Private Duty Nursing Rate Increase

As required by the N.C. Session Law 2015-241, the N.C. Department of Health and Human Services (DHHS) submitted N.C. State Plan Amendment (SPA) 16-001 to the Centers for Medicare & Medicaid Services (CMS) requesting approval for a ten percent rate increase for Private Duty Nursing (PDN) with an effective date of January 1, 2016. CMS approved this SPA on April 14, 2016 and the rate was implemented in NC Tracks on April 21, 2016. Beginning April 21, 2016, claims for PDN will be reimbursed at the lessor of this new rate, $9.90 per 15 minutes, or billed charges. Providers are reminded to bill their usual and customary charges.

Claims with dates of service January 1, 2016 through April 21, 2016 will be systematically reprocessed at a later date. N.C. Division of Medical Assistance (DMA) will provide updates and additional details on the reprocessing in upcoming Medicaid bulletins.