration itself is assembled on the federal page.

The published process

Requesting the hearing

The notice form's appeal-rights paragraph: "You have the right to appeal this transfer/discharge to the DHHS Hearing Office WITHIN 11 CALENDAR DAYS of the date of" "this notice if you want to continue to stay at this facility." "The request for" "an appeal (see attached form) must be received by the hearing officer no later than the 11 th calendar day or your right to appeal is" "waived." "The appeal will be at no cost to you or your representative." The hearing office itself, per NC Medicaid's appeals page: "The Hearings Office conducts formal hearings for residents appealing a notice of discharge from a Skilled Nursing Facility. (10A NCAC 22H.0200)". Its published contact is "NC Medicaid Hearing Office" "919-814-0090" "Fax: 984-687-9584" "Medicaid.Hearings@dhhs.nc.gov". The page links a "Nursing Home Hearing Request Form" as the filing route, but that form itself (NC Medicaid-9051) returned HTTP 404 at the address found and is capture-pending; no street address for filing, and no statement that an appeal stays the transfer or discharge while pending, appears in the sources reviewed. Not stated in the sources reviewed.

The notice's required contents

NC Medicaid-9050 (6/2026) is itself the notice, and its own fields are what it requires: "DATE OF NOTICE", resident and facility identification, "DATE OF TRANSFER/DISCHARGE", the checked federal reason, "In addition to notifying you (i.e. the resident) of this transfer/discharge," a named representative "has also been" "notified", and the destination — "NAME OF FACILITY/LOCATION" and address. Its appeal-rights block, quoted above in full, is followed by an ombudsman block: "You may wish to contact your regional Long Term Care Ombudsman for help in mediation with the facility or for assistance in" "obtaining free legal services, if qualified." The form leaves the regional ombudsman's "NAME", "EMAIL", "ADDRESS" and "PHONE" as blanks and carries a checkbox for "Facility sent Ombudsman a copy of the Notice". Where "mentally ill or developmentally disabled" applies, the form directs the reader to "DISABILITY" "RIGHTS NORTH CAROLINA, 3724 National Drive, Suite 100, Raleigh, NC 27612. Telephone number: (919) 856-2195 or 1-" "877-235-4210 or TTY 1-888-268-5535". No separate first-party statement of the notice's required contents exists apart from the form itself in the sources reviewed; the statute's own notice clause states only the five-day period, quoted below.

Bed-hold and return

NC Medicaid's Nursing Facilities Clinical Coverage Policy No. 2B-1 (Amended Date: October 1, 2015), subsection 5.7, "Therapeutic Leave": "Therapeutic leave must be provided in accordance with 10A NCAC 22O.0409." "Each Medicaid eligible resident who is occupying a nursing facility bed for which the" "N.C. Medicaid program is then paying reimbursement shall be entitled to take up to" "60 days of therapeutic leave in any calendar year from any such bed, without the" "facility’s suffering any loss of reimbursement during the period of leave." The leave "must be for therapeutic purposes only, and must be ordered" "by the resident's attending physician", and "Facilities must reserve a therapeutically absent resident's bed for him or her, and are" "prohibited from deriving any Medicaid revenue for that resident other than the" "reimbursement for that bed during the period of absence." "No more than 15 consecutive therapeutic leave days may be taken without approval" "of the DMA."

The same policy's subsection 7.4, "Bed Holds", addresses hospitalization separately and states there is no Medicaid bed-hold program at all: "In accordance with 42 CFR 483.12(b), when a resident must be hospitalized, the resident" "or responsible party may arrange to reserve the resident’s bed in the nursing facility." "Medicaid has no provision for bed hold; it is a private agreement between the resident or" "responsible party and the nursing facility. The admission contract must state the charge" "for bed hold and the resident must be notified of any changes as they are made." No first-party statement of a Medicaid hospital bed-hold payment (as distinct from the private admission-contract arrangement just quoted) was found in the sources reviewed (searched: this policy's own bed-hold and therapeutic-leave subsections, the statute, the notice form, and the appeals page). Not stated in the sources reviewed. On return after a hearing, no first-party statement of a readmission right was captured; the federal bed-hold floor is quoted on the federal page and is not restated here.

The three rows above hoist the questions a facility's counsel answers in the first fifteen minutes. They are quotations from North Carolina's published sources, not a determination that any of them applies to any situation.

Notice periods and deadlines, as stated in the sources

All quoted; none calculated.

Five days' advance notice — § 131E-117(15): the patient "shall be" "given at least five days' advance notice to ensure orderly transfer or" "discharge, unless the attending physician orders immediate transfer".

