On Jan. 28, 2018, the NC Department of Health and Human Services (DHHS) implemented updates to NCTracks pharmacy prior approval (PA) requests for North Carolina Medicaid and NC Health Choice beneficiaries. New electronic PA submissions are available for the following drugs and the temporary fax forms were removed:
Topics Related to Bulletins
The Verification of School Nursing Form – Attachment I (DMA-3171), and Instruction Sheet (DMA-3171-I) are now on the NC Medicaid PDN forms web page. The form is used to document Private Duty Nursing (PDN) school hours in accordance with Section 3.4.1, PDN and Schools, of Clinical Coverage Policy 3G-2, Private Duty Nursing for Beneficiaries Under 21 Years of Age.
By Feb. 28, 2018, non-accredited nursing service providers previously providing services under the Community Alternatives Program for Children (CAP-C) waiver must obtain accreditation and meet all required occupational licensing entity regulations.
With each prior approval (PA) entry beginning with the third and subsequent benefit periods, providers must fax a copy of the Approval Status Inquiry Form, or the NCTracks Web Submitted Request for Hospice Prior Approval Confirmation Page, to DMA at 919-715-9025. DMA requests that providers include their name and e-mail address on the above forms.
The Freestanding Birth Center fee for CPT Code 59409 has been updated to $1,510.97 effective Jan. 1, 2018.
Registration is open for several instructor-led training courses for providers that will be held in January 2018.
Per Session Law (S.L.) 2015-241, as amended by S.L. 2017-57, North Carolina providers who are reimbursed by the state for providing health care services under N.C. Medicaid and N.C. Health Choice programs must join NC HealthConnex, the state-designated Health Information Exchange.
There are only four months left to submit an attestation for Program Year 2017.
Clinical Coverage Policy (CCP) 11B-4, Kidney (Renal) Transplantation, has been revised.
The revisions, which will become effective Feb. 1, 2018, will remove the prior authorization requirement from live donor kidney transplants and reflect coverage based on glomerular filtration rate (GFR) and age, rather than diagnosis.
The following new or amended combined N.C. Medicaid and N.C. Health Choice clinical coverage policies are available on DMA’s clinical coverage policy web pages.