Per Section 4.6 of the North Carolina General Assembly’s recently approved Session Law 2020-4 (House Bill 1043), NC Medicaid is implementing a 5% rate increase for all Fee-For-Service (FFS) Medicaid providers who had not yet received a 5% increase during the COVID-19 public health emergency.
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NC Medicaid has implemented COVID-19 rate increase functionality to reimburse hospice care provided in a skilled nursing facility (SNF) designated as a “SNF COVID-Outbreak site” or “SNF COVID-Response site” in a ratio consistent with how hospice care is reimbursed in all other SNFs.
Medicaid and NC Health Choice providers now have a single source to find answers to questions about COVID-19. The online resource is a collection of Medicaid and behavioral health COVID-19 information, including answers to questions received in the COVID-19 mailbox, during webinars, from COVID-19 Special Medicaid Bulletins and other sources.
Panelists will present a structured PowerPoint presentation focused on Appendix K and Retention Payments for the Innovations Waiver on Thursday, June 11, 2020, at 3 p.m.
Effective with date of service April 15, 2020, the Medicaid and NC Health Choice programs cover trastuzumab-dttb for injection, for intravenous use (Ontruzant®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5112 - Injection, trastuzumab-dttb, biosimilar, (Ontruzant®), 10 mg.
North Carolina is experiencing increased community transmission of COVID-19 in many areas of the state, particularly among our historically marginalized populations, especially our Latinx community. Pre-symptomatic and asymptomatic spread is playing an important role. Updated clinician and laboratory testing guidance and a new resource on community testing in historically marginalized populations are available.
In December 2019, DHHS released the draft Tailored Care Management Provider Manual and application questions for providers interested in becoming Advanced Medical Home Plus practices or Care Management Agencies. The Department received many thoughtful comments on the draft Provider Manual and has made several updates.
Effective July 26, 2020, changes will be made to initial enrollment, re-enrollment, re-verification applications and manage change requests (MCRs) for individual providers (excluding disaster relief and Out of State Lite providers). The updates include the addition of a new page, as well as additional exclusion sanction questions.
NC Medicaid will allow temporary changes to Clinical Coverage Policy 12B for Written Physician Orders, Use of Remote Technology and Signature Requirements.
Beginning June 2020, the Remittance Advice will include a detailed explanation of any refund (Lump Sum / Miscellaneous Payment) issued to the provider. This message will be on the Financial Transactions page.
Program Year 2019 is Closed, NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series and The Security Risk Analysis (SRA).
NC Medicaid is temporarily increasing the number of therapeutic leave days for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs) from 60 days to 120 days. This is a change from the previous increase to 90 days. NC Medicaid continues to waive the requirement of approval needed for more than 15 consecutive days per Clinical Coverage Policy 8E.
Effective July 1, 2020, coverage of therapeutic Continuous Glucose Monitoring products will transition from the Durable Medical Equipment Program to the Outpatient Pharmacy Point of Sale Program.
Congress created a $175 billion Provider Relief Fund to support providers as they deal with COVID-19. Recently, the federal Department of Health and Human Services (HHS) began distribution of the first $50 billion of this fund—through the so-called “General Distribution” mechanism—for providers who billed Medicare in 2019. To help providers understand how to access funding, NC Medicaid has developed the Federal Provider Relief Fund: Guidance on How to Access “General Distribution” Funds.
Effective Sunday, May 31, 2020, NC Medicaid is terminating the auto approval for lung imaging requested through EviCore, NC Medicaid’s contracted vendor for imaging services.