Topics Related to Medicaid Direct

Updated: Federally Qualified Health Centers and Rural Health Clinics Reimbursement Methodology Changes Approved

Standard Plans will reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.

Hospital at Home Program Extended Through Sept. 30, 2025

Providers can continue billing Diagnosis Related Group claims using revenue code 0161 for room and board and occurrence span code 82.

NC Medicaid Guidance on Sunsetting of Innovations Waiver Appendix K Flexibilities

Temporary flexibilities to the Innovations Waiver after Hurricane Helene are ending July 1, 2025.

NC Innovations Waiver: Supports Intensity Scale-Adult Version® 2nd Edition

The Centers for Medicare & Medicaid Services (CMS) requires individuals in the NC Medicaid Innovations waiver program to have a valid and comprehensive assessment.

Managed Care Electronic Visit Verification Home Health Implementation Hard Launch Effective Oct. 1, 2025

NC Medicaid’s Electronic Visit Verification (EVV) system for Home Health ensures compliance with federal requirements.

Specialty Care Referrals in NC Medicaid – 2025 Update

Reminder: NC Medicaid does not require Carolina Access/Advanced Medical Home referrals for specialty care.

Carolina ACCESS Enrollment Refresher

Individual provider enrollment and Additional Managed Care Options

Changes to the Clinical Coverage Policy: 1E-7: Family Planning Services

Policy is updated effective May 1, 2025

An Update on the Population Health Approach Guiding NC Medicaid

Public Comments Requested by May 30, 2025.

Updates on Multi-Factor Authentication for Sandata Electronic Visit Verification System Access

NC Medicaid’s Electronic Visit Verification (EVV) vendor, Sandata, will implement multi-factor authentication process for those accessing Sandata EVV and the Aggregator portals.