NC Medicaid Hurricane Helene flexibilities for Community Alternatives Program for Children (CAP/C) and Community Alternatives Program for Disabled Adults (CAP/DA) Waiver programs will expire on June 30, 2025.
Topics Related to Division of Health Benefits
NC Medicaid Guidance on Sunsetting of Community Alternatives Program Waiver Appendix K Flexibilities
NCTracks will implement system enhancements to improve the processing of Private Duty Nursing (PDN) Prior Approvals (PAs) and claims.
Updated guidance for forms NC Medicaid 372-124 and DMA-0100.
NC Medicaid is hosting program specific office hours. Sessions will provide an opportunity for stakeholders to request technical assistance about issues and concerns.
Providers can continue billing Diagnosis Related Group claims using revenue code 0161 for room and board and occurrence span code 82.
Tobacco-related policy requirements will be effective Jan. 1, 2027.
Temporary flexibilities to the Innovations Waiver after Hurricane Helene are ending July 1, 2025.
The Centers for Medicare & Medicaid Services (CMS) requires individuals in the NC Medicaid Innovations waiver program to have a valid and comprehensive assessment.
NC Medicaid’s Electronic Visit Verification (EVV) system for Home Health ensures compliance with federal requirements.
Budget proposals from the North Carolina General Assembly do not include funding for Healthy Opportunities Pilots services beyond June 30, 2025