SPECIAL BULLETIN COVID-19 #74: NC Medicaid Temporarily Increases Rates for Federally Qualified Health Centers and Rural Health Clinics

NC Medicaid is temporarily increasing financial assistance to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to support them in maintaining critical access to care for Medicaid beneficiaries during the COVID-19 emergency.

Rate Increase Summary

FQHC and RHC rates are temporarily changed as outlined below:

• Effective April 1, 2020 
  • Per member per month (PMPM) primary care provider medical home reimbursement rates double for all patients served by FQHCs and RHCs
    • Aged, Blind and Disabled (ABD) rates increase from $5.00 to $10.00
    • Non-ABD rates increase from $1.00 to $2.00 and from $2.50 to $5.00, respectively 
  • Each FQHC and RHC provider-specific Core Service (T1015) billing rate increases by 20%
  • Each FQHC and RHC provider-specific Prospective Payment System (PPS) rate increases by 25%
• Effective March 10, 2020
  • Telephonic rate for covered services (G0071) increases from $11.27 to $26.80
  • For dates of service March 10 - 31, 2020, covered telephonic services (G0071) shall be deemed encounters for purpose of year-end cost reporting and Prospective Payment System (PPS) reconciliation.

Providers may resubmit claims previously adjudicated with dates of service within the effective dates of the respective rate changes. 

Additional Resources

NC Medicaid COVID-19 Resources website
NCDHHS COVID-19 Response website

Contact

Medicaid Contact Center: 888-245-0179