Blog Entry List

Reminder: Medical and Routine Eye Exams and Visual Aids are not Covered Under Telehealth

Guidance for ophthalmologists, optometrists and opticians regarding clinical coverage policies for medical and routine eye exams and visual aids.

NC Medicaid to Cover Imported Benzathine Benzylpenicillin (Extencilline): Billing Guidelines

Effective with date of service Jan. 16, 2024, NC Medicaid covers benzathine benzylpenicillin (Extencilline)

Bicillin® L-A Rates Increased Effective Feb. 1, 2024

This rate increase in the latest Physician Administered Drug Program fee schedule supports treating Medicaid members for Congenital Syphilis.

Clinical Coverage Policy updates for the 1115 Substance Use Disorder Waiver Demonstration

Policies to promulgate on May 1, 2024.

Community Alternative Program (CAP) Personal Care Services (PCS) Rate Update

Fee schedule rate corrected on Feb. 5, 2024.

Updates to Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies

An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of Dec. 1, 2023, is posted.

NC Medicaid Accepting Federally-Facilitated Marketplace Eligibility Determinations

NC Medicaid began accepting Federally-facilitated Marketplace Eligibility Determinations Feb. 1, 2024

NCDHHS Consolidates Local Management Entity/Managed Care Organizations Ahead of Tailored Plan Launch

Eastpointe and Trillium Health Resources have consolidated into one entity, and Sandhills Center has dissolved.

NC Medicaid Guidance on Sunsetting of Traumatic Brain Injury Appendix K Flexibilities

Permanent flexibilities approved in the TBI Waiver amendment effective March 1, 2024.

NC Managed Care Capitation Rates – Updated Care Management Assumptions for Expansion Population

Includes rate considerations for Medicaid Expansion members effective Dec. 1, 2023.

NC Medicaid Guidance on Sunsetting of Innovations Waiver Appendix K Flexibilities

Permanent flexibilities approved in the Innovations Waiver amendment effective March 1, 2024.

NC Medicaid Managed Care Provider Update – Jan. 30, 2024

Includes information on LME/MCO consolidation, Innovations and TBI waivers, federal fee increase, updates to NCTracks, Medicaid expansion and more.

Electronic Visit Verification for NC Medicaid-Funded Personal Care Services and Home Health Services

Manual entries and Sandata Mobile Connect 2.0.

Over-the-Counter COVID-19 Test for Home Use Pharmacy POS Coverage

CorDx, GoToKnow, FaStep COVID-19 AG Home Tests added to coverage.

Quality of Care Fact Sheets Available

Fact sheets provide key findings, trends, improvements and new programs