North Carolina is transitioning to NC Medicaid Managed Care effective July 1, 2021. In the first year, prepaid health plans (PHP) will be required to cover nursing facility admissions up to 90 days for those members whose only coverage is Medicaid. If the member remains in the nursing home 90 days or more, coverage for the care will move from NC Medicaid Managed Care to Medicaid Direct.
After managed care launch, for a nursing home provider to receive payment for services delivered to a member who moves from NC Medicaid Managed Care to Medicaid Direct, the nursing home provider will be required to request Prior Approval for Nursing Home Services via NCTracks. The PHP is expected to follow established NC Medicaid transition of care protocol and transfer the information necessary to the nursing home when requested to ensure continuity of care to include the effective Managed Care disenrollment date.
The nursing home provider shall follow the prior approval requirements noted in section 5.3 of Clinical Policy 2B-1 and submit the Prior Approval request to NCTracks. A current PASRR authorization should be included with the request. In the event the PASRR authorization has expired or is close to expiring, the nursing home provider should submit a significant change PASRR authorization request via NCMUST.
End-Dating the Use of Taxonomy Code 313M00000X (Nursing Home-Intermediate Level of Care) From Provider Permissions Matrix
In 2018, NC Medicaid removed Taxonomy Code 313M00000X (Nursing Home-Intermediate Care Level of Care) from the Provider Permissions Matrix.
Effective June 1, 2021, NC Medicaid will end-date the use of Taxonomy Code 313M00000X (Nursing Home-Intermediate Care Level of Care) from the Provider Permissions Matrix. Nursing Facilities must utilize Taxonomy Code 314000000X (Nursing Home-Skilled Nursing Level of Care).
Nursing Facilities must add the 314000000X Taxonomy Code to their NC Medicaid enrollment record if not previously added.
Continuation of Temporary Suspension of Level I and Level II Assessments for New Nursing Home Admissions
In response to COVID-19, NC Medicaid temporarily suspended the requirement of a Level I and II Preadmission Screening and Resident Review (PASRR) for new admissions. The temporary suspension remains in effect. If the individual is expected to remain in the nursing facility for more than 30 days, a notice of the need for a PASRR review should be submitted through NCMUST. Please note, the requirement to submit a PASRR when an individual has experienced a significant change of condition has not been suspended.
Individuals transferred from one nursing facility to another nursing facility as a result of COVID-19 will not be considered a new admission and will not need a PASRR. The transferring nursing facility must ensure that all copies of the resident’s PASRR paperwork (including any Level II information) is transferred with the individual.
Additionally, in response to COVID-19, Medicaid temporarily suspended the requirement of a PASRR number on the PA for 30 days. The temporary suspension remains in effect. Providers should continue to enter the number “8888” in place of the PASRR number when submitting a PA to NCTracks for approval. Providers should add all the pertinent information about the beneficiary’s level of care needs in their portal submission. The admitting nursing facility is responsible for submitting a claim for payment.
The above temporary changes will end the latter of the North Carolina state of emergency declaration OR Federal state of emergency.
NC Medicaid NCMUST Webpage Update
Effective June 1, 2021, the NC Medicaid NCMUST webpage will be updated. The NCMUST page will only contain information regarding the NCMUST application, user and login information.
General information about the PASRR program has been transitioned to the NC DHB webpage and can be accessed at https://medicaid.ncdhhs.gov/providers/programs-and-services/long-term-care/pre-admission-screening-and-resident-review-pasrr.
Reminder - PASRR Submission and Required Supporting Documentation
NC Medicaid PASRR Nurses review PASRR screens which are flagged by the NCMUST system for a manual review. If the NCMUST system flags a PASRR screen for a manual review, the NC Medicaid PASRR nurse will request submission of patient information to complete the Level I manual review. In order to complete the review, the following information is required:
- Most recent Health and Physical (H&P)
- Comprehensive progress notes dated within the last 30 days
- A comprehensive drug history including current or immediate use of medications.
- A copy of the FL2 documenting diagnosis, dated within the last 30 days and signed by a physician (MD or DO). Please note that hospitals are not required to submit an FL2 but must submit a comparable document which includes all the clinical elements noted on an FL2.
- Psychiatric notes if available.
The supporting documents can either be uploaded in NCMUST or faxed to 919-224-1072. Providers have always had the ability to upload PASRR related documents directly to the NCMUST application. Please upload information directly to the NCMUST application whenever possible. Information that is uploaded to the NCMUST application is available immediately to PASRR reviewers and is reviewed faster, thereby providing a PASRR number in a timelier manner.
Contact
NCTracks Call Center: 800-688-6696