When did North Carolina stop scheduling Medicaid site-visit appointments?

NC Medicaid’s Oct. 1, 2026, bulletin says federally mandated site visits under 42 CFR § 455.432 for moderate- and high-risk providers are no longer scheduled by date and time. Public Consulting Group notifies providers of a timeframe instead.

What happens if a North Carolina Medicaid provider blocks an unannounced site visit?

The bulletin and the NCDHHS Provider Administrative Participation Agreement say providers must allow unannounced on-site inspections during normal hours. Failure to grant prompt, reasonable access can lead to suspension of the provider or reimbursements, or termination from North Carolina Medicaid.

Do Medicare site visits count for North Carolina Medicaid screening?

Providers who completed a Medicare site visit for the same name, NPI, and location within the past five years should report that on their application. NC Medicaid says those providers will not need another site visit at that time. Visits already scheduled before Oct. 1 still go forward as planned.

North Carolina: Medicaid site visits go unannounced Oct. 1

NC Medicaid ended scheduled appointment times for moderate- and high-risk provider site visits on Oct. 1, 2026. Contractors will give a window, not a clock time; blocking access can mean suspension or termination.

agencies · north-carolina · medicaid · provider-screening · oversight

DiscoA340, Wikimedia Commons, CC BY-SA 4.0

Direct Support News desk · October 1, 2026 · Updated October 2, 2026 · 1 min read

North Carolina Medicaid will no longer book a clock time for many provider site visits. Beginning Oct. 1, 2026, federally required screening visits for moderate- and high-risk providers arrive as a notice that a visit will happen inside a window—not as a calendar appointment, according to an NC Medicaid bulletin posted that day.

Public Consulting Group (PCG) still performs the visits under contract. The change tracks 42 CFR § 455.432, which tells state Medicaid agencies to require enrolled providers to allow CMS, contractors, and the state to conduct unannounced on-site inspections of every location.

What providers should expect

Providers get a PCG notice that a visit will occur within a stated timeframe. Visits already scheduled before Oct. 1 keep their original date and time. If a provider already completed a Medicare site visit for the same name, NPI, and location within five years, the bulletin says they should mark that on the application and will not need another visit now.

The NCDHHS Provider Administrative Participation Agreement still requires cooperation with announced and unannounced site visits, audits, and program-integrity reviews during normal operating hours. Blocking prompt, reasonable access can bring suspension of the provider or of reimbursements, or termination from North Carolina Medicaid.

Why this matters for providers and DSPs

I/DD and HCBS agencies billed as moderate or high risk should treat every business day as a possible visit day: keep enrollment files, staffing records, and service locations ready without relying on a scheduled appointment. Front-desk and frontline supervisor teams need a clear who-to-call path when PCG arrives so a locked door or missing manager does not become a participation risk for people supported through Innovations and related waivers.

Common questions

When did North Carolina stop scheduling Medicaid site-visit appointments?: NC Medicaid’s Oct. 1, 2026, bulletin says federally mandated site visits under 42 CFR § 455.432 for moderate- and high-risk providers are no longer scheduled by date and time. Public Consulting Group notifies providers of a timeframe instead.
What happens if a North Carolina Medicaid provider blocks an unannounced site visit?: The bulletin and the NCDHHS Provider Administrative Participation Agreement say providers must allow unannounced on-site inspections during normal hours. Failure to grant prompt, reasonable access can lead to suspension of the provider or reimbursements, or termination from North Carolina Medicaid.
Do Medicare site visits count for North Carolina Medicaid screening?: Providers who completed a Medicare site visit for the same name, NPI, and location within the past five years should report that on their application. NC Medicaid says those providers will not need another site visit at that time. Visits already scheduled before Oct. 1 still go forward as planned.

Sources

Unannounced Site Visits Effective October 1, 2026 · October 1, 2026 · Primary NC Medicaid bulletin on unannounced moderate- and high-risk screening visits
42 CFR § 455.432 Site visits by Medicaid agencies · Federal rule requiring unannounced on-site inspections of enrolled providers