NC Medicaid is extending through June 30, 2022, at either current or revised levels, several COVID-19 temporary provider rate increases that are in effect in March 2022. These extended temporary increases are intended to continue helping providers with COVID-19 costs and support providers in increasing direct care worker (DCW) wages toward a minimum of $15 per hour.
NC Medicaid is also clarifying a number of the Home- and Community-Based Services (HCBS) rate increases noted in Special Bulletin COVID-19 #230. NC Medicaid continues to strongly encourage providers who are receiving an HCBS rate increase to pass along at least 80% of that increase to DCW wage increases.
The specific details of each of the temporary COVID-19 rate extensions and/or revisions and the HCBS direct care worker rate clarifications are listed below. Any temporary rate increase in effect in March 2022 that is not specifically extended and/or revised below will end date March 31, 2022.
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 June 2022 for certain long-term services and supports and HCBS services not delivered by direct care workers (non-DCW). While the legislated HCBS DCW increases are permanent, any temporary increases extended through June 2022 will need to be re-evaluated as that date approaches. NC Medicaid will continue to review the need and available funding for the continuing COVID-19 rate increases, which are described below.
Skilled Nursing Facilities (SNF)
The 5% and 10% temporary COVID-19 rate increases and the uniform temporary COVID-19 rate increase of $47.50 per diem (referenced in Special Bulletin COVID-19 #230) will continue through the month of June 2022. NC Medicaid will review the need and available funding for continuing the rate increases prior to the end of June 2022.
Hospice Room and Board
The Hospice Room and Board rate for services provided within a SNF will remain at 100% of the applicable SNF rate of the facility where the Medicaid beneficiary resides effective through the month of June 2022.
Personal Care Services (PCS) and Community Alternatives Programs (CAP/C and CAP/DA)
Effective April 1, 2022, through June 30, 2022, PCS rates will be revised back to Jan. 1, 2022 levels described previously in Special Bulletin COVID-19 #203.
The PCS rate per 15-minute increment will be $5.96 for the following program:
Personal Care Services (NC Medicaid Direct) (CPT Code 99509)
Effective April 1, 2022, PCS service codes, as defined by the department in the current CAP programs below will continue to receive the 5% and 10% temporary COVID-19 rate increases along with the uniform rate increase of $1 through the month of June 2022.
- Community Alternatives Programs for Children (CAP/C) and Disabled Adults (CAP/DA) Personal Care Services
- Community Alternatives Program Consumer Direction (CAP/CD) Personal Care Services (formerly CAP/Choice (CAP/CO)
The applicable PCS codes receiving the rate increases can be found on the NC Medicaid website fee schedule page. NC Medicaid is in the process of revising this published fee schedule to reflect the rate changes described above.
NOTE: For both PCS and CAP programs, the rates from April – June 2022 will reflect the legislated permanent HCBS DCW increase of $0.54 per 15-minute unit (or $2.16 per hour), plus an additional temporary increase to bring the total rates to the amounts described above. As stated in prior communications regarding the permanent HCBS increase portion (see Special Bulletin COVID-19 #214), providers are strongly encouraged to pass on at least 80% (or $1.73 per hour) to DCW wages as soon as is practicable.
Program of All-inclusive Care for the Elderly (PACE)
The 5% temporary COVID-19 rate increase in effect in March 2022 for PACE will remain in place through the month of June 2022. NC Medicaid will review the need and available funding for the continuing rate increases prior to the end of June 2022.
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 in this bulletin 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. As indicated in Special Bulletin COVID-19 #230 and noted below, a number of temporary increases will only continue through March 31, 2022.
LME/MCO Service Considerations
|
Service |
COVID Increase in Capitation |
April 2022 Action |
|
PRTF |
15% |
Temporary COVID increase extends through |
|
Inpatient (State Facilities) |
5% |
|
|
ICF-IID (State Facilities) |
15% |
|
|
SA Non-Med and Medical Community Residential |
5% |
|
|
Mobile Crisis |
5% |
|
|
Crisis Services (except Mobile Crisis) |
5% |
|
|
Case Management |
5% |
Temporary COVID increase ends |
|
Opioid Tx, Ambulatory Detox |
5% |
|
|
Diagnostic Assessment |
5% |
|
|
ACT |
5% |
|
|
MST |
5% |
|
|
IIHS |
5% |
|
|
|
|
|
|
Community Support |
5% |
Temporary COVID increase ended Feb. 28, 2022, and was replaced with HCBS Direct Care Worker (DCW) Adjustment March 1, 2022 |
|
Outpatient SUD – SAIOP, SACOT |
5% |
|
|
Partial Hosp/Day Tx |
5% |
|
|
Psych Rehab |
5% |
|
|
BH Long-Term Residential |
15% |
|
|
Innovations – Non-Residential* |
5% |
|
|
Innovations – Residential |
15% |
|
|
Peer Support |
5% |
|
|
TBI – Non-Residential |
5% |
|
|
TBI – Residential |
15% |
|
|
1915(b)(3) Services* |
5% |
|
|
ICF/IID (Private Facilities) |
15% |
Temporary COVID Increase replaced with ICF Direct Care Worker Adjustment Feb. 1, 2022 |
*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 – Clarifications
PCS and CAP Tables
As noted above, effective April 1 through June 30, 2022, NC Medicaid will implement a total rate increase for PCS and CAP providers that is composed of both a permanent HCBS increase component and a temporary COVID-19 increase component. The tables below for PCS and CAP, previously published in Special Bulletin COVID-19 #230, have been revised to reflect only the HCBS DCW add-on (the permanent component) that will be in effect as of April 1, 2022 as part of the total PCS and CAP rates noted above in this bulletin. As stated in prior communications regarding the permanent HCBS increase component (see Special Bulletin COVID-19 #214), providers are strongly encouraged to pass on at least 80% (or $1.73 per hour) to DCW wages as soon as is practicable.
All Other HCBS Tables
NC Medicaid has revised a number of other items in the other HCBS tables based on feedback or internal review that identified needed updates to codes, descriptors, and/or rates originally published in Special Bulletin COVID-19 #230. The list of specific edits contained in the tables below is as follows:
Innovations Waiver:
- Added Codes- T2012 HQ, T2012 GC, T2012 GC HQ:
- Revised DCW Add-on – T2033 HI, T2033 TF
1915(b)(3) Services (B3):
- Added Codes- T 2012, T2012 HQ, T2012 GC, T2012 GC HQ:
- Revised DCW Add-on – T2033 HI U4, T2033 TF U4
TBI:
- Added Codes- T 2012 U5, T2012 HQ U5:
- Revised DCW Add-on – T2033 HI, T2033 TF
ICF ILOS:
Revised DCW add-on for all codes listed on ICF table below.
Providers may contact Medicaid.ProviderReimbursement@dhhs.nc.gov with any inquiries.