SPECIAL BULLETIN COVID-19 #265: Ending Clinical Policy Flexibilities Associated with the Federal Public Health Emergency

Flexibilities ending at or after the end of the Federal Public Health Emergency

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 is providing a list of all the clinical policy flexibilities related to the Federal Public Health Emergency (PHE), including:

  • Flexibilities that have been or are being incorporated into permanent policy
  • Temporary Disaster SPA flexibilities that will end at the end of the federal PHE (May 11, 2023)
  • Temporary Appendix K flexibilities that will end six months after the end of the federal PHE (Nov. 11, 2023)

NC Medicaid has evaluated data from the use of federal COVID-19 public health emergency flexibilities and stakeholder feedback on the State’s pandemic response. Based on this review, many of the policy flexibilities implemented during federal PHE have been or will be incorporated into permanent NC Medicaid Clinical Coverage Policy. These flexibilities have been shown to be beneficial for both providers and members, improving the access and/or quality of care provided to NC Medicaid beneficiaries.

NC Medicaid continues to be committed to providing as much advance notice as possible to the provider community as temporary COVID-19 flexibilities end. NC Medicaid continues to monitor a variety of factors, including:

  • Beneficiary and provider impact of sunsetting some flexibilities
  • 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

Please see the details in Ending Clinical Policy Flexibilities Associated with the Federal Public Health Emergency for more information on which flexibilities will be sunsetting. 

As a reminder, many flexibilities associated with the end of the North Carolina State of Emergency ended on June 30, 2022. These flexibilities were published in COVID-19 Special Bulletin #237. The flexibilities which ended on June 30, 2022, are also included in each section for providers to reference.



NC Medicaid updated flexibilities related to:

  • Permanent Telehealth Services Flexibilities   
  • Behavioral Health Services  
  • Children’s Development Services Agencies  
  • Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA)   
  • Dental Services   
  • Durable Medical Equipment   
  • End Stage Renal Disease (ESRD) Services  
  • Family Planning   
  • Home Health  
  • Home Infusion Therapy (HIT)  
  • Hospice   
  • NC Medicaid Optional Eligibility Group (Includes MAFDN Family Planning Medicaid and Uninsured MCV Beneficiaries)    
  • Nursing Facility    
  • Obstetrical Services    
  • Outpatient Specialized Therapies    
  • Pharmacy    
  • Pregnancy Management Program (formerly Pregnancy Medical Home)    
  • Private Duty Nursing    
  • Program of All-Inclusive Care for the Elderly (PACE)    
  • Remote Physiologic Monitoring Treatment Management Services   
  • Smoking and Tobacco Cessation Counseling  
  • Well Child Visits    

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