Topics Related to Medicaid Managed Care

An amended version of Clinical Coverage Policy 5A-3, Nursing Equipment and Supplies with an effective date of March 1, 2025, was posted to the NC Medicaid Clinical Coverage Policy web page.

Summary of Updates

In the table Related Clinical Coverage Policies, added reference to clinical coverage policy 3D, Hospice Services.

The terms ‘approval,’ ‘authorization’ and ‘prior authorization’ were changed to ‘prior approval’ for consistency throughout.

Effective Date: April 1, 2025.

The PREP Act is extended to Dec. 31, 2029, expanding COVID-19 and flu vaccine access at pharmacy Point-of-Sale for ages 3 and older.

Effective Feb. 3, 2025, unless communicated otherwise by the Department

Information on Hurricane Helene Flexibilities, OPR Updates, MFA for All NCTracks Users, and more.

Includes Consolidated Appropriations Act Section 5121 Guidance.

Health plans are required to pay interest to providers if they fail to accurately pay or inappropriately deny a claim.

Providers affected by Hurricane Helene have additional time to submit requests for services

NC Medicaid updates mental health and substance use disorder policies.

NC Medicaid is aware of challenges and concerns from retro-enrollment changes, particularly their impact on claims and recoupments.