NC Medicaid is updating the special focused financial assistance to Skilled Nursing Facilities (SNFs) provided through outbreak rates. These rates were designed to address the higher costs of caring for Medicaid beneficiaries who were COVID-positive (COVID+).
In light of evolving needs in SNFs, in place of the outbreak rates, NC Medicaid will provide all SNFs a single, uniform temporary rate increase that will enable them all to better address the various increased costs associated with staffing during the COVID-19 Public Health Emergency (PHE).
COVID-19 rates and billing guidelines affected by this change were established in SPECIAL BULLETIN COVID-19 #82: Expedited Hardship Advances and Retroactive Targeted Rate Increases for Skilled Nursing Facilities and Adult Care Homes Serving COVID-positive Patients and revised in SPECIAL BULLETIN COVID-19 #144: COVID-Nursing Facility Response Site Criteria Revised. NC Medicaid established the nursing home “COVID Response Facility” option to support nursing homes that accepted COVID+ beneficiaries discharging from an acute care facility.
Skilled Nursing Facilities
Effective Oct. 1, 2021, all COVID-19 SNF outbreak rates will be terminated and replaced with a single uniform PHE add-on rate of $95 applying to all SNFs except those designated as COVID-19 Response Facilities.
- This new PHE add-on rate will be added to each SNF provider’s Oct. 1, 2021, quarterly calculated base rate and will be in effect through Dec. 31, 2021.
- The new PHE rate will be added on top of the 5% and 10% COVID-19 rate increases currently included in the quarterly SNF base rate update process.
SNF Response Facilities
The rate structure, billing criteria and reporting requirements for COVID-Response Sites established in Special Bulletin #82 will remain in effect. COVID-Response sites operating on Friday, Oct. 1, 2021 do not need to do anything to continue their Response Facility status.
NC Medicaid will continue to consider on a case-by-case basis Response Facility Designation Requests submitted by SNFs.