SPECIAL BULLETIN COVID-19 #99: North Carolina General Assembly Mandates Temporary 5% Rate Increase for Certain Medicaid Providers

Monday, June 15, 2020

Per Section 4.6 of the North Carolina General Assembly’s recently approved Session Law 2020-4 (House Bill 1043), NC Medicaid is implementing a 5% rate increase for all Fee-For-Service (FFS) Medicaid providers who had not yet received a 5% increase during the COVID-19 public health emergency. 

Rate Increase Details

These 5% rate increases apply only to Medicaid provider types that have not previously received rate increases implemented under the Medicaid Disaster State Plan Amendment (SPA) submitted to the Centers for Medicare & Medicaid Services on April 8, 2020. The rate increases also only apply to Medicaid and NC Health Choice services billed through NCTracks and do not apply to behavioral health and I/DD services billed to local management entities-managed care organizations (LME-MCOs).

Eligible Fee-for-Service Providers

Ambulance

Independent Diagnostic Testing Facilities

Ambulatory Surgical Centers

Indian Health Services (1 Cherokee Indian Hospital)

Anesthesiology/CRNA

Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID)

Behavioral Health Providers (excluding CDSA & LEA)

LEAs – Other than OT, PT, RT & Speech / Audiology

Birth Centers

Long Term Acute Care Hospitals

Chiropractors

Nurse Midwives

Clinical Pharmacist Practitioner (CPP)

Nurse Practitioner

Critical Care Hospitals (Base Rates)

Optical Program

Dental

Optometrist

Dialysis

Orthotics & Prosthetics

Durable Medical Equipment (DME)

Out-of-State Hospitals (Base Rates)

Extended Service for Pregnant Women

Pharmacy Dispensing Fees

FQHC and RHC Physician Service codes.

Physician Administered Drug Program (PADP)

Freestanding Psych and Rehab facilities

Physician Assistant

General Acute Care Hospitals (Base Rates)

Physician Services

Hearing Aids

Podiatry

HIV Case Management

Pregnancy Medical Home

Home Infusion Therapy

State Institutions

Hospital Outpatient

State Lab

Independent Lab

X-ray Services

 

The rate increases are effective March 1, 2020, and will be applied retroactively to claims already submitted with a date of service on or after March 1, 2020. (NC Medicaid will systematically reprocess previously submitted claims.)

Per the legislation, these rate increases will expire on the earlier of: 

  1. The date the declared nationwide public health emergency as a result of the 2019 novel coronavirus expires. 
  2. The date Executive Order No. 116, Declaration of a State of Emergency to Coordinate Response and Protective Actions to Prevent the Spread of COVID-19 expires or is rescinded. 
  3. March 31, 2021.

NC Medicaid will provide updates and additional details regarding the reprocessing of claims meeting the referenced criteria once those details have been determined.  

Contact

NC Medicaid Contact Center: 888-245-0179