Home and Community-Based Service (HCBS) providers may be eligible to receive retainer payments for employed Direct Care Workers (DCWs) who are unable to deliver HCBS services under an active, approved service plan to one or more Medicaid beneficiaries due the impacts of Hurricane Helene. These retainer payments are for DCWs as defined in 42 C.F.R. § 441.302(k)(1)(ii) and 42 C.F.R. § 441.311(e)(1)(ii) and are intended to help maintain the NC Medicaid provider network.
Eligibility Criteria
To receive retainer payment, qualifying providers and their DCW(s) must comply with terms set out in the attestation along with the following:
- Home and community-based service (HCBS) provider delivering one of the following services:
- 1915 (c) Community Alternatives Program for Children (CAP/C) Waiver
- 1915 (c) Community Alternatives Program for Adults (CAP/DA) Waiver
- 1915 (c) Innovations Waiver
- Specific 1915(i) services
- Community Living and Supports
- Supported Employment
- Individuals Placement and Supports
- Individuals and Transitional Supports
- Home Health
- Personal Care Services (PCS)
- Private Duty Nursing (PDN)
- Provider’s employed DCW(s) is unable to provide services under an active, approved service plan due to the impacts of Hurricane Helene
- Provider’s employed DCW(s) or member receiving HCBS services has a physical address within a FEMA declared disaster individual assistance county
- Retainer payments are limited to hours/services under a service plan approved prior to Sept. 25, 2024
- Retainer payments are limited to no more than one (1) 30-day billing period per DCW and Member that is unable to be served
- Providers must complete and upload the required attestation
Providers must retain the required DCW attestation for each DCW for which a retainer payment is requested.
To receive retainer payments, providers will initially submit an attestation and collect attestations from their DCWs. Once a completed attestation has been submitted, providers may request a retainer payment by submitting claims using the process described below to the Managed Care plan with whom the Member unable to receive services is enrolled or to NCTracks based on eligibility of the Member unable to receive services. The following sections provide additional information on the process.
Attestation Submission Process for CAP/C and CAP/DA Services
Providers approved to render services under the CAP/C and CAP/DA waivers will access the required attestations and upload completed attestations through e-CAP.
After providers submit the required attestations, NC Medicaid will create a new service plan for the retainer payment. Once the service plan has been approved, providers can submit claims using the CR modifier for the retainer payment.
Providers must retain the required DCW attestation for each DCW for whom a retainer payment is approved for CAP/C and CAP/DA. Providers should accept their service authorization and upload the attestations as supporting documentation in e-CAP. The CAP case manager may be able to assist if needed.
Attestation Submission Process for Non-CAP/C and CAP/DA Services
Qualifying providers and employers of record (EOR) under the consumer direction model of care must complete and upload the Retainer Payment Provider Attestation form via the Service NOW portal. Financial Supports Agencies (FSAs) will support the EOR in uploading the Provider Attestation.
- The EOR is expected to sign the Retainer Payment Provider Attestation form (Provider Attestation) as the provider.
- Additionally, providers/EORs must have each DCW requesting a retainer payment complete a DCW attestation and maintain that attestation for their records.
- Providers and EORs with the support of FSAs may submit one Provider Attestation for use by both NC Medicaid Direct and Managed Care plans.
- Providers can submit multiple Provider Attestation forms for different DCWs if they receive DCW attestations at different times.
- Once submitted, DHB will review the Provider Attestations and notify providers of the Provider Attestation status and readiness to submit claims.
Claim Submission Process
After providers receive notification from the Department that they may submit claims for retainer payment, they can submit a claim to request a retainer payment for services in an active, approved service plan when the DCW is unable to deliver the services using the following codes:
- Professional Claims: Use Modifier CR
- Institutional Claims: Use Condition Code DR
These claims will be reviewed and validated to confirm that they comply with the necessary requirements outlined in the Provider Attestation. Claims that do not meet these standards may be denied or recouped. Claims will be paid in accordance with current rates as defined on the appropriate fee schedules posted on the DHHS fee schedule portal or in the provider’s contract with the Managed Care plan with whom the Member unable to receive services is enrolled.
Thank you for your continued dedication to supporting Medicaid beneficiaries and DCWs during this challenging time. For additional information on the financial supports available to North Carolina Medicaid providers, please see the Financial Support Available for Providers Impacted by Hurricane Helene bulletin.
Contact Information
Health Plan Provider Service Lines
Standard Plans
- AmeriHealth Caritas: 1-888-738-0004 (TTY: 1-866-209-6421)
- Carolina Complete: 1-833-552-3876 - Option 3
- Healthy Blue: 1-844-594-5072
- United Healthcare: 1-800-638-3302
- WellCare: 1-866-799-5318
Tailored Plans and LME/MCOs
- Alliance Health: 1-855 759-9700
- Partners Health Management: 1-877-398-4145
- Trillium Health Resources: 1-855-250-1539
- Vaya Health: 1-866-990-9712
NC Medicaid Direct Contact Information
- NCTracks Call Center: 1-800-688-6696
- Provider Ombudsman: 1-866-304-7062, Medicaid.ProviderOmbudsman@dhhs.nc.gov