SPECIAL BULLETIN COVID-19 #215: NC Medicaid COVID-19 Omicron Surge Flexibilities Additional information to what was published in COVID-19 #210

This bulletin was updated on Jan. 19, 2022 to include information about a waiver of concurrent and level of care reviews for inpatient admissions. 

This bulletin provides additional information regarding SPECIAL BULLETIN COVID-19 #210, which outlines many COVID-19 surge response flexibilities enacted by NC Medicaid. An update on over-the-counter tests for home use is included in SPECIAL BULLETIN COVID-19 #219, posted on Jan. 21, 2022. 

 Additional flexibilities granted during the COVID-19 surge will include the following:

• Extension of Prior Authorization for Elective Procedures

  Due to facilities cancelling or postponing elective procedures due to the surge of COVID-19 Omicron variant hospitalizations and staffing burdens, expiration for prior authorization for elective procedures will be extended to 90 days from the original approval expiration date. This will remain in effect until further notice. Providers should continue to verify eligibility prior to service delivery.
   

• Waiver of Medical Necessity Determination for COVID-19 Admissions

  To relieve the administrative burden on inpatient facilities, for admissions with a primary diagnosis of COVID-19, medical necessity reviews may not be utilized for the purpose of rendering adverse determination at the time of admission. Facilities still must provide notification within 24 hours of admission and medical necessity reviews will ensue when continued stay is required. This will remain in effect until Feb. 14, 2022.
   

• Waiver of Concurrent and Level of Care Reviews for Inpatient Admissions

  Effective Jan. 19, 2022, the prepaid health plans (PHPs) have agreed to temporarily waive initial concurrent and level of care reviews for non-elective, medically necessary inpatient admissions. This is an effort to allow hospitals to optimize capacity and avoid the need to shut down beds due to inadequate clinical staffing, and to redeploy resources within their institutions during the most recent COVID-19 surge. This limited waiver will initially be allowed through Jan. 28, 2022, and will be reconsidered weekly by NC Medicaid. The PHPs will continue to require the hospitals to notify them of any admitted patients within five calendar days of the admission so they can assist in discharge planning and care management.

Contact

NCTracks Contact Center: 800-688-6696