Count Down to April 1, 2025 PCS Per Diem Payment

Steps to Make Sure You Are Prepared

For PCS Per Diem Billing

NCSLA Sponsored Webinar with Richard Rutherford

Free Webinar

On March 26th, NCSLA hosted Richard Rutherford, with SembraCare and LTSS Consulting, for a one-hour review and Q&A on the upcoming Medicaid PCS Per Diem Reimbursement Payment Structure that begins April 1, 2025. Beginning April 1, 2025, NC Medicaid Personal Care Services (PCS) in adult and family care homes will be reimbursed on a per diem (per day) payment structure, rather than the current 15-minute increment, and will be called Congregate Care Setting services.

The recording from the webinar is now available on the NCSLA website by clicking Here

In addition, there is also a link on the above web page to the January 29th webinar NCSLA hosted with Wrenia Bratts-Brown with the Division of Health Benefits on the Medicaid PCS Per Diem payment structure. We strongly encourage providers to familiarize themselves with this new process since April 1st will be here next week!

Providers experiencing a hardship after April 1, 2025, due to pended or denied claims that are not able to adjudicate because the claim doesn’t align with the new billing guideline, may qualify for a hardship advancement.

Contact: Medicaid.ProviderReimbursement@dhhs.nc.gov

We hope the above information is helpful. If there are questions regarding Medicaid, regulatory or other issues, please do not hesitate to contact the NCSLA office at the number below.

Stacy Massey, NCSLA Education Director

Email:stacy@ncseniorliving.org

Phone: 919-787-3560