This Bulletin was updated on Nov. 18, 2021, in SPECIAL BULLETIN COVID-19 #200.
NC Medicaid is updating the special focused financial assistance to Personal Care Services (PCS) providers provided through outbreak rates. These rates were designed to address the higher costs of caring for Medicaid beneficiaries who were COVID-positive (COVID+).
In consideration of the evolving needs for PCS providers, in place of the outbreak rates, NC Medicaid will provide all PCS providers, including CAP/C and CAP/DA, a single, uniform temporary rate increase that will enable them all to better address the various increased costs associated with staffing during the COVID-19 Public Health Emergency (PHE).
PCS COVID-19 rates and billing guidelines affected by this change were established in the following Special Bulletins:
- 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
- SPECIAL BULLETIN COVID-19 #88: Additional Temporary Rate Increases for Skilled Nursing Facilities, LTSS Personal Care Service Providers and Home Health Providers to support Strengthening Infection Prevention Activities
- SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients
Personal Care Services Providers
Effective Nov. 1, 2021 through Dec. 31, 2021, all COVID-19 PCS outbreak rates will be terminated and replaced with a single uniform PHE rate of $6.70 (per 15-minute increment) applying to all PCS providers including CAP/C and CAP/DA PCS providers.
- This new PHE rate includes a $1.74 add-on rate on top of the current PCS COVID-19 calculated base rate of $4.96 and will be in effect through Dec. 31, 2021.
- The previous 5% and 10% COVID-19 rate increases and the EVV rate increase currently included in the PCS base rate remain in effect.
Private Duty Nursing
In further consideration, NC Medicaid recognizes the evolving need to address Private Duty Nursing (PDN) service rates. NC Medicaid will provide all PDN providers a single, uniform temporary PHE rate increase that will enable them all to better address the various increased costs associated with staffing during the COVID-19 PHE.
Effective Nov. 1, 2021 through Dec.31, 2021, the current PDN service rate will be increased by $1.56 to a PHE rate of $11.96. This DHHS rate includes the previously implemented 5% increase under SPECIAL BULLETIN COVID-19 #32: Rate Increase and Claims Processing.
NC Medicaid will provide bulletin updates as more information becomes available regarding rate changes resulting from the PHE or legislative action.
For Additional Information
Please email Medicaid.ProviderReimbursement@dhhs.nc.gov.