This bulletin documents modifying the Skilled Nursing Facilities (SNF) Provider Assessment and temporary COVID-19 add-on, and explains how each action will affect the SNF per diem rates. The bulletin also documents the status of the other temporary COVID-19 rate add-ons currently in effect.
Provider Assessment Modifications
Effective retroactively to Nov. 1, 2022, NC Medicaid is modifying the structure of the existing provider assessment on SNFs. Consistent with current Centers for Medicare and Medicaid Services (CMS)-approved state authority, this modification will allow NC Medicaid to reinvest additional provider tax collections and associated federal matching dollars into an increase in Medicaid SNF-specific per diem rates.
The revised SNF provider assessment program is structured:
- The per diem assessments are imposed on non-Medicare patient days as allowed for under 42 CFR 433.68(d);
- The assessments imposed on nursing facilities will be calculated as follows:
- Continuing Care Retirement Centers and Tribal Facilities will be assessed at a uniform per diem rate equal to $0.00 per non-Medicare day.
- Nursing facilities with a total annual census greater than 42,000 will be assessed at uniform per diem rate equal to $8.64 per non-Medicare day.
- All other nursing facilities that do not meet the criteria of (a) or (b) above will be assessed at a uniform per diem rate equal to $26.74 per non-Medicare day.
As a result of the modified assessment structure, effective Nov. 1, 2022, all SNF provider rates will be retroactively increased on a permanent basis by a net amount of $31.90 after all the appropriate new tax assessment amounts are factored in.
NC Medicaid will load the above provider assessment rates in the Nursing Home Assessment portal beginning with the December 2022 service month.
- Providers must remit their November 2022 service month assessments by Dec. 15, 2022, using the assessment rates currently loaded in the portal.
- The December 2022 service month assessments are due Jan. 15, 2023.
NC Medicaid performs an annual reconciliation of health care assessments (a/k/a provider tax) during the audit of the cost reports and the November 2022 service month differential in assessment rates will be reconciled.
NC Medicaid will systematically reprocess all SNF claims with dates of service (DOS) between Nov. 1, 2022, and Dec. 31, 2022. Through December 31, 2022, the permanent $31.90 net increase described above will be on top of the current 5% and 10% temporary COVID-19 rate increases and the uniform temporary COVID-19 rate increase of $47.50 per diem that will continue.
**Please Note** Rates initially released the first week of November as revised rates have been adjusted to reflect all updated modifications in adherence to state statue and CMS guidelines, and those adjustments will be included in the reprocessing of claims with DOS between Nov. 1, 2022, and Dec. 31, 2022.
Changes to the SNF Temporary COVID-19 Rate Increases
Effective Jan. 1, 2023, NC Medicaid is modifying the temporary COVID-19 rate add-ons for SNFs in order to recognize permanent increases due to the Oct. 1, 2022, base rate inflation and the Nov. 1, 2022, assessment modifications described above, but keep the average SNF per diem at the level that was being paid on Sept. 30, 2022.
- The 5%, 10%, and flat $47.50 temporary add-ons end Dec. 31, 2022.
- In their place, each SNF will receive a revised temporary add-on amount of $37.74 per diem through March 31, 2023.
Continuation of Other Temporary COVID-19 Rate Increases
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 March 2023.
Personal Care Services (PCS) and Community Alternatives Programs (CAP/C and CAP/DA)
The PCS rate per 15-minute increment will remain $5.96 through March 31, 2023, for the following program:
- Personal Care Services (NC Medicaid Direct) (CPT Code 99509)
PCS service codes, as defined by DHHS, 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 March 2023.
- 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.
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.
Effects on NC Medicaid Managed Care Plans and Contracted Providers
LME/MCO Rates
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 Home and Community-Based Services (HCBS) and some residential care and crisis services covered in the LME/MCO program or incorporate the permanent, legislated increases for applicable HCBS programs and Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID).
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 continue the temporary COVID-19 rate increases for SNF, PCS, Hospice and Mobile Crisis. Capitation rates will be adjusted retroactively, as appropriate, to reflect the extensions through March 31, 2022.
Contact
NCTracks Call Center: 800-688-6696