July 13, 2022. This bulletin has been revised to update information on temporary rate increases.
The newly enacted 2022 Current Operations Appropriations Act (SL 2022-74) appropriates funding that enables NC Medicaid to extend temporary COVID-19 rate increases for the services identified below through Dec. 31, 2022. NC Medicaid will evaluate the need and ability to continue these increases as December 2022 approaches.
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 Dec. 31, 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 Dec. 31, 2022.
Personal Care Services (PCS) and Community Alternatives Programs (CAP/C, CAP/DA and CAP/CD [Consumer Direction/formerly CAP/Choice])
Current PCS and Community Alternative Program rates are being extended through Dec. 31, 2022.
The PCS rate per 15-minute increment will be $5.96 for the following program:
Personal Care Services (NC Medicaid Direct) (CPT Code 99509)
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 Dec. 31, 2022.
- Community Alternatives Programs for Children (CAP/C) and Disabled Adults (CAP/DA) Personal Care Services
- Community Alternatives Program Consumer Direction (CAP/CD) 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 through December, 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.
Mobile Crisis Services
The current 5% temporary COVID-19 rate increase in effect for community-based Mobile Crisis intervention services is being extended through April 1, 2027, as authorized by section 9813 of the American Rescue Plan Act of 2021 (ARPA) (Pub. L. 117-2). Mobile crisis reimbursement rates for both Standard Plans and LME/MCOs must be no less than those in NC Medicaid Direct (fee-for-service), inclusive of the 5% rate increase.
Program of All-inclusive Care for the Elderly (PACE)
The 5% temporary COVID-19 rate increase in effect in March 2022 for PACE will end as of June 30, 2022. Effective July 1, 2022, the PACE rate will be set at 90% of the most recently determined AWOP.
The State will ensure any future rate update will comply with the requirements under 42 CFR 460.182 and submit necessary documentation.
Effects of COVID-19 Rate Changes on Standard Plan Prepaid Health Plan (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 continue the temporary COVID-19 rate increases for SNF, PCS, Hospice and Mobile Crisis. July 1, 2022, capitation rates will be adjusted retroactively, as appropriate, to reflect the extensions through Dec. 31, 2022.
NCTracks Contact Center: 800-688-6696