Author: GDIT, (800) 688-6696
On March 10, 2020, Governor Roy Cooper issued an executive order declaring a State of Emergency for North Carolina to respond to COVID-19. In addition, the Department of Health and Human Services made several recommendations to slow the spread of COVID-19 and reduce the number of people infected. In response to those recommendations, NC Medicaid is taking the following precautions regarding independent assessments conducted to determine eligibility for Personal Care Services (PCS):
Annual Assessments
Medicaid will extend prior approvals for current beneficiaries approaching their annual due date. Prior approvals will be extended, at minimum, 90 calendar days and face-to-face assessments will be scheduled for a later date.
Initial Assessments
Initial requests for services will continue to be received and processed by the Independent Assessment Entity (IAE). The IAE will conduct a telephonic assessment with the beneficiary/legally responsible party or others who are able to speak to the beneficiary’s care needs. The telephonic assessment is the current mini assessment used for expedited requests and asks questions related to the assistance needed with activities of daily living and exacerbating conditions that may be present. The mini assessment allows eligible beneficiaries to receive up to 80 hours of PCS per month. Beneficiaries who submit an initial request with a signed attestation will receive a mini-assessment and if determined eligible, a telephonic full assessment will be conducted to assess beneficiary care needs and authorize additional hours if appropriate. Liberty Healthcare will work to complete the full telephonic assessment within 5 business days of the mini assessment. A face to-face assessment will be scheduled for a later date.
Expedited Assessments
Expedited requests will continue to be processed and provisional hours awarded for eligible beneficiaries pursuant to PCS policy section 5.4.4. The provisional PA will be extended to allow for face-to-face assessments to be scheduled for a later date. Current time for processing expedited requests is two business days from date of discharge or date of request; the IAE will work to decrease processing time as possible to one business day. Individuals submitting expedited requests must continue to have a provider identified at time of submission.
Change of Status Assessments
Change of Status Assessments will be received and processed by the IAE. The IAE will conduct a telephonic assessment with the beneficiary/legally responsible party or others who are able to speak to the beneficiary’s care needs. Telephone assessments for change of status requests will follow the current full assessment. The IAE will follow their current process for scheduling and providing a 24-hour confirmation call. All telephonic assessments will continue to encourage caretaker and/or person familiar with the beneficiaries’ care needs to be present. A face-to-face assessment will be scheduled for a later date.
Assessments Conducted During Appeal
Assessments scheduled to resolve mediations and appeals will be managed on a case-by-case basis. During this state of emergency, no face-to-face assessments will be conducted. The IAE and Medicaid will employ alternative measures to resolve appeals such as additional requests for records or assessments scheduled for a later date as options to address appeals during this time to adhere to required beneficiary appeals rights and meet appropriate timeframes.
EPSDT Short-Term Intensive Requests
Medicaid will continue to process EPSDT short-term intensive requests for beneficiaries under 21 years of age using the designated form (https://nc-pcs.com/Medicaid-PCS-forms/EPSDT%20Short-Term%20Increase%20Request%20Form%20(NC%20Medicaid-3116)%209.2018.pdf).
The temporary changes identified in this bulletin were effective Friday March 27, 2020. The use of telephonic assessments and extension of prior authorizations for current beneficiaries will assist in slowing the spread of COVID-19; no additional policy changes have been made at this time. PCS monthly service hour limits per clinical coverage policy 3L remain the same. Questions about the temporary process of telephonic assessments may be sent to PCS_Program_Questions@dhhs.nc.gov or directed to Liberty Healthcare of NC. Temporary changes will end the earlier of the cancellation of the North Carolina state of emergency declaration or at a date to be determined by the Department.