Oct. 10, 2022. This bulletin was updated to add information on telephone assessment and management codes billed by a qualified non-physician health care professional to an established patient. This flexibility was not made into permanent policy and will end with the Federal PHE.
May 26, 2022. This bulletin was updated to add and correct information on Behavioral Health, Community Alternatives Program, Hospice and Pharmacy flexibilities.
April 6, 2022. This bulletin was updated to include Behavioral Health services.
This Bulletin REPLACES SPECIAL BULLETIN COVID-19 #234
The policy changes listed within this bulletin will apply to NC Medicaid Direct and NC Medicaid Managed Care.
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 June 30, 2022
- temporary Flexibilities that will end at the end of the federal PHE (date TBD).
Please find detailed information in the full PDF version of this bulletin (linked at the end below) for your reference.
Based on the North Carolina 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would end at the earlier of the cancellation of the NC State of Emergency or when the policy modification was rescinded by NC Medicaid.
NC Medicaid has evaluated data from the use of federal COVID-19 public health emergency (PHE) flexibilities and stakeholder feedback on the State’s pandemic response. 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.
The original sunset date for certain temporary COVID-19 flexibilities was planned for March 31, 2022 (see SPECIAL BULLETIN COVID-19 #226 and SPECIAL BULLETIN COVID-19 #234). This date was established to provide the field adequate notice to adapt to those changes as well as try to anticipate when authorities related to the state of emergency would change.
Since the announcement of that decision, NC Medicaid has continued to monitor a variety of factors:
- The projected/pending end dates for the PHE and the NC State of Emergency
- Beneficiary and provider impact as a result of the sunsetting of some flexibilities
- The time needed by providers to adjust to the rescinding of the policy given the unprecedented nationwide workforce shortages which impact providers’ ability to deliver care
Due to uncertainty of the end of the NC State of Emergency, NC Medicaid will extend the temporary COVID-19 flexibilities previously set to sunset on March 31, 2022, an additional 90 days to sunset June 30, 2022.
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 beneficiaries 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).
NC Medicaid continues to be committed to providing as much advance notice as possible to the provider community as temporary COVID-19 flexibilities end. Please see the details in the document linked in this bulletin for more information on which flexibilities will be sunsetting as of June 30, 2022.
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.