Blog Entry List

On March 10, 2020, Governor Roy Cooper issued an executive order declaring a State of Emergency for North Carolina to respond to COVID-19. In addition, the Department of Health and Human Services made several recommendations to slow the spread of COVID-19 and reduce the number of people infected.

Effective March 30, 2020 NC Medicaid is temporarily modifying the Home Infusion Therapy Clinical Coverage Policy No.: 3H-1 to better enable the delivery of remote care to Medicaid members. These temporary changes will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded. This expansion of home infusion therapy serves to allow beneficiaries to receive services in the home rather than in a dedication infusion center to reduce potential exposure to COVID-19.

PACE organizations are responsible for providing all required Medicare and Medicaid covered services to its PACE participants. This responsibility also extends to the participants’ home setting. Due to the COVID-19 pandemic, NC Medicaid recognizes that PACE organizations will need to adjust business operations and the methods utilized to address the needs of PACE participants.

NOTE: SPECIAL BULLETIN COVID-19 #28 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications - Definitions, Eligible Providers, Services and Codes.

NOTE: SPECIAL BULLETIN COVID-19 #20 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #35: Telehealth Clinical Policy Modifications - Enhanced Behavioral Services

NOTE: SPECIAL BULLETIN COVID-19 #21 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #36: Telehealth Clinical Policy Modifications - Outpatient Specialized Therapies and Dental Services

NOTE: SPECIAL BULLETIN COVID-19 #22 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #143: CAP/C and CAP/DA Home- and Community-Based Services Flexibilities Update for Beneficiaries Enrolled in 1915(c) Waivers

The Centers for Medicare & Medicaid Services (CMS) have approved Appendix K flexibilities mentioned below. - April 9, 2020

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries may access and receive Medicaid services in the wake of COVID-19. Prior approval and service utilization limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19, including individuals participating in the Community Alternatives Program (CAP) waivers.

NOTE: The Centers for Medicare & Medicaid Services (CMS) have approved Appendix K flexibilities mentioned below. - April 9, 2020

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries may access and receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver. NC Medicaid has created an emergency planning document called Appendix K to seek approval to modify the scope, frequency, amount and setting of how waiver services are used and approved.

Select provider types enrolled in the North Carolina Medicaid Program are required to file annual Medicaid cost reports utilizing cost reporting schedules which are based on approved Medicare cost reporting platforms.

Effective March 25, 2020, due to drug shortages in the marketplace, the NC Medicaid and NC Health Choice PDL Category of “Respiratory: Beta-Adrenergic Handheld, Short Acting” has changed.

To offset potential hardships due to COVID-19, for NC Medicaid and Health Choice providers who were due to re-verify their enrollment between the dates of March 1, 2020 and June 30, 2020, NCTracks has reset your re-verification due date to Sept. 13, 2020. 

Effective March 27, 2020, North Carolina Medicaid is requiring prior approval for hydroxychloroquine and chloroquine containing products. Prior approval is required to ensure beneficiaries continue to have access to these medications for maintenance of their autoimmune conditions, for treatment of malaria, and for treatment of extraintestinal amebiasis.  

This Bulletin provides information to local Departments of Social Services (DSS) and NEMT providers on NC Medicaid’s requirements for NEMT services, the recommended safety procedures and protocols to help reduce the spread of COVID-19 and guidance. 

Effective March 23, 2020, if medically necessary, the following additional respiratory equipment and supplies that typically require prior authorization (PA) may be provided to beneficiaries without first seeking PA: