Electronic Visit Verification Personal Care Services Upcoming Claims Reprocessing Rate increase for EVV PCS claims

This bulletin is to provide notice to Personal Care Services (PCS) providers of the pending reprocessing of PCS claims subject to the 10% rate increase to the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) Home- and Community-based Services (HCBS) waivers. The rate increase comes with adherence to Electronic Visit Verification (EVV) for PCS claims. 

NC Medicaid successfully implemented EVV as required by the 21st Century Cures Act with an effective date of Jan. 1, 2021. 

NC Medicaid will systematically reprocess CAP/C and CAP/DA claims for providers subject to the EVV mandate. Claims submitted with dates of service on or after Jan. 1, 2021 will be reprocessed to include the 10% EVV rate increase in three separate checkwrites: July 12, 2022, July 19, 2022 and July 26, 2022.

In addition, NC Medicaid will append EVV data to previously processed claims subject to the EVV requirements that were not captured during the pay and report period. The EVV data validation completed during this reprocessing effort will not impact paid claims but will assist NC Medicaid in measuring its key performance indicators for the EVV requirements.

The 10% increased unit rate applies to the PCS types included in the CAP/C and CAP/DA HCBS waivers, including participants using consumer direction (CAP/CD), to ensure parity across state Medicaid programs. The CAP PCS are included in the table below:

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NCTracks Contact Center 800-688-6696