Additional Safeguards Session Law Revised Payment Adjustment Plan Personal Care Services State Plan Amendment August 20, 2014 Revised version of webinar presented on July 2nd & 9th titled Personal Care Services (PCS) Recoupment/Repayment Plan Revised 11/5/14: PCS payment adjustment schedule now reflects correct date of the first checkwrite of each month.

Session Law House Bill 492 Purpose: Direct the Department of Health and Human Services (DHHS) to adjust Medicaid Personal Care Services (PCS) to provide additional safeguards for qualified individuals. –Approved 18 th day of July, 2013

Provider Rates & Reimbursement With the approval of SPA (HB492) by CMS, the reimbursement rate from October 1, 2013 through December 31, 2013 is $3.58 per 15 minutes ($14.32 per hour). The rate prior to October 1, 2013 was $3.88 per 15 minutes or ($15.52 per hour). To comply with the Shared Savings plan enacted by N.C. Session Law , DMA applied the 3% reduction on January 1, 2014 to the current rate of $3.88 per 15 minutes ($15.52 per hour) which equated to $3.76 per 15 minutes ($15.04 per hour). The reimbursement rate from January 1, 2014 will now be $3.47 per 15 minutes ($13.88 per hour). This equates to $3.58 per 15 minutes reimbursement rate less the 3% reduction.

Provider Rates & Reimbursement Dates of ServiceRate Prior to 10/1/13$3.88per 15 minutes ($15.52 per hour) 10/1/ /31/13 $3.58per 15 minutes ($14.32 per hour) 01/01/2014 forward $3.47per 15 minutes ($13.88 per hour)

Revised Payment Adjustment Plan Systematic Payment Adjustments will begin with the September 9 check write and will continue through April 2015 beginning with claims with Dates of Service from October 1, 2013 through May 22, 2014 Month of ServiceDate of Service Begin DateDate of Service End Date Systematic Payment Adjustment Begin date October 2013October 1, 2013 October 31, 2013September 9, 2014 November 2013November 1, 2013 November 30, 2013October 7, 2014 December 2013December 1, 2013December 31, 2013November 4, 2014 January 2014January 1, 2014January 31, 2014December 2, 2014 February 2014February 1, 2014February 28, 2014January 2015 [1] [1] March 2014March 1, 2014March 31, 2014February 2015 April 2014April 1, 2014April 30, 2014March 2015 May 2014May 1, 2014May 22, 2014April 2015 [1] [1] Check-write calendar for calendar year 2015 are available on the PCS provider webpage at

Notification of Payment Adjustment PCS providers will receive a letter stating the estimated total payment adjustment amount prior to the September 9th check write. All amounts owed to DMA that are not satisfied within 30 days from the Systematic Payment Adjustment Begin Date will incur penalty and interest.

Payment Adjustment by Setting of Service: Calculating Adjustment from SPA Payment amounts are then recalculated for the period using the reduced rates. The difference between the actuals and this amount represent adjustment to DMA. –The table below shows calculated adjustment resulting from the implementation of the SPA by Type and Setting, across the impact period (October 2013 to date) Source data: Actual hours provided by James Campbell on 5/24/2014 Estimated hours provided by Talbatha Myatt on 6/3/2014 Rate obtained from PCS SPA presentation posted on DMA website

Average Monthly Payout vs. Gross Adjusment by Setting of Service Source data: Actual hours provided by James Campbell on 5/24/2014 Estimated hours provided by Talbatha Myatt on 6/3/2014 Rate obtained from PCS SPA presentation posted on DMA website

Gross Adjustment Histogram 80% of providers will owe less than $15,000 Approximately 60% will owe less than $5,000 Source data: Actual hours provided by James Campbell on 5/24/2014 Estimated hours provided by Talbatha Myatt on 6/3/2014 Rate obtained from PCS SPA presentation posted on DMA website

Estimate Your Adjusted Payment The Payment Adjustment Calculator will provide a rough estimate of the adjustment, not the exact amount. The Payment Adjustment Calculator is available on the PCS Webpage:

Manual Provider Repayment Option Providers can pay the balance owed to DMA at any point in the adjustment process by sending a check to the lockbox address listed below. Miscellaneous Medicaid Payments PO Box Charlotte, NC

Please note that you can only have one check per NPI/Payer otherwise those funds will not be able to be posted correctly. Payments will be posted to your accounts more quickly by including the accounts receivable page from the remittance advice statement with the payment. Manual Provider Repayment Option

Resources DMA will continue to host monthly stakeholder meetings and update the PCS webpage with current information. Contact the DMA PCS program at or Contact the DMA Finance Section at

Personal Care Services Contacts Beneficiaries and Providers who have questions about the additional safeguards allowed by N.C. Session Law and the implementation of additional hours may contact: The DMA PCS Program at or Liberty Healthcare-NC, Call Center at or ; Independent Assessment for questions.

Resources DMA website: PCS website: Liberty Healthc are: NCTracks:

Questions submitted through the chat box will be posted in the FAQ section on DMA’s Website following the August 20, 2014 Webinar Frequently Asked Questions (FAQ)