This bulletin provides additional guidance to help stakeholders understand and apply the Aug. 1, 2026, implementation of the rate increase for hands-on care services in the Community Alternatives Program Consumer Direction (CAP/CD).
For providers billing services for Agency Led Care beneficiaries
Beneficiaries who have selected the Agency Led care model (are not self-directing their care under Consumer Directed model) will automatically receive the increased service rates requiring no action by the provider agency.
- Provider agencies should continue billing their usual and customary charges to minimize extra steps when rates change.
- Claims will pay up to the revised rate or the billed amount, whichever is lower.
Plan of Care updates are not required to access revised rates for hands-on services or other unit-based services for Agency Led Care beneficiaries as service levels and quantities remain unchanged.
For provider billing services for Consumer Directed beneficiaries
In the Consumer Directed model, the financial management agency (FMA) bills on behalf of the beneficiary and their family. Direct care worker rates for hands-on services in the Consumer Directed model are negotiated by the Employer of Record (EOR) to establish reimbursement rates for caregivers hired on the beneficiary’s behalf.
When NC Medicaid increases provider rates for hands-on CAP/CD services, Consumer-Directed caregivers whose services qualify for the adjustment may receive the higher rates through a negotiated rate change.
- If rate changes are desired, the EOR must request a renegotiation through their Care Advisor and the FMA to update the rates in the system.
- Rate changes are effective once the FMA receives the request and all necessary information needed to process the change is completed.
- Consumer Directed Plans of Care must also be updated to access the increased service rates.
- If the EOR chooses to maintain the caregiver’s current reimbursement rate, no action is required.