Effective April 30, 2020, NC Medicaid in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability (I/DD) Clinical Coverage Policies to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic.
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NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and Health Choice beneficiaries.
Update (May 8, 2020)
- Bulletin #78 includes information that Local Health Department (LHDs), Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes and Rural Health Clinics (RHCs) may use, as out
NC Medicaid is temporarily adding Telemedicine and Telepsychiatry clinical coverage codes for specialty providers and increasing reimbursement rates for telephonic visits and primary care medical home per member per month fees to help primary and specialty care providers continue to serve patients during the COVID-19 emergency.
NOTE: SPECIAL BULLETIN COVID-19 #79 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #103. This Bulletin clarifies that skilled nursing facilities (SNF) are eligible originating sites for telemedicine visits and enables such facilities to bill for a facility fee when a beneficiary located in a SNF receives care via telemedicine from an eligible remote provider.
Effective April 27, 2020, prescriptions for NC Medicaid and NC Health Choice beneficiaries are eligible for the addition of a mailing or delivery fee via the guidelines below. NC Medicaid encourages beneficiaries to request, and pharmacy providers to mail or deliver prescriptions to beneficiaries, during the COVID-19 pandemic to achieve better social distancing within their community.
NC Medicaid temporarily suspended the requirement of Level I and Level II Preadmission Screening and Resident Reviews (PASRRs) for new nursing home admissions as well as the requirement of a PASRR number on the prior approval (PA). The temporary suspension was due to COVID-19 and was in effect from March 25 – April 24, 2020, as noted in SPECIAL BULLETIN COVID-19 #15: Medicaid and NC Health Choice Temporary Flexibilities - 1135 Waiver Provisions.
NC Medicaid has adjusted home health requirements currently in Home Health Clinical Coverage Policy No: 3A to align with a CMS regulatory change focused mostly on changes to the Medicare policy addressing COVID-19.
Effective May 1, 2020, Liberty Healthcare of North Carolina will resume completion of annual assessments. SPECIAL BULLETIN COVID-19 #30: Personal Care Services Assessments also indicated that annual assessments due would have Prior Approvals extended for a minimum of 90 days.
NC Medicaid is temporarily increasing financial assistance to Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to support them in maintaining critical access to care for Medicaid beneficiaries during the COVID-19 emergency.
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.
NOTE: This bulletin has been replace in its entirety by SPECIAL BULLETIN COVID-19 #82.
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: Temporary Flexibilities Effective March 23, 2020 (posted March 24, 2020); and SPECIAL BULLETIN COVID-19 #11: Outpatient Specialized Therapies Temporary Flexibilities (posted March 24, 2020).