The Medicaid State Plan Amendment was approved by the Centers for Medicare & Medicaid Services with an effective date of Oct. 1, 2019. The clinical coverage policy was posted on Oct. 10, 2019 for an additional 15-day public comment period. Following the 15-day public comment period, the final Community Support Team policy will be posted with an effective date of Nov. 1, 2019.
Blog Entry List
A new or amended clinical coverage policy regarding facility-based crisis management for children and adolescents is available on NC Medicaid’s website.
NC Medicaid has updated its ICD-10 diagnosis code list. Diagnosis code K35.891 (other acute appendicitis without perforation, with gangrene) has been added as an acceptable ICD-10 diagnosis code effective Oct. 1, 2018.
Unpaid medical bills and current medical expenses count toward NC Medicaid applicants’ deductibles. Private Duty Nursing (PDN) services qualify as a medical expense and may be used toward meeting this deductible.
As NC Medicaid's managed care launch date approaches, Advanced Medical Home (AMH) providers who believe they are not ready to meet program requirements to perform at the tier level to which they attested may now submit a request to change their AMH Tier status from Tier 3 to Tier 2. The AMH Tier 3 providers may not downgrade lower than AMH Tier 2.
Per Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies on the NC Medicaid website, HCPCS code A4252 (blood ketone test or reagent strip, each) has a quantity limitation of 100 test strips per month. Considering the national description of A4252 refers to each test strip, DME providers are reminded to submit their claims with the number of test strips supplied to the beneficiary, not the number of boxes of test strips.
The North Carolina Department of Health and Human Services (DHHS) has expanded the regions awarded to Carolina Complete Health, Inc. (CCH) to serve as a health plan under the state’s transition to Medicaid Managed Care. In addition to serving regions 3 and 5 in the state, the provider-led health plan will also serve region 4.
The clinical criteria used by NC Medicaid for the 2019-2020 Respiratory Syncytial Virus (RSV) season are consistent with guidance published by the American Academy of Pediatrics (AAP): 2018 – 2021 Report of the Committee on Infectious Diseases, 31st Edition. This guidance for Synagis use among infants and children at increased risk of hospitalization for RSV infection is available online by subscription. The coverage season is Nov. 1, 2019, through March 31, 2020. Providers are encouraged to review the AAP guidance prior to the start of the RSV season.
Several new or amended clinical coverage policies are available on NC Medicaid’s website.
The Community Alternatives Program for Disabled Adults (CAP/DA) §1915(c) Home and Community-Based Services (HCBS) waiver application has been renewed by the Centers for Medicare and Medicaid Services (CMS), effective Nov. 1, 2019 through Oct. 31, 2024.
Providers were notified in the August Medicaid bulletin that as of May 1, 2019, the sterilization consent form was updated with an expiration date of April 30, 2022. The sterilization consent form found on the U.S. Department of Health & Human Services (HHS) website has been updated. Providers should now be using this version when submitting the sterilization consent form to the NC Medicaid fiscal agent.
The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations. All eligible professionals (EPs) attesting in Program Year 2019 will be required to attest to Stage 3 MU and use a 2015 Edition of certified EHR technology (CEHRT).
The 2020 ICD-10 update will be in place effective Oct. 1, 2019 through Sept. 30, 2020, for provider use. Providers can access the list of ICD-10 codes on the Centers for Medicare and Medicaid Services (CMS) website.
Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab-anns for injection, for intravenous use (Kanjinti™) for use in the Physician Administered Drug Program (PADP) when billed with Healthcare Common Procedure Coding System (HCPCS) code J9999 - not otherwise classified, antineoplastic drugs.
Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover bevacizumab-awwb injection, for intravenous use (Mvasi™) for adult use in the Physician Administered Drug Program when billed with HCPCS code Q5107 - Injection, bevacizumab, (Mvasi™), 10 mg.