The December 2021 NC Medicaid Personal Care Services (PCS) Public Health Emergency (PHE) Uniform rates previously released in Special Bulletin COVID-19 #194 are being revised effective Dec. 1, 2021, to account for a data error discovered in the calculation of the rates.
The adjusted rate for December will still support PCS providers in addressing the higher costs of staffing during the COVID-19 PHE. Even with the correction, the two temporary uniform rate increases across November and December are estimated to provide over $30 million in additional funding to support PCS providers in maintaining access to needed care for Medicaid beneficiaries.
Rate Adjustment for Personal Care Services Providers
Effective Dec. 1, 2021 through Dec.31, 2021, all COVID-19 PCS single uniform PHE rates will be adjusted from the previously communicated rate of $6.70 (per 15-minute increment) to $5.21 for procedure code 99509.
Add-on rate amount adjustments will be applied to all NC Medicaid Direct (formerly fee-for- service) PCS providers, including CAP/C and CAP/DA PCS providers, and PHP COVID-19 add-on amounts under managed care.
- This add-on rate adjustment from $1.74 to $0.25 only applies to December 2021.
- The $1.74 add-on amount remains in effect for PCS rendered Nov. 1, 2021 through Nov. 30, 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.
- This adjustment also applies to the COVID-19 add-on rate amount PHPs are required to pay on top of provider-negotiated PCS rates under managed care for December 2021 dates of service.
The add-on rate amount will be applied to the current individual CAP code rates, which include the previous 5% and 10% COVID-19 rate increases and the EVV rate increase.
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.