This bulletin was updated in SPECIAL BULLETIN COVID-19 #220: Temporary Rate Increases Extended or Replaced, posted on Jan. 21, 2022. This bulletin was amended for clarity on Dec. 20, 2021 and Jan. 21, 2022.
Effective Dec. 31, 2021, NC Medicaid will end several of the temporary COVID-19 rate increases. Some of the rate increases in effect in December 2021 will be extended – at either current or revised levels - through Jan. 31, 2022. The specific details of each of these COVID-19 rate actions are listed below.
Temporary COVID-19 Rate Increases that are Ending
5% Legislated Increases
The temporary 5% COVID-19 rate increase associated with Session Law 2020-4 (House Bill 1043) will be end-dated as of Dec. 31, 2021 for all NC Medicaid Direct (formerly known as fee-for-service) programs that are not classified as Home- and Community-Based (HCBS) services, as defined in Section 9817 of the American Rescue Plan.
*COVID-19 Increases to the Physician Codes end-dated December 31, 2021. Increases to the T1015 core service rate and the PPS rate are scheduled to be end-dated January 31, 2022
**Includes end-dating any increases above the GA 5% rate increase
Carolina Access Payments and Advanced Medical Home Payments
The temporary COVID-19 rates in effect in December 2021 for Carolina Access payments under NC Medicaid and Advanced Medical Home payments under managed care will be end-dated on Dec. 31, 2021.
Effective Jan. 1, 2022, reimbursement of the following Medical Home Fees to Carolina Access and AMH practices shall be revised as listed below:
- $2.50 PMPM for members not in the aged, blind and disabled eligibility category
- $5.00 PMPM for members in the aged, blind and disabled eligibility category
- $61.65 PMPM for members assigned to Cherokee Indian Hospital Authority (CIHA) as AMH/PCP
Temporary COVID-19 Rate Increases that are Continuing
NC Medicaid will continue temporary COVID-19 rate increases for the month of January 2022 for certain HCBS provider categories in accordance with Section 9817 of the American Rescue Plan and other long-term services and supports. In January 2022, NC Medicaid will review the need and available funding for these continuing rate increases, which are described below.
Skilled Nursing Facilities (SNF):
The 5% and 10% temporary COVID-19 add-ons will continue to be included in the final SNF rates effective for the month of January 2022. In addition, the uniform add-on rate of $95 referenced in Special Bulletin COVID-19 #187 will adjust to $47.50 for the month of January 2022. NC Medicaid will review the need and available funding for these continuing rate increases prior to the end of January.
The monthly SNF COVID-Outbreak site status and COVID+ resident status reporting previously required by NC Medicaid Provider Reimbursement through the reporting template is no longer required.
Private Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID):
The temporary COVID-19 rate increases in effect in December 2021 for ICFs-IID will remain in place for the month of January 2022. NC Medicaid will review the need and available funding for these continuing rate increases prior to the end of the month.
Program of All-inclusive Care for the Elderly (PACE):
The 5% temporary COVID-19 rate increase in effect December 2021 for the PACE program will remain in place for the month of January 2022. NC Medicaid will review the need and available funding for these continuing rate increases prior to the end of the month.
HCBS Programs:
All temporary COVID-19 rates in effect in December 2021 for HCBS will continue for the month of January 2022. NC Medicaid will review the need and available funding prior to the end of January for these continuing rate increases, which are described below.
Personal Care Services (PCS) and Community Alternatives Programs (CAP)
The corrected two-month rate add-on across November and December 2021 provided an additional $1 per 15-minute increment for PCS and CAP programs. This level of temporary COVID-19 add-on will continue in January 2022. This amount will be on top of the 5% and 10% temporary COVID-19 increases already built into the rate.
For the month of January 2022, the rate per 15-minute increment will be $5.96 for the following programs:
- Personal Care Services (NC Medicaid Direct)
- Community Alternatives for Children (CAP/C) Personal Care Services
- Community Alternatives for Disabled Adults and Choice (CAP/DA)/(CAP/CO) Personal Care Services
The Private Duty Nursing rate per 15-minute increment will remain $11.96 for the month of January 2022.
Other HCBS Services
The temporary 5% and 10% COVID-19 rate increases to the base rate for the following HCBS programs will also remain in effect through the month of January 2022:
- Home health
- Occupational therapy
- Physical therapy
- Respiratory therapy
- Speech therapy/Audiology
Effects on NC Medicaid Managed Care Plans
LME/MCO Rates:
The LME/MCOs are required by contract to adjust provider reimbursement rates by an amount no less than the associated percentage change in the fee schedule made by NC Medicaid in the NC Medicaid Direct program in response to COVID-19. LME/MCOs will be required to continue the temporary COVID-19 payment increases for ICF-IID and HCBS services covered in the LME/MCO program.
Standard Plan Prepaid Health Plans (PHP) Rates:
The Standard Plan PHPs are required by contract to adjust provider reimbursement rates by an amount no less than the associated dollar amount change in the fee schedule made by NC Medicaid in the NC Medicaid Direct program in response to COVID-19. PHPs will be required to continue the public health emergency payment increases for Skilled Nursing Facilities, PCS, PDN and HCBS services noted above.