This bulletin replaces in full the December 2025 Utilization Management by Managed Care Plans Aligned with Food and Drug Administration Labeling bulletin.
Topics Related to Medicaid Managed Care
NC Medicaid, in collaboration with the four NC Medicaid Managed Care Standard Plans, will host the Sixth Annual Virtual Statewide Quality Forum on Wednesday, Oct. 14, 2026, from 11 a.m. to 1 p.m.
Amendments to Clinical Coverage Policy 1A-20, expanding medical necessity criteria and updating coverage for sleep studies and polysomnography services are effective July 1, 2026.
Care Management rate considerations effective July 1, 2026.
Impacted NC Medicaid providers will be included in the Active Provider Reverification Report, and notifications with specific deadlines are expected by the end of September 2026.
The deadlines stated in this bulletin replace those previously published in the Post-Enrollment National Accreditation Update bulletin April 16, 2026.
Adverse determination letters generated through NCTracks have been updated to reflect these changes.
Beginning Jan. 1, 2027, all current maternity service codes, including global billing, will be deleted from the fee schedule.
Effective July 1, 2026, NC Medicaid has amended Clinical Coverage Policy 10A, Outpatient Specialized Therapy Services.
On Dec. 31, 2026, the NC Integrated Care for Kids (InCK) pilot program will conclude. This applies to NC Medicaid Direct and NC Medicaid Managed Care.