Topics Related to Division of Health Benefits

Bicillin® L-A Rates Increased Effective Feb. 1, 2024

This rate increase in the latest Physician Administered Drug Program fee schedule supports treating Medicaid members for Congenital Syphilis.

Community Alternative Program (CAP) Personal Care Services (PCS) Rate Update

Fee schedule rate corrected on Feb. 5, 2024.

Clinical Coverage Policy updates for the 1115 Substance Use Disorder Waiver Demonstration

Policies to promulgate on May 1, 2024.

Updates to Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies

An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of Dec. 1, 2023, is posted.

NC Medicaid Accepting Federally-Facilitated Marketplace Eligibility Determinations

NC Medicaid began accepting Federally-facilitated Marketplace Eligibility Determinations Feb. 1, 2024

NCDHHS Consolidates Local Management Entity/Managed Care Organizations Ahead of Tailored Plan Launch

Eastpointe and Trillium Health Resources have consolidated into one entity, and Sandhills Center has dissolved.

NC Medicaid Guidance on Sunsetting of Traumatic Brain Injury Appendix K Flexibilities

Permanent flexibilities approved in the TBI Waiver amendment effective March 1, 2024.

NC Medicaid Managed Care Provider Update – Jan. 30, 2024

Includes information on LME/MCO consolidation, Innovations and TBI waivers, federal fee increase, updates to NCTracks, Medicaid expansion and more.

NC Managed Care Capitation Rates – Updated Care Management Assumptions for Expansion Population

Includes rate considerations for Medicaid Expansion members effective Dec. 1, 2023.

NC Medicaid Guidance on Sunsetting of Innovations Waiver Appendix K Flexibilities

Permanent flexibilities approved in the Innovations Waiver amendment effective March 1, 2024.