Author: Medicaid Long-Term Services and Supports, (919) 855-4340
Session Law 2017-57, Section 11H.13/(a) was amended to appropriate funding to be used to increase the rate for in-home aide services to no more than three dollars and ninety cents ($3.90) paid per 15-minute billing unit provided under the Community Alternatives Program for Disabled Adults (CAP/DA) waiver pursuant to Clinical Coverage Policy 3K-2, effective Jan. 1, 2019.
The approved rate increase for CAP/DA services applies to the following services listed on the Community Alternatives Program Fee Schedule for Disabled Adults:
- S5125 – Personal Care Aide
- S5150 – Non-institutional Respite
The approved rate increase for CAP/DA Consumer Direction services applies to the following services listed on the Community Alternatives Program Fee Schedule for Choice:
- S5135 – Personal Care Assistance
- S5125 – Personal Care Aide
- S5150 – Non-institutional Respite
In addition, effective Apr. 3, 2018, rate increases were approved for four (4) oral nutritional supplements covered through the CAP/DA waiver. The rate increases apply to the following oral nutritional supplements listed on the Community Alternatives Program Fee Schedules for Disabled Adults and Choice:
- B4154BO – rate increased to $1.42
- B4155BO – rate increased to $2.55
- B4157BO – rate increased to $3.73
- B4162BO – rate increased to $3.86
All rate increases have been implemented and are currently reflected in NCTracks. Affected claims will be systematically reprocessed as adjustments to apply the corrected rate. Providers are not required to take any action.
These rate increases will not require revisions to a beneficiary’s CAP Plan of Care (POC) or service authorizations. The rate increases will automatically update in the e-CAP system and populate in the approved POC. Service providers that have been authorized to render any one of the above listed services dating back to Jan. 1, 2019 for in-home aide services and Apr. 3, 2018 for oral nutritional supplements should append this announcement to their currently active service authorization to reflect the rate increase(s). Additional guidance about the rate increases may be found on the NC Medicaid and NCTracks websites.
Should you have any questions, please contact the assigned CAP Consultant directly.