March 24, 2022. Please see SPECIAL BULLETIN COVID-19 #239 for updates to this bulletin.
Feb. 24, 2022. This bulletin was updated to add fee schedule charts for B3, TBI and ICF-ILOS.
Effective Feb. 28, 2022, NC Medicaid will end all temporary COVID-19 rate increases except those indicated in this bulletin as continuing in some form. Some COVID-19 temporary rate increases in effect in February 2022 will be extended at either current or revised levels through March 31, 2022.
Effective March 1, 2022, NC Medicaid will also implement the Home- and Community-Based Services (HCBS) provider rate increases directed in the Current Operations Appropriations Act of 2021. As described in SPECIAL BULLETIN COVID-19 #214, these increases are intended to support providers in increasing direct care worker (DCW) wages toward a minimum of $15 per hour.
The specific details of each of these COVID-19 and HCBS direct care worker rate actions are listed below.
Continuing or Revised Temporary COVID-19 Rate Increases
NC Medicaid is continuing and/or revising temporary COVID-19 rate increases that will stay in place through the month of March 2022 for certain long-term services and supports and HCBS services not delivered by direct care workers (non-DCW). In March 2022, NC Medicaid will review the need and available funding for the continuing rate increases, which are described below.
Skilled Nursing Facilities (SNF):
The 5% and 10% temporary COVID-19 rate increases will continue to be included in the final SNF rates effective through the month of March 2022. In addition, the uniform rate increase of $47.50 referenced in SPECIAL BULLETIN COVID-19 #220 will continue through the month of March 2022. NC Medicaid will review the need and available funding for the continuing rate increases prior to the end of March.
Personal Care Services (PCS) and Community Alternatives Programs (CAP):
For the month of March 2022, the rate per 15-minute increment will be revised to $5.46 for the following programs:
- Personal Care Services (NC Medicaid Direct)
- Community Alternatives for Children (CAP/C) and Disabled Adults (CAP/DA) Personal Care Services
- Community Alternatives Consumer Direction (CAP/CD) Personal Care Services (formerly CAP/Choice (CAP/CO)
Non-DCW HCBS Services:
The temporary COVID-19 rates for the following services (which were listed specifically in SPECIAL BULLETIN COVID-19 #203) will remain in place for the month of March 2022:
- Home health (all except In-Home Aid, which is replaced by an HCBS increase, as described below)
- Occupational therapy
- Physical therapy
- Respiratory therapy
- Speech therapy/Audiology
Program of All-inclusive Care for the Elderly (PACE):
The 5% temporary COVID-19 rate increase in effect February 2022 for the PACE program will remain in place for the month of March 2022. NC Medicaid will review the need and available funding for the continuing rate increases prior to the end of the month.
Ending Temporary COVID-19 Rate Increases
Effective Feb. 28, 2022, the temporary COVID-19 rate increases for all HCBS providers not otherwise noted in this bulletin are end-dated.
The temporary COVID-19 rate increase for Private Duty Nursing (PDN) is end-dated as of Feb. 28, 2022, and is replaced, effective March 1, by the legislated rate of $11.25 per 15-minute increment.
Effects of COVID-19 Rate Changes on NC Medicaid Managed Care Plans
Local Management Entity/Managed Care Organization (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 and/or revise any temporary COVID-19 payment increases described above as continuing for services covered in the LME/MCO program. The LME/MCOs will also be required to continue the temporary COVID-19 payment increases for certain non-DCW HCBS services, State Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID), and some residential care and crisis services covered in the LME/MCO program; or incorporate the permanent, legislated increases for applicable HCBS programs, as summarized below.
LME/MCO Service Considerations
*Most Innovations and 1915(b)(3) services are included in the DCW wage analysis, but not all.
Standard Plan Prepaid Health Plans (PHP) Rates:
The NC Medicaid Managed Care 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. To reflect the changes noted in this bulletin, PHPs are required to either continue the temporary COVID-19 rate increases for SNF, PCS, and the non-DCW HCBS services specified above, or incorporate the permanent, legislated increases for HCBS services listed below, as applicable.
HCBS Provider Rate Increases for Increasing DCW Worker Wages
Per North Carolina Senate Bill 105, the North Carolina General Assembly intends to increase hourly wages of direct care workers of HCBS providers to a minimum of $15 per hour and has appropriated funds to begin moving worker wages toward that goal beginning during State Fiscal Year 2022 (SFY 2022).
NC Medicaid collaborated with our contracted actuary, Mercer Government Human Services Consulting (Mercer), to perform an analysis to assess NCDHHS’ available State Plan, 1915 (c) waivers and managed care contract services to determine which meet the definition of HCBS direct care worker within the Senate Bill and calculate equitable rate increases at the procedure code level to fully allocate the available funds ($210 million). These rate increases, which are based on a uniform dollar amount per 15-minute unit, adjusted for amount of service delivered by a direct care worker in each service category, are intended to be permanent.
The analysis was developed with input from NC Medicaid policy and program managers, NC Medicaid’s internal Actuary team, members of the Finance section team and with NC Medicaid Executive Management approval.
The fee schedule increases depicted below within this document summarize each of the included services by procedure code. The list of codes considered in this analysis are based on services offered under NC Medicaid’s LME/MCO programs and NC Medicaid Direct. Additional modifier combinations may exist beyond what is presented in this table. In these instances, providers and the LME/MCOs will need to work with NC Medicaid to determine whether the service is eligible for the direct care increases presented in these summaries.
The HCBS rate increases, effective March 1, 2022, are as follows:
Providers may contact Medicaid.ProviderReimbursement@dhhs.nc.gov with any inquiries.