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Innovations Direct Care Workers (DCW) Rate Increase Communication

The NC General Assembly appropriated $176 million in state and federal recurring funding in the Current Operations Appropriations Act of 2023 (SL 2023-134, Section 9E.15) to raise NC Medicaid Innovations waiver services rates so that Innovations services providers can in turn raise the hourly wages of the direct care workers (DCW) they employ.  While the increases vary by service type/payment methodology, they share a uniform unit increase of $1.13 per 15-minute increment of service. These rate increases will be effective July 1, 2023, and will be included retroactively in adjusted capitation rates for Local Management Entities/Managed Care Organizations (LME/MCOs). Trillium will be required contractually to reprocess claims for dates of service on or after July 1, 2023, to ensure that providers receive the increased rates beginning on that date.

Trillium has released an updated fee schedule containing the Innovations DCW increases retroactive to July 1, 2023.  Providers can begin using the updated rates on or after December 20, 2023.  Please note that member and provider-specific rates that are above the new rates will retain the higher rate and no action is required by the provider.

Additional details regarding the services impacted and the base rate assumptions can be found here: NC Medicaid Innovations Waiver Provider Rate Increase.

If you have questions regarding these rate increases, please contact the Rates team at RatesFinance@TrilliumNC.org.

Innovations DCW Rate Increase Reprocessing

Impacted Innovations claims submitted before December 16 will be reprocessed by Trillium back to July 1, 2023.  There is no action needed by the provider at this time. Once processed, the updated claims will be included in the provider’s Remittance Advice.