Topics Related to Private Duty Nursing (PDN) Providers

Proposed CAP/DA Waiver amendment posted for public comment

Providers are required to complete the EVV readiness survey by July 22, 2022

EVV for Home Health in January 2023

Sharing Vacant CAP/DA Slots and Waiver Amendments

Waiver extension has been approved by CMS

Oct 1, 2021 Update: The policy is amended with the effective date of Sept. 1, 2021.

NC DHHS awarded a contract to Sandata Technologies, LLC on Sept. 24, 2020, and will implement services for Electronic Visit Verification (EVV) statewide on Jan. 1, 2021. EVV is a method used to verify visit activity for services delivered as part of home- and community-based service programs. EVV offers a measure of accountability to help ensure that individuals who are authorized to receive services in fact receive them.

This Bulletin clarifies which specific Prior Authorizations were lifted on the March 1, 2020, effective date stated in SPECIAL BULLETIN COVID-19 #15: Medicaid and NC Health Choice Temporary Flexibilities - 1135 Waiver Provisions (posted March 24, 2020), including references all relevant Prior Authorization information included in other Bulletins; replaces the effective dates originally stated in the following Bulletins: SPECIAL BULLETIN COVID-19 #2: General Guidance and Policy Modifications (posted March 13, 2020); SPECIAL BULLETIN COVID-19 #10: Durable Medical Equipment: Temporary Flexibilities Effective March 23, 2020 (posted March 24, 2020); and SPECIAL BULLETIN COVID-19 #11: Outpatient Specialized Therapies Temporary Flexibilities (posted March 24, 2020).

To avoid delays in beneficiaries receiving needed private duty nursing services, NC Medicaid is temporarily approving prior authorizations that are in pending status for documentation of validation of primary insurance for 60 calendar days. This will allow for the delayed verification responses from individual third-party insurance providers to be uploaded to the prior authorizations in NCTracks. Details regarding documentation, supervisory visits and eligible remote technologies are included in this bulletin.

PACE organizations should continue to follow the guidance of the local, state and federal officials regarding COVID-19 and thoroughly document reasoning for making decisions which may fall outside of the PACE program model. This guidance supplements the Special Bulletin COVID-19 #27 released on March 30, 2020.  The temporary flexibilities noted in Special Bulletin COVID-19 #27 and this Special Bulletin will end the earlier of the cancellation of the North Carolina state of emergency declaration or December 31, 2020.