Topics Related to Medicaid Managed Care

2023 Medicaid Provider Experience Survey Report Released

Describes findings from the third assessment of provider experience and satisfaction with the NC Medicaid program.

OTC COVID-19 Test for Home Use Pharmacy POS Coverage

Two FASTEP COVID 19 AG HOME TEST NDCs added to coverage.

NC Medicaid Temporary Flexibilities Due to Tropical Storm Debby

Flexibilities effective Aug. 6, 2024, for NC Medicaid beneficiaries due to Tropical Storm Debby.

NC Medicaid to Remove Copays for Drugs used to treat Opioid Use Disorder and Nicotine Replacement Therapy

Changes are effective Aug. 1, 2024

Guidance for Beneficiaries Enrolled in Medicaid and Other Coverage

This bulletin provides guidance to providers caring for NC Medicaid beneficiaries also enrolled in Marketplace coverage through HealthCare.gov.

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

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

New Prior Authorizations Required for Substance Use Disorder Prescriptions

Providers need to submit new prior authorizations (PA) for services subject to 42 Code of Federal Regulations (CFR) Part II.

NC Medicaid to Add Coverage for Obesity Management Medications

Effective Aug. 1, 2024, NC Medicaid will cover obesity management medications for beneficiaries 12 years of age and older.

Opill to be Covered Without a Prescription

Effective Aug. 1, 2024, over the counter oral contraceptive Opill will be available without a prescription, at no cost.

Updates to Clinical Coverage Policy 10A: Outpatient Specialized Therapies

Effective Dec. 1, 2023, updates increased treatment visit limits for beneficiaries aged 21 and older. The home health ordering practitioner reference was also updated.