SPECIAL BULLETIN COVID-19 #234: UPDATE to Permanent Changes Made for PHE Flexibilities and Plan for Sunsetting of Temporary Policies Certain COVID-19 Flexibilities implemented by NC Medicaid under State Authority will be end-dated as of March 31, 2022
March 21, 2022. This Bulletin has been REPLACED by SPECIAL BULLETIN #237: Extension of NC State of Emergency Temporary Flexibilities
March 2, 2022. This Bulletin replaces SPECIAL BULLETIN #226
Based on the NC State of Emergency established through Executive Order (EO) 116, NC Medicaid implemented temporary changes to clinical policy to support providers and beneficiaries during the COVID-19 State of Emergency. Policy changes were announced by bulletin which indicated that certain flexibilities would end at the earlier of the cancellation of the North Carolina State of Emergency or when the policy modification was rescinded by NC Medicaid.
NC Medicaid has evaluated data from the use of COVID-19 public health emergency (PHE) flexibilities implemented during the state’s pandemic response as well as considered stakeholder feedback over the past two years of these flexibilities. Based on this review, many of the policy flexibilities implemented during the NC State of Emergency and federal PHE have been made into permanent NC Medicaid Clinical Coverage. NC Medicaid added these flexibilities because they have been shown to be beneficial for both providers and members and additionally, they improve the access and/or quality of care provided to NC Medicaid beneficiaries.
NC Medicaid is choosing not to add certain temporary flexibilities into permanent policy based on several factors including:
- The flexibility was not used by the field broadly (or NC Medicaid did not have evidence that a given flexibility was used by the field).
- NC Medicaid does not have the authority to keep the flexibility outside of the COVID-19 PHE.
- The flexibility was evaluated through feedback from a multidisciplinary stakeholder group, and it was determined that certain flexibilities did not strengthen and/or add to the NC Medicaid program from a quality, cost and/or safety perspective.
As a reminder, for services provided to Medicaid beneficiaries under 21 years of age, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) provisions apply. EPSDT is a federal Medicaid requirement that requires the state Medicaid agency to cover services, products, or procedures for Medicaid beneficiary under 21 years of age if the service is medically necessary health care to correct or ameliorate a defect, physical or mental illness, or a condition (health problem) identified through a screening examination (includes any evaluation by a physician or other licensed practitioner).
Note: The policy changes listed within this bulletin will apply to Medicaid Direct and Medicaid Managed Care. The Standard Plans and LME/MCOs may be no more restrictive in amount, scope and duration than the permanent policies, unless required by NC Medicaid’s contract with the Standard Plans and LME/MCOs.
NC Medicaid continues to be committed to providing as much advance notice as possible to the provider community as temporary COVID-19 flexibilities end. While the NC State of Emergency has not been rescinded, NC Medicaid has decided to rescind some of the temporary COVID-19 flexibilities, effective April 1, 2022. Please see the details in the remaining pages of this bulletin for more information on which flexibilities will be sunsetting as of March 31, 2022.
Many Clinical Policy provisions were enacted to support the COVID-19 response and do not require new federal authorities. These changes are in the process of becoming permanent policy and NC Medicaid is seeking federal authority where appropriate. For permanent policy changes to the Medicaid program, NC Medicaid will post changes publicly. All stakeholders are encouraged to provide feedback. Temporary flexibilities tied directly to the federal public health emergency remain in effect until the termination.
At the time of this bulletin, the federal PHE is still in effect. Please refer to the federal Public Health Emergency website for more information and updates.
To support providers and the NC Medicaid community, the NC Medicaid team has pulled together a comprehensive list of all the clinical policy flexibilities. You can find information about:
- Flexibilities that have been or are being incorporated into permanent policy.
- Temporary Flexibilities that will end on April 1, 2022 (i.e., sunsetting on March 31, 2022).
- Temporary Flexibilities that will end at the end of the federal PHE.
Please find detailed information in the PDF document below for your reference.