June 21, 2022. This bulletin was updated to remove following sentence: "Currently the SOE is scheduled to end July 14, 2022."
As communicated previously in SPECIAL BULLETIN COVID-19 #237: Extension of NC State of Emergency Temporary Flexibilities, multiple COVID-related flexibilities are set to sunset on June 30, 2022.
To support providers and the NC Medicaid community, the NC Medicaid team compiled a comprehensive list of all the clinical policy flexibilities developed in response to COVID-19. Information on these can be found in SPECIAL BULLETIN COVID-19 #237 and includes:
- 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 public health emergency (PHE) (date TBD).
The flexibilities detailed in SPECIAL BULLETIN COVID-19 #237 have not changed.
Note: The policy changes listed within this bulletin will apply to NC 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 or LME/MCOs.
Based on the North Carolina State of Emergency (SOE) established through Executive Order (EO) 116, NC Medicaid (including NC Medicaid Direct and NC Medicaid Managed Care) implemented temporary changes to clinical policy to support providers and beneficiaries during the COVID-19 SOE. Policy changes were announced by bulletin and indicated that certain flexibilities would end at the earlier of the cancellation of the SOE or when the policy modification was rescinded by NC Medicaid.
Many of the policy flexibilities implemented during the NC SOE and federal PHE have been made into permanent NC Medicaid clinical coverage as shown in the linked document.
As a reminder, for services provided to Medicaid beneficiaries (not NC Health Choice) 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 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). It is possible that providers could request one of the temporary flexibilities based on the need of the beneficiary under EPSDT.
Additionally, NC Medicaid continues to study and evaluate many flexibilities utilized in the PHE. If you would like to submit a Clinical Coverage Request for an item to be considered for permanent coverage, please use the Provider/Stakeholder Request for Coverage Form and follow that process. Submitting a request will result in future consideration for permanent policy coverage and will not impact the June 30 end date.
Federal PHE
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.