Eleven calendar days to appeal — the notice form, quoted above in full: the appeal must reach the hearing officer "WITHIN 11 CALENDAR DAYS of the date of" "this notice", and a late request means "your right to appeal is" "waived."

Five working days to review the medical record before the hearing — the notice form: a resident who wishes to review it must be allowed to see it "no later than five working days prior to the" "hearing."

Sixty days of therapeutic leave per calendar year — Clinical Coverage Policy 2B-1, subsection 5.7, quoted above in full.

Fifteen consecutive therapeutic leave days without prior approval — subsection 5.7: no more than that many days "may be taken without approval" "of the DMA," which requires "prior approval on behalf of the beneficiary through" "DMA’s fiscal agent for therapeutic leave that exceeds 15 consecutive days."

What any of these periods means for a particular case is for the hearing office to determine.

Source map

Captured: all six, in tools/packets/north-carolina-packet.txt. Pending: the Nursing Home Hearing Request Form (NC Medicaid-9051), 10A NCAC 22H.0200 in full, and a statewide ombudsman contact — per the packet's pending list.

Change log

2026-09-13 — Deepened to a full page. Newly captured: two slices of NC Medicaid's Nursing Facilities Clinical Coverage Policy No. 2B-1 (Amended Date: October 1, 2015) — subsection 5.7, "Therapeutic Leave" (source 5), and subsection 7.4, "Bed Holds" (source 6) — both by curl with a browser user-agent and pdftotext -layout, sliced because the two provisions sit roughly forty printed pages apart in one long policy document. The recipe's four standing sources were recaptured in the same pass (tools/recipes/north-carolina.json, digest 62f09b26277f) and promoted as a rebuild; no content change was found in any of the four beyond ordinary re-verification. Section 01 (the grounds) and section 02 (the published process, including the notice's required contents in full, bed-hold and return, and the notice-periods register) are now written.

Findings, continuing the numbering from 2026-08-30: (7) Medicaid's own clinical coverage policy states plainly that "Medicaid has no provision for bed hold; it is a private agreement between the resident or" "responsible party and the nursing facility" for a hospital stay — while for therapeutic leave (not hospitalization), the same policy entitles a resident to "60 days" of leave per calendar year "without the" "facility's suffering any loss of reimbursement." The two are different arrangements under the same policy and are shown separately rather than merged. (8) No first-party source states that an appeal stays a transfer or discharge while pending — unlike Indiana, Michigan, and Texas, whose sources each state such a rule. The absence is stated rather than filled from another state's pattern. (9) The notice form's own appeal deadline renders "the 11 th calendar day" with a space before "th", an extraction artifact of the form's superscript ordinal; reproduced as it appears in the captured text rather than silently closed up. Capture pending: per the source map. Internet Archive: not yet submitted for the two new sources. Reviewer: Carrie Schluter, reviewed 2026-09-15. Corrections: hello@fieldassembly.net.

2026-08-30 — Baseline page built from the first North Carolina packet: docket, lede, source map, change log. Not yet captured or written: section 01 (the grounds, as North Carolina describes them) and section 02 (the published process, including the notice's required contents in full, bed-hold and return, and the notice-periods register). Findings: (1) The state's two publishers state different notice periods and different grounds. The patient's rights statute states "at least five days' advance notice" and a four-part ground; NC Medicaid's prescribed notice form states the six federal reasons under 42 CFR §483.15 and no advance-notice period at all. Both are quoted as published, reconciled nowhere. (2) The appeal deadline is eleven calendar days from the date of the notice, and the form states that a late request means the "right to appeal is" "waived." — quoted, not restated as advice about when to act. (3) The hearing request form the notice calls attached, NC Medicaid-9051, could not be captured: the download URL found for it returned HTTP 404 with an HTML error page. (4) The Office of the State Long-Term Care Ombudsman publishes no statewide telephone number on the page captured; the program runs through sixteen regional offices in Area Agencies on Aging, and the notice form leaves the regional ombudsman's contact for the facility to fill in — so on this state's notice, the ombudsman's details depend on the facility completing them. (5) The NC Medicaid appeals page carries its own standing caveat about its webinars, that federal transfer and discharge language "has been refined and additional requirements added" since recording; the page is quoted for the hearing office and the rule citation only. (6) No first-party statement of a North Carolina Medicaid bed-hold period was captured. Capture pending: per the source map. Internet Archive: not yet submitted. Reviewer: Carrie Schluter, reviewed 2026-08-30. Corrections: hello@fieldassembly.net.