UPDATE Oct. 28, 2021: Procedure code T1004 has been removed from this list, as it is excluded, and was originally listed in error. EVV visits for respite services must follow EVV capture requirements.
[This Bulletin was originally posted on May 28, 2021.]
Effective June 1, 2021, claims submitted for personal care-type services for Medicaid beneficiaries enrolled in the Community Alternatives Programs (CAP) for Children and Disabled Adults (CAP/C and CAP/DA) must have on file in the NCTracks system electronic visit verification (EVV) data to bypass the EVV edits of 02077 and 02079 to assist with claim adjudication. All claims for personal care services approved in the CAP 1915(c) Home- and Community-based Services (HCBS) waivers will require EVV data. The personal care services approved in the CAP waivers are:
- S5125 – CAP/C and CAP/DA in-home aide services
- S5125UN – CAP/DA in-home aide congregate care services
- S5150 – CAP/C and CAP/DA in-home respite care
- T1019 - CAP/C pediatric nurse aide services
- T2027TF- CAP/C personal assistance congregate care services
- S9122 TG - CAP/C pediatric nurse aide congregate care services
- S9122 TF - CAP/C in-home aide congregate care services
A subset of caregivers authorized to render personal care services in the CAP/C and CAP/DA waivers are exempted from the EVV visit capture mandate. These caregivers are referred to as paid live-in caregivers.
- When submitting a claim for services rendered by a paid live-in caregiver, the provider agency must select the place of service (POS) code 99.
- POS code 99 is designated by NC Medicaid as the paid live-in caregiver exemption code to bypass the EVV edits.
- An in-home aide agency, home health agency and financial management entity must attest to compliance to this exemption by signing a Paid Live-In Caregiver Attestation Form.
- An in-home aide, home health agency or financial management entity does not have to report visits of a paid live-in caregiver in their EVV solution or the State’s aggregator.
A paid live-in caregiver is defined as a person who lives in the same household as the waiver participant and is hired and paid by an in-home aide or home health agency or through the consumer direction program to assist with activities of daily living (ADL) and instrumental activities of daily living (IADL).
The in-home aide, home health agency and financial management entity must document in their records the confirmation the paid live-in caregiver shares the same address as the CAP participant.
- The documentation includes two supporting pieces of evidence, one of which must be a driver’s license or another valid photo ID and the other a utility-type or credit card statement/bill, a residential lease agreement, school enrollment forms if enrolled in school or graduated from school within the past three months, or an acceptable piece of evidence approved by NC Medicaid at the request of the provider.
- These two supporting pieces of evidence must list the address of the paid live-in caregiver to be the same address as the waiver participant which must be confirmed beginning on June 1 and every six months after that.
- The Paid Live-In Caregiver Attestation form is an agency-wide form and filed in your business files.
- The documentation confirming the hired worker meets the paid live-in caregiver status must be filed in your agency’s personnel file or waiver participant’s case file.
The CAP personal care service codes associated with the paid live-in caregiver exemption under section 1915(c) of the Social Security Act are listed below.
- S5125 – CAP/C and CAP/DA in-home aide services
- S5125UN – CAP/DA in-home aide congregate care services
- T1004 – CAP/C pediatric nurse aide respite services
- T1019 - CAP/C pediatric nurse aide services
- T2027TF - CAP/C personal assistance congregate care services
- S9122 TG - CAP/C pediatric nurse aide congregate care services
- S9122 TF - CAP/C in-home aide congregate care services
Contact
NCTracks Call Center: 800-688-6696