Beginning April 1, 2021, NC Medicaid will begin strictly applying its timeline business rules for the receiving, processing and closing out referral requests.
Topics Related to Community Alternatives Program (CAP/C & CAP/DA) Providers
NC Medicaid has updated its Appendix K to extend flexibilities on how Medicaid providers and beneficiaries access and receive home- and community-based services through CAP/C, CAP/DA, NC Innovations waiver and Traumatic Brain Injury waiver.
To ensure that NC Medicaid meets implementation timelines and can fully integrate EVV through claims adjudication for all providers, alternate EVV Solutions must pass testing validation by March 10, 2021. If the solution has not passed testing by March 10, 2021, provider agencies currently enrolled with their solution may be required to enroll with the State’s EVV solution, Sandata, to ensure they are compliant with EVV requirements.
The Community Alternatives Program for Children (CAP) §1915(c) Home- and Community-Based Services (HCBS) waiver will expire on Feb. 28, 2022. By October 2021, NC Medicaid will submit a request to the Centers for Medicare and Medicaid Services (CMS) to renew the CAP/C waiver.
NC Medicaid acknowledges challenges with implementing EVV and is extending flexibilities for EVV dates of service to providers who make a good faith effort to connect with their EVV vendor of choice.
After Jan. 31, 2021, providers are required to capture EVV visits for all beneficiaries subject to EVV. Claims paid for services that are not captured through EVV may be subject to recoupment.
An independent review of referrals for individuals seeking to enroll in the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) waivers is intended to provide an unbiased assessment to ensure the enrollment processes are executed appropriately in each waiver application.
January marks the go-live date for Electronic Visit Verification (EVV) Phase 1 Implementation. Beginning on January 1, 2021, all providers subject to the Federal EVV mandate should make every effort to capture visits through their chosen EVV solution.
EVV Training for providers using NC Medicaid’s EVV solution, Sandata, is now underway with instructor-led training webinars filling up fast. Training is required to ensure all agency employees are ready to capture EVV visit data.
NC Medicaid will host a Stakeholder Engagement meeting regarding Electronic Visit Verification on Thursday, Dec. 17, 2020, at 10 a.m. Registration is required.