NC Medicaid continues provide support to Skilled Nursing Facilities (SNF) and Personal Care Services (PCS) and Home Health (HH) providers to strengthen their infection prevention and management activities as they serve beneficiaries at high risk of contracting COVID-19.
The temporary rate increases for services listed below are effective April 1, 2020, and will be applied retroactively to any claims submitted already with dates of service (DOS) on or after April 1, 2020 (NC Medicaid will systematically reprocess previously submitted claims at a date still to be determined).
All SNF base rates are increased 10% in addition to previously implemented base rate increases for all claims submitted with DOS on or after April 1, 2020. This base rate increase will also be applied on top of recent NPI-specific targeted base rate increases granted to SNF COVID-Outbreak and SNF COVID-Response sites.
All PCS provider base rates, including State Plan PCS, CAP-DA, and CAP-C, are increased 10% in addition to any recently implemented rate increases for all claims submitted with DOS on or after April 1, 2020. This base rate increase will also be applied to recent NPI-specific targeted base rate increases granted to ACH COVID-Outbreak sites.
All HH provider base rates are increased 10% in addition to any recently implemented rate increases for all claims submitted with DOS on or after April 1, 2020.
Note: All previous billing, diagnosis coding, COVID positive resident and outbreak site status reporting requirements will remain in effect for facilities expecting to be reimbursed at the COVID-19 outbreak targeted rates recently implemented. Please refer to Special Bulletin COVID-19 #82.
NC Medicaid will systematically reprocess claims meeting the referenced criteria at a date yet to be determined. Providers do have the option to resubmit their claims. NC Medicaid will provide updates and additional details regarding the reprocessing schedule in upcoming Medicaid bulletins.
Strengthening Infection Prevention Activities
NC Medicaid is providing financial support to the above providers to strengthen their infection prevention activities. As part of this work, NC Medicaid expects that any provider receiving this rate increase will assess its current infection prevention and management capacities using the standardized self-assessment tools outlined below.
Each provider should, separately for each facility, use the COVID-19 Long-Term Care Infection Control Assessment and Response (ICAR) Self-Assessment Tool (available under the Facility Self-Assessment section on the SPICE webpage) to conduct a self-assessment, and then submit the following by email to Evelyn Cook:
- The completed ICAR Self-Assessment (if not otherwise submitted through the webpage directly)
- An Action Plan (using the template provided at the webpage above) based on the ICAR Self-Assessment
- The current Infection Control Plan required by licensure for the facility.
Note: Please ensure that the subject line of your submission email includes only the word “COVID.”
In conjunction with the NC Statewide Program for Infection Control and Epidemiology (NC SPICE), the NC DHHS Division of Public Health's (DPH) Communicable Disease Branch Surveillance for Healthcare Associated and Resistant Pathogens Patient Safety Program is making subject matter experts available for technical assistance and consultation.
Providers should submit the ICAR Self-Assessment by Monday, May 18, 2020.
Providers should submit the Self-Assessment Action Plan and current Infection Control Plan (including identified infection control Point of Contact) within 30 calendar days following the completion of the ICAR Self-Assessment.
Follow-up consultation may occur to review implementation of facilities’ infection prevention measures.
For additional information on infection prevention issues ONLY please submit your question through the Ask SPICE portal.
For questions about infection control licensure requirements, please consult with the appropriate licensure section at the NC DHHS Division of Health Services Regulation.
Medicaid Contact Center: 888-245-0179