Changes to two clinical coverage policies – 2A-1, Acute Inpatient Hospital Services and 1A-4, Cochlear and Auditory Brainstem Implants – will soon become effective.
Topics Related to Bulletins
Every year, in accordance with 2 CFR part 200, subpart F, the NC Office of the State Auditor selects a sample of North Carolina Medicaid and NC Health Choice claims to review to determine the state’s compliance with federal and state regulations for claims paid in the prior state fiscal year, which runs from July 1 to June 30.
Per Session Law (S.L.) 2015-241, as of June 1, 2018, hospitals, mid-level physicians and nurse practitioners who currently have an electronic health record system must be connected to NC HealthConnex to continue to receive payments for North Carolina Medicaid and NC Health Choice services.
The following new or amended combined North Carolina Medicaid and NC Health Choice (NCHC) clinical coverage policies are available on Medicaid’s clinical coverage policy web pages.
April is the last month to submit an attestation for the NC Medicaid Electronic Health Record Incentive Program for Program Year 2017. North Carolina’s Medicaid EHR Incentive Payment System will close for Program Year 2017 at midnight on April 30, 2018.
Beginning April 1, 2018, diabetic testing supplies will be transitioned to the North Carolina Medicaid and NC Health Choice Preferred Drug List and Roche diabetic testing supplies will remain preferred.
Effective March 2018, DMA will begin a quarterly review of providers identified as non-compliant with the timely completion of the online Personal Care Services (PCS) service plan as required by Clinical Coverage Policy 3L, State Plan Personal Care Services.
Personal Care Services (PCS) regional training sessions will be held April 30 – May 16, 2018. Registration begins at 8 a.m. and training will be held from 9 a.m. to 1 p.m. Training sessions are free, but registration is required.
Effective with date of service Dec. 11, 2107, the North Carolina Medicaid and NC Health Choice (NCHC) programs cover letermovir injection (Prevymis) for intravenous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service March 1, 2018, North Carolina Medicaid and NC Health Choice (NCHC) programs cover buprenorphine extended-release injection (Sublocade), for subcutaneous use in the Physician’s Drug Program (PDP) when billed with HCPCS code J3490 - Unclassified drugs.