Temporary COVID-19 Rate Increases Ending
Consistent with the end of the federal COVID-19 Public Health Emergency, NC Medicaid is ending all* temporary COVID-19 rate increases and/or uniform adjustments included in rates through June 30, 2023, for the specific Medicaid services identified below.
*Note: Consistent with federal authorization by section 9813 of the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2), the current 5% temporary COVID-19 rate increase in effect for community-based Mobile Crisis intervention services will remain in place through April 1, 2027.
New Temporary/Interim Estimated Budget Increases Added
To maintain access to care for Medicaid members by supporting Medicaid providers whose temporary COVID-19 rate increases are ending while the General Assembly continues budget deliberations, NC Medicaid is implementing new temporary/interim rate increases, effective July 1, 2023** through July 31, 2023, that estimate the permanent rate increases anticipated to be adopted by the General Assembly. These estimates are based on the publicly available House and Senate legislative budget proposals currently being considered in the Conference process.
**Note: There may be a lag of approximately one week before the new temporary/interim rate increases are reflected in NCTracks. NC Medicaid will systematically reprocess as soon as practicable any paid claims with dates of service between July 1 and the temporary/interim rate implementation date. This reprocessing is designed to help minimize any effects on provider cash flow from the change in rates.
As July 31 approaches, if a State budget has not yet been finalized, NC Medicaid will evaluate whether it is feasible to extend the new temporary/interim increases at some level.
Once a State budget has been finalized, NC Medicaid will implement any permanent increases at the levels appropriated in the budget and intends to systematically reprocess claims (or direct managed care organizations to reprocess claims, as applicable) retroactive to July 1 to adjust payments to the level of the appropriated permanent increases. This reprocessing will ensure that providers receive the full value of the legislated increases.
Skilled Nursing Facilities (SNF)
Effective July 1, 2023, Skilled Nursing Facility (SNF) rates will no longer include the temporary COVID-19 add-on amount of $37.74 per patient day (PPD), but will include a temporary/interim estimated budget increase of $27.28 PPD through July 31, 2023.
Hospice Room and Board
The Hospice Room and Board rate for services provided within a SNF will revert to 95% of the applicable SNF rate of the facility where the Medicaid beneficiary resides.
Personal Care Services (PCS) and Community Alternatives Programs (CAP/C, CAP/ CD [formerly CAP/Choice] and CAP/DA)
Effective July 1, 2023, PCS and CAP rates will no longer include the COVID-19 temporary add-ons, but will include a temporary/interim estimated budget increase of $0.85 per 15-minute increment through July 31, 2023.
The PCS rate per 15-minute increment therefore will be $5.74 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 listed below, will no longer receive temporary COVID-19 rate increases nor a uniform rate increase.
Effective July 1, 2023, CAP program rates will revert to the established Direct Care Worker (DCW) rate or the rate in effect prior to any COVID-19 rate adjustments, whichever is applicable, plus the temporary/interim estimated budget increase of $0.85 per 15-minute increment, through July 31, 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 relevant to these rate adjustments 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.
Effects of COVID-19 Rate Changes on NC Medicaid Managed Care Plans
Local Management Entity/Managed Care Organization (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. LME/MCOs will be required to continue and/or revise any rate adjustments described in this bulletin as continuing for services covered in the LME/MCO program.
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. To reflect the changes noted in this bulletin, PHPs are required to adjust rates for SNF, PCS, and Hospice.
Public Notice of Potential Permanent Increases
NC Medicaid is also posting State Plan Amendment Public Notices in anticipation of potential permanent rate increases up to the highest publicly available House and Senate legislative budget proposals for SFY 2024-25. These notices simply enable the State to meet federal regulations for estimated permanent increases that might be funded retroactively to begin on July 1, 2023; the notices do not guarantee any additional increases.
Once a State budget has been finalized, NC Medicaid will implement any permanent increases at the levels appropriated by the General Assembly and intends to systematically reprocess claims (or direct managed care organizations to reprocess claims, as applicable) retroactive to July 1, 2023, to adjust payments to the level of the appropriated permanent increases. This reprocessing will ensure that providers receive the full value of any legislated increases.
Contact
NC Medicaid Contact Center, 888-245-0179