Blog Entry List
Effective with date of service Feb. 24, 2020, the Medicaid and NC Health Choice programs cover cefiderocol for injection, for intravenous use (Fetroja®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Feb. 19, 2020, the Medicaid and NC Health Choice programs cover cetirizine hydrochloride injection, for intravenous use (Quzyttir™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Feb. 15, 2020, the Medicaid and NC Health Choice programs cover trastuzumab-qyyp for injection, for intravenous use (Trazimera™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5116 - Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg.
Strength/Package Size: For Injection: 420 mg lyophilized powder in a multiple-dose vial for reconstitution
Indicated for:
NOTE: This bulletin has been replace in its entirety by SPECIAL BULLETIN COVID-19 #82.
NC Medicaid is directing increased financial assistance to North Carolina Skilled Nursing Facilities (SNF) and Adult Care Homes (ACH) to support addressing the increased costs of caring for COVID positive (COVID+) residents in a congregate care setting. This targeted assistance, which is retroactive to April 1, 2020, addresses:
This Bulletin clarifies which specific Prior Authorizations were lifted on the March 1, 2020, effective date stated in SPECIAL BULLETIN COVID-19 #15: Medicaid and NC Health Choice Temporary Flexibilities - 1135 Waiver Provisions (posted March 24, 2020), including references all relevant Prior Authorization information included in other Bulletins; replaces the effective dates originally stated in the following Bulletins: SPECIAL BULLETIN COVID-19 #2: General Guidance and Policy Modifications (posted March 13, 2020); SPECIAL BULLETIN COVID-19 #10: Durable Medical Equipment:
NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries may access and receive Medicaid services in the wake of COVID-19. Retainer payments may be made for direct care providers of services that include habilitation or personal care that are currently authorized in the Individual Support Plan (ISP).
NC Medicaid has temporarily enabled licensed clinical social workers at Local Health Departments to conduct Health and Behavior Intervention visits for pregnant and postpartum women who have serious psychosocial needs via telemedicine. Local health departments can bill for a variety of other medical and behavioral services provided by an MD, NP, PA, CNM, or appropriate Behavioral Health personnel when delivered via telehealth or virtual patient communications, as outlined in various NC Medicaid Special Bulletins (#34, 35, 36, 43, 48 and 49) regarding Telehealth Clinical Policy Modifications
NC Medicaid has temporarily enabled providers to conduct postpartum depression screenings of postpartum women via several remote modalities in light of social distancing measures that may prevent in-person visits.
NC Medicaid is temporarily adding telemedicine coverage for providers to conduct Well Child Visits with patients to ensure the provision of comprehensive and preventive health care services for children under age 21. Providers are encouraged to continue providing well child visits, immunizations and or preventive care during the pandemic.
NC Medicaid has eliminated the restriction that teletherapy services cannot be conducted via “video cell phone interactions.” These services can now be delivered via any HIPAA-compliant, secure technology with audio and video capabilities, including (but not limited to) smart phones, tablets and computers.
Effective April 20, 2020, NC Medicaid is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability Clinical Coverage Policy 8C: Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic. This guidance on allowing telephonic outpatient psychotherapy is in addition to the telehealth flexibilities previously added.
Effective April 16, 2020, any Assertive Community Treatment (ACT) team or Individual Placement and Support (IPS) team that met fidelity prior to the State of Emergency related to COVID-19 will continue to meet Medicaid and State-funded services policy requirements through the end of the declared State of Emergency.
Considering the challenges providers are facing with COVID-19 pandemic, Medicaid is extending the due date for March 31, 2020, credit balance reports by 90 days. The extension will allow providers to submit their March 31 and June 30, 2020, credit balance reports. All credit balance reports for March 31 and June 30, 2020, quarter ends will be due July 30, 2020.
NCDHHS is directing providers to stop collecting copayments from Medicaid and NC Health Choice beneficiaries on all COVID-19 related testing, services and treatments. This change is effective retroactive to Jan. 1, 2020 through the end of the calendar quarter of the federally declared public health emergency period. Suspension of beneficiary cost sharing for COVID-19 related testing and treatment services is required of states taking advantage of additional federal Medicaid funding available through the federal Families First Coronavirus Response Act, which became law on March 18, 2020.
SPECIAL BULLETIN COVID-19 #56: Key Federal Funding Available for Health Care Providers and Hospitals
Congress has enacted three significant stimulus packages to help the country weather the COVID-19 pandemic, which establish a variety of funding sources to support providers, each with distinct features including which provider types are eligible, if providers must apply to be considered and if the financial benefit is a grant or a loan that must be repaid. NC Medicaid has created a summary of financial relief available by provider type.