Feb. 11, 2022. This bulletin was updated to extend the following limited waivers to Feb. 28, 2022:
- Post-discharge Peer-to-Peer Discussions for Inpatient Reviews
- Reinstatement of temporary suspension of prior authorization for home health skilled nursing visits and skilled nursing hospital admissions under NC Medicaid Managed Care
- Waiver of Medical Necessity Determination for COVID-19 Admissions
- Prior Authorization Extension for Elective Procedure
See table below for additional information.
Feb. 4, 2022. This bulletin was updated to include information about Swing Beds and change the end date of limited waivers to Feb. 14, 2022.
NC Medicaid continues to strive to support hospitals during the COVID-19 Omicron surge 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 bulletin provides additional flexibilities during the COVID-19 Omicron surge response enacted by NC Medicaid. Please see summary table at the end of the bulletin with current provisions and their expiration dates.
Swing Beds
As a reminder: NC Medicaid implemented a targeted enhanced swing bed reimbursement rate to provide additional financial support to hospitals and to allow flexibility in bed utilization, which remains in effect. Please refer to SPECIAL BULLETIN COVID-19 #115: Targeted Rate Increase and Associated Requirements for Swing Bed Services for details about the rate increase and associated requirements.
Extension of Waiver of Concurrent and Level of Care Reviews for Inpatient Admissions
Effective Jan. 19, 2022, the prepaid health plans (PHPs) and LME/MCOs will temporarily waive initial concurrent and level of care reviews for non-elective, medically necessary inpatient admissions. This limited waiver will now be allowed through Feb. 14, 2022 and will be reconsidered weekly by NC Medicaid. Please see SPECIAL BULLETIN COVID-19 #215 for additional details.
Delayed Notifications for Admitted Patients
As a reminder, the PHPs and LME/MCOs 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. This limited waiver will initially be allowed through Feb. 14, 2022, and will be reconsidered weekly by NC Medicaid.
Review of Technical Denials for Inpatient Stays
Through the duration of the waiver for concurrent and level of care reviews for inpatient admissions, the PHPs have agreed to allow technical denials for inpatient stays during the waiver period to be reversed on appeal based on satisfying medical necessity criteria. This limited waiver will initially be allowed through Feb. 14, 2022, and will be reconsidered weekly by NC Medicaid.
Post-discharge Peer-to-Peer Discussions for Inpatient Reviews
Effective Jan. 19, 2022, PHPs and LME/MCOs will temporarily allow peer-to-peer discussions for inpatient stays to happen after discharge. This limited waiver will initially be allowed through Feb. 28, 2022, and will be reconsidered weekly by NC Medicaid.
Table Effective Feb. 11, 2022
Omicron Surge Response Lever |
COVID -19 Bulletin |
Effective Date |
Expiration Date |
Review of Technical Denials for Inpatient Stays |
See above |
1/19/2022 |
2/14/2022 |
Post-discharge Peer-to-Peer Discussions for Inpatient Reviews |
See above |
1/19/2022 |
2/28/2022 |
Waiver of Concurrent and Level of Care Reviews |
1/19/2022 |
2/14/2022 |
|
Reinstatement of temporary suspension of prior authorization for home health skilled nursing visits and skilled nursing hospital admissions under NC Medicaid Managed Care |
1/10/2022 |
2/28/2022 |
|
Reinstatement of temporary suspension of prior authorization for inpatient rehabilitation, long-term care hospital under NC Medicaid Managed Care |
1/10/2022 |
2/14/2022 |
|
Delayed Notifications for Admitted Patients |
Bulletin #215 |
1/14/2022 |
2/14/2022 |
Waiver of Medical Necessity Determination for COVID-19 Admissions |
1/14/2022 |
2/28/2022 |
|
Prior Authorization Extension for Elective Procedures |
1/14/2022 |
2/28/2022 |
|
Remdesivir Ambulatory Infusion |
1/10/2022 |
N/A |
CONTACT
NCTracks Contact Center: 800-688-6696