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).
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Eligible Fee-for-Service Providers |
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Ambulance |
Independent Diagnostic Testing Facilities |
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Ambulatory Surgical Centers |
Indian Health Services (1 Cherokee Indian Hospital) |
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Anesthesiology/CRNA |
Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID) |
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Behavioral Health Providers (excluding CDSA & LEA) |
LEAs – Other than OT, PT, RT & Speech / Audiology |
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Birth Centers |
Long Term Acute Care Hospitals |
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Chiropractors |
Nurse Midwives |
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Clinical Pharmacist Practitioner (CPP) |
Nurse Practitioner |
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Critical Care Hospitals (Base Rates) |
Optical Program |
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Dental |
Optometrist |
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Dialysis |
Orthotics & Prosthetics |
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Durable Medical Equipment (DME) |
Out-of-State Hospitals (Base Rates) |
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Extended Service for Pregnant Women |
Pharmacy Dispensing Fees |
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FQHC and RHC Physician Service codes. |
Physician Administered Drug Program (PADP) |
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Freestanding Psych and Rehab facilities |
Physician Assistant |
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General Acute Care Hospitals (Base Rates) |
Physician Services |
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Hearing Aids |
Podiatry |
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HIV Case Management |
Pregnancy Medical Home |
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Home Infusion Therapy |
State Institutions |
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Hospital Outpatient |
State Lab |
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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:
- The date the declared nationwide public health emergency as a result of the 2019 novel coronavirus expires.
- 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.
- 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