Author: NCTracks, 1-800-688-6696
North Carolina Governor Cooper issued Executive Order 51 on Sept. 7, 2018, which declared a state of emergency for North Carolina in anticipation of potential severe weather caused by the approach of Hurricane Florence. As of the date of this Medicaid Bulletin, the state of emergency remains in place.
NC Medicaid is committed to North Carolina's response to and recovery from the destruction caused by Hurricane Florence. We are working with county and federal partners, receiving authority from the Centers for Medicare & Medicaid Services where appropriate, to make it faster and easier for beneficiaries to receive—and for health care professionals to provide—Medicaid and NC Health Choice care and services. Flexibilities temporarily added to several key polices and procedures are described below. For current Hurricane Florence information and resources, visit https://medicaid.ncdhhs.gov/nc-medicaid-hurricane-florence-response-recovery.
Unless otherwise noted, these exceptions are in effect for dates of service from Sept. 14 through Sept. 28, 2018. NC Medicaid will continue to evaluate the need to extend the exceptions and will publish any changes.
Reimbursement for Medically Necessary Services during Hurricane Florence
North Carolina Medicaid and NC Health Choice will reimburse providers for medically necessary drugs and services, and equipment and supplies, provided during Hurricane Florence declared state of emergency without prior approval (PA) from Sept. 14 through Sept. 28, 2018. Medical documentation must support medical necessity.
In addition, beneficiaries who have been evacuated out-of-state (OOS), voluntarily or involuntarily, can receive medical care if needed and Medicaid and NC Health Choice will reimburse the OOS provider without prior approval. OOS providers must enroll as North Carolina Medicaid providers in an abbreviated, expedited process (OOS Lite) here.
Providers are encouraged to obtain a prior approval if it is possible to do so (and normally required for the service). All claims are subject to audit.
Expediting Nursing Home Admissions for Individuals Displaced due to Hurricane Florence
Providers should upload the signed Physician Signature form with their portal submissions to NCTracks. NCTracks is designed to receive long term care PA information in the FL2 format. NC Medicaid has temporarily suspended the requirement of a Pre-Admission Screening and Annual Resident Review (PASSR) number on the PA. Providers should add numbers 8888 in the PASRR number field and add a note on their portal submissions stating that the PASRR is unavailable due to Hurricane Florence emergency placement. In addition, providers should add all the pertinent information about the recipient’s levels of care needs in their portal submission.
NC Medicaid Special Bulletin Sept. 21, 2018: Replaces Medicaid Bulletin Issued Sept. 13, 2018
Additionally, the Medicare requirement of a 3-day qualifying hospital stay is waived for NC Medicaid beneficiaries who require a short-term stay in a nursing facility due to care needs or shelter needs related to Hurricane Florence from Sept. 12 through Sept. 28, 2018.
Critical Access Hospital (CAH) Bed Limit Lifted During Hurricane Florence
As outlined in 42 CFR 485.620(a), Condition of Participation: Number of Beds and Length of Stay, "Except as permitted for CAH having distinct part units under 42 CFR 485.647, the CAH maintains no more than 25 inpatient beds. Inpatient bed may be used for either inpatient or swing-bed services."
From Sept. 14 through Sept. 28, 2018, Medicaid is lifting the limit of 25 beds to accommodate the needs of beneficiaries and providers due to Hurricane Florence.
Pharmacy Emergency Preparedness Information
North Carolina Medicaid and Health Choice beneficiaries in impacted areas may require an early refill of their medications or medications that require prior authorization. CMS has granted waiver authority for North Carolina Medicaid to allow for the following:
- Early refill of all covered medications from Sept. 11 through Sept. 28, 2018.
- Waive prior authorization requirements for all covered medications from Sept. 14 through Sept. 28, 2018.
- Waive prior authorization requirements for medically necessary medical equipment and supplies from Sept. 14 through Sept. 28, 2018.
NCTracks Call Center, 1-800-688-6696
Pharmacy providers: NCTracks Pharmacy Call Center, 1-866-246-8505