SPECIAL BULLETIN COVID-19 #270: Clinical Policy Flexibilities Ending on Nov. 11, 2023

This bulletin contains information on flexibilities that are ending six months after the end of the Federal Public Health Emergency on Nov. 11, 2023.

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

  • All COVID-19 Clinical Policy flexibilities which were made permanent.
  • Temporary Appendix K flexibilities that will end six months after the end of the federal PHE (Nov. 11, 2023).

The Centers for Medicare & Medicaid Services (CMS) allows states to apply for Appendix K flexibilities during emergency situations to request amendments to approved 1915(c) Home and Community-Based Services (HCBS) waivers. NC Medicaid has four approved 1915(c) waivers which are the Community Alternatives Program for Children (CAP/C), Community Alternatives Program for Disabled Adults (CAP/DA), Innovations and Traumatic Brain Injury (TBI) waivers. All flexibilities ending on Nov. 11, 2023, are related to flexibilities for these four waivers. Information on the flexibilities which are ending are found in the Behavioral Health Services section and the Community Alternatives Program for Children and Disabled Adults (CAP/C and CAP/DA) section in the full version of this bulletin.

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. The flexibilities are outlined below.

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 the document linked in this bulletin for more information on which flexibilities will be sunsetting Nov. 11, 2023.

As a reminder, many flexibilities associated with the end of the Federal PHE ended on May 11, 2023. These flexibilities were published in COVID-19 Special Bulletin #265.



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