Blog Entry List
Providing the most accurate and complete provider information is a top priority so Medicaid and NC Health Choice beneficiaries can make the most informed choice for their health plan and primary care provider.
Effective with the date of service April 1, 2021, the Centers for Medicare & Medicaid Services added new HCPCS codes (J codes), deleted others and changed the description of some existing codes.
Effective July 1, 2021, NC Medicaid will increase fee-for-service rates and establish rate floors for facility-based crisis and mobile crisis management services that will mandate minimum reimbursement rates.
The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.
Program Year 2020 Webinar Series, The Security Risk Analysis (SRA) and Program Year 2021 Announcements.
An updated draft of NC Medicaid’s Managed Care Quality Strategy is posted for public comments until May 6, 2021.
NCDHHS has implemented a PCP practice reassignment process to better match beneficiaries to the PCP with whom they already have an active relationship with to help ensure the best health plan is selected during auto-enrollment.
The NC Medicaid Annual Quality report and an updated NC Medicaid Managed Care Quality Measurement Technical Specifications Manual are available.
Upcoming stakeholder sessions are announced for the Community Alternatives Program for Children (CAP/C) waiver, which will expire on Feb. 28, 2022. By October 2021, NC Medicaid will submit a request to the Centers for Medicare and Medicaid Services (CMS) to renew the CAP/C waiver.
An amended version of Clinical Coverage Policy 1E-7, Family Planning Services, with an effective date of May 1, 2021, will post to the NC Medicaid Clinical Coverage Policy webpage.
Clinical Coverage Policy 1A-41, Office-Based Opioid Treatment is being updated to add buprenorphine for the treatment of patients aged 16 years and older.
Effective with date of service Jan. 28, 2021, the Medicaid and NC Health Choice programs cover remimazolam for injection, for intravenous use (Byfavo™).
Cabotegravir and Rilpivirine Co-Packaged for IM Use (Cabenuva™) HCPCS Code J3490: Billing Guidelines
Effective with date of service Feb. 1, 2021, the Medicaid and NC Health Choice programs cover cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension, co-packaged for intramuscular use (Cabenuva™).
NC Medicaid will extend the pay and report period for providers subject to Electronic Visit Verification (EVV) past the original cutoff date of March 31, 2021. Medicaid will provide 30 days’ notice prior to the conclusion of pay and report.
This Bulletin gives guidance on the use of EVV for the Community Alternatives Programs for Children and Disabled Adults (CAP/C and CAP/DA) to ensure compliance with Section 12006 of the 21st Century Cures Act.