SPECIAL BULLETIN COVID-19 #93: Targeted Rate Increase, Additional Hours and Associated Reporting Requirements for In-Home Personal Care Services (PCS) Providers under State Plan PCS and CAP/C and CAP/DA Programs
NOTE: UPCOMING PROVIDER WEBINAR
NC Medicaid COVID+ Rate Reporting Technical Assistance Session
Wednesday, June 3, 1:00 p.m.
NC Medicaid is implementing a targeted rate increase and additional billable hours for State Plan and CAP/C and CAP/DA In-Home Personal Care Service (PCS) providers for direct service to a COVID-19-positive (COVID+) beneficiary. This bulletin:
- Clarifies how this targeted rate increase and additional billable hours are in addition to other recently implemented base rate increases for these providers
- Explains the details of the targeted rate increase and additional billable hours
- Outlines the eligibility requirements that a provider must meet to receive the targeted rate increase and additional billable hours for direct service to a COVID+ beneficiary
Rate Increases for In-Home PCS Providers
In March 2020, NC Medicaid implemented a 5% rate increase for many Medicaid providers including all PCS providers (including In-Home State Plan and CAP/C and CAP/DA providers).
In May 2020, as noted in “Special Bulletin COVID-19 #88: Additional Temporary Rate Increases for Skilled Nursing Facilities, LTSS Personal Care Service Providers and Home Health Provider to Support Strengthening Infection Prevention Activities,” NC Medicaid implemented an additional 10% rate increase for all PCS providers (including In-Home State Plan and CAP/C and CAP/DA providers).
The total of these two “across the board” rate increases brought the current In-Home PCS base rate to $18.04 per hour for all PCS providers (including In-Home State Plan and CAP/C and CAP/DA providers), applicable to all Medicaid beneficiaries served by these providers.
Now, to address the additional costs associated with serving COVID+ beneficiaries, NC Medicaid is implementing a targeted rate increase (to $8.25 per 15 minutes or $33 per hour) and up to 40 additional billable hours per month ONLY for In-Home PCS providers (including In-Home State Plan and CAP/C and CAP/DA providers) for direct service to a COVID+ beneficiary. These targeted changes, which are in addition to the increased base rates explained above, are similar to the targeted increases NC Medicaid has implemented for congregate care sites serving COVID+ beneficiaries (Skilled Nursing Facilities and Adult Care Homes). See “Special Bulletin #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients.”
Process for Accessing Rate Increase and Additional Billable Hours
Step 1: Document Eligibility
To document eligibility for the targeted rate increase and additional billable hours for serving a COVID+ beneficiary, an In-Home PCS provider (State Plan or CAP/C and CAP/DA) must first submit a “COVID+ Report Template for In-Home Providers” (see Required Reporting section below).
Step 2: Access Increased Rate
State Plan and CAP/C and CAP/DA PCS providers serving a COVID+ beneficiary are eligible to bill the increased rate for the hours serving that beneficiary. For each provider from which NC Medicaid receives the report referenced above, NC Medicaid will assign an NPI-specific rate applicable to that provider at the reported location and increase the rate to $8.25 per 15-minute unit for all Medicaid COVID+ beneficiaries served at that location by that provider.
To receive the enhanced rate, the provider must include the COVID-19 diagnosis code U07.1 on claims submitted for the Medicaid COVID+ beneficiaries.
Step 3: Access Increased Hours
For State Plan PCS only, an eligible provider may bill up to 40 additional service hours per month as appropriate for each Medicaid beneficiary diagnosed as COVID+.
For CAP/C and CAP/DA providers, because a COVID+ CAP beneficiary qualifies for flexibilities under Appendix K, the case management entity assigned to the COVID+ CAP beneficiary must update the COVID-19 Care Coordination Plan to document the positive diagnosis and a description of current needs. If additional service hours are needed, a plan of care revision must be initiated for approval. The plan may add up to 40 service hours per month, as appropriate for each COVID+ beneficiary.
- To access the COVID+ rate and additional hours described above, eligible providers must submit the “COVID+ Report Template for In-Home Providers” and appropriately reflect COVID-19 diagnosis code U07.1 on the related claim.
- The “COVID+ Report Template for In-Home Providers” must be submitted monthly to the NC Medicaid Finance Section at Medicaid.ProviderReimbursement@dhhs.nc.gov. Please note: The reporting deadline is the 5th day (or following business day) of the month following the reporting period. Providers may submit the report retroactively to April 1, 2020. For initial submissions covering April and/or May, the reporting deadline is extended to Wednesday, June 10, 2020.
- Status reports and related instructions can be obtained on the NC Medicaid Cost Reports and Assessments web page.
- NC Medicaid will offer a COVID+ Rate Reporting technical assistance session on Wednesday, June 3, at 1:00 p.m. Providers may register at https://attendee.gotowebinar.com/register/9126678092806853645.
- Status reports will be used to conduct post payment audits to ensure all claims are billed in accordance with this Medicaid Bulletin.
Note: Providers will receive a rate letter directly from Provider Reimbursement confirming the increased rate and its effective date for the reported beneficiaries. The increased rate will apply only to claims with date of service on or after April 1, 2020. NC Medicaid will systematically reprocess previously submitted claims that may have been processed prior to the actual implementation date of the COVID+ resident rate.
NC Medicaid will provide updates and additional details regarding the reprocessing of claims meeting the referenced criteria when scheduled in upcoming Medicaid bulletins.