Skilled Nursing Facilities (SNF)
Effective July 1, 2023, Skilled Nursing Facility (SNF) rates will include a permanent increase of $37.74 per patient day (PPD). This permanent increase replaces the previous temporary increase of $27.28.
In addition to this increase, NC Medicaid will make the following adjustments as part of systematically reprocessing SNF claims:
- July 1, 2023, SNF rates will be adjusted to reflect the final SNF resident rosters for the Jan. 1, 2023 through March 31, 2023, Minimum Data Set (MDS) reporting period that is appropriately applicable to the quarter ending Sept. 30, 2023.
- SNF provider tax assessments will be retroactively adjusted to July 1, 2023, to reflect the appropriate tax assessment rates below:
| Bed Days | Tax Rate |
|---|---|
| 0-42,000 | $29.25 |
| 42,000+ | $9.45 |
The adjusted assessments will be included in the final SNF provider rates for the quarter ending Sept. 30, 2023 through the end of SFY 2024 (June 30, 2024).
Personal Care Services (PCS) and Community Alternatives Programs (CAP/C, CAP/CD and CAP/DA)
Effective July 1, 2023, PCS and CAP rates will include the following permanent increases:
- PCS rate per 15-minute increment will be $5.96 in NC Medicaid Direct (CPT Code 99509).
- PCS service codes, as defined by NC Medicaid in the current CAP programs below, will receive a permanent increase of $1.07 added to either the previously established Direct Care Worker (DCW) rate or to the rate in effect prior to the Public Health Emergency (PHE). Electronic Visit Verification (EVV) rate adjustments to applicable PCS codes will remain in effect.
- 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
The applicable PCS codes relevant to these rate adjustments can be found at: https://ncdhhs.servicenowservices.com/fee_schedules . NC Medicaid is in the process of revising the applicable published fee schedules to reflect the rate changes described above.
Private Duty Nursing (PDN)
Effective retroactively to July 1, 2023, the PDN rate will increase to $13.00 per 15-minute increment.
Retroactive Dates of Service Claims That Require Reprocessing
NC Medicaid will systematically reprocess all claims with dates of service occurring between the retroactive effective date of July 1, 2023, through the actual NCTracks rate implementation date for all affected programs. To further advise affected providers, NC Medicaid will release additional reprocessing-focused communications as details become available.
Effects of Rate Changes on NC Medicaid Managed Care Plans
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 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 services covered in their plans and reprocess affected claims.
Contact
NCTracks Contact Center: 800-688-6696