Temporary COVID-19 Rate Increases Continuing
Skilled Nursing Facility Rates
Effective April 1, 2023, through June 30, 2023, Skilled Nursing Facility (SNF) rates will continue to include the revised temporary add-on amount of $37.74 per patient day (PPD).
Hospice Room and Board
Effective April 1, 2023, through June 30, 2023, 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.
Personal Care Services (PCS) and Community Alternatives Programs (CAP/C and CAP/DA)
Effective April 1, 2023, through June 30, 2023, the PCS rate per 15-minute increment will remain $5.96 for the following program:
- Personal Care Services (NC Medicaid Direct) (CPT Code 99509)
Effective April 1, 2023, through June 30, 2023, 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.
- 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 will continue 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
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 the temporary COVID-19 payment increases for HCBS services and some residential care and crisis services covered in the LME/MCO program or incorporate the permanent, legislated increases for applicable HCBS programs and ICF-IID.
Standard Plan Rates
The NC Medicaid Managed Care Standard Plans 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, Standard Plans 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 June 30, 2023.
Contact
NCTracks Call Center: 800-688-6696