10A NCAC 22G .0505. PERSONAL CARE SERVICES

(a)  Payment for personal care services in recipient's home, prescribed in accordance with a plan of treatment and provided by an in-home aide who meets the requirements of 10A NCAC 13J .1110 and is under the supervision of a registered nurse, shall be based on a negotiated hourly fee not to exceed reasonable cost.

(b)  The Division of Medical Assistance shall enter into contracts with private and public non-medical inpatient institutions using 42 CFR 434-12 for the provision of personal care services for State/County Special Assistance clients residing in adult care homes.

(1)           Effective August 1, 1995 reimbursement for private providers shall be determined by the Division of Medical Assistance based on a capitation per diem fee (fee) derived from review of industry costs and determination of reasonable costs with annual inflation adjustments.  The initial fee shall be based on one hour of services per patient day.  Additional payments shall be made utilizing the one hour fee as a factor, for Medicaid eligibles that have a demonstrated need for additional care.  The initial one hour fee is computed by adding together the estimated salary, fringes, direct supervision and administration cost.  Effective January 1, 2000 the cost of medication administration and additional personal care services direct supervision shall be added to the fee.  The fee(s) shall be recalculated each year based on the most current annual cost report available to the state. This annual adjustment shall not exceed the amount approved by the North Carolina General Assembly.  Payments may not exceed the limits set in 42 CFR 447.361.  Effective January 1, 2000, private provider payments shall be cost settled with any overpayment repaid to the Division of Medical Assistance.  No additional payment to the provider shall be made due to cost settlement.  The first cost settlement period shall be the nine months ended September 30, 2000.  Subsequently, the annual cost settlement shall be the 12 months ended September 30.

(2)           Effective January 1, 1996 public providers shall be paid on an interim basis using the above method.  Payments shall be cost settled with any overpayment repaid to the Division of Medical Assistance.  No additional payments to the provider shall be made due to cost settlement.

(c)  Changes to the Payment for Services Prospective Plan for Personal Care Services shall become effective when the Centers for Medicare and Medicaid Services (CMS), U.S. Department of Health and Human Services, approves amendment submitted to CMS by the Director of the Division of Medical Assistance as #TN 01-14

 

History Note:        Authority G.S. 108A-25(b); 108A-54; 108A-55; 131D-4.1; 131D-4.2; S.L. 1995 c. 507, s. 23.10; 42 C.F.R. 440.170(f);

Eff. January 1, 1986;

Temporary Amendment Eff. April 22, 1996; January 9, 1997;

Amended Eff. August 1, 1998;

Temporary Amendment Eff. January 1, 2000;

Temporary Amendment Expired on October 28, 2000;

Temporary Amendment Eff. July 1, 2002;

Amended Eff. August 1, 2002;

Temporary Amendment Eff. January 13, 2003;

Amended Eff. August 1, 2004.