Medicaid Bulletin

The following updates are in effect for the Orthotics & Prosthetics (O&P) policy to comply with the Centers for Medicare and Medicaid Services (CMS) Attending, Rendering, Ordering, Prescribing or Referring Providers Federal Regulation, 42 CFR, Part 455.410, and to clarify compliance with the CMS Home Health Final Rule, 42 CFR, Part 440.70.

Effective with the date of service of April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-3, Intravenous Iron Therapy, within the Physician Drug Program.

Effective with the date of service of April 30, 2018, the North Carolina Medicaid and N.C. Health Choice programs will be terminating Clinical Policy 1B-3, Intravenous Iron Therapy, within the Physician Drug Program.

By Feb. 28, 2018, non-accredited nursing service providers previously providing services under the Community Alternatives Program for Children (CAP-C) waiver must obtain accreditation and meet all required occupational licensing entity regulations.

Effective with the date of service of April 30, 2018, the North Carolina Medicaid and Health Choice programs will be terminating Clinical Policy 1B-3, Intravenous Iron Therapy, within the Physician Drug Program.

This email is an update to yesterday’s email and previous North Carolina Medicaid Bulletins. In response to provider feedback, the use of the NPI Exemption List for residents and interns enrolled in graduate dental and medical programs, and area health education centers will be extended from January 31, 2018 to April 30, 2018.

The Freestanding Birth Center fee for CPT Code 59409 has been updated to $1,510.97 effective Jan. 1, 2018.

With each prior approval (PA) entry beginning with the third and subsequent benefit periods, providers must fax a copy of the Approval Status Inquiry Form, or the NCTracks Web Submitted Request for Hospice Prior Approval Confirmation Page, to DMA at 919-715-9025. DMA requests that providers include their name and e-mail address on the above forms.

The provision of family planning services and family planning-related services has been the sole purpose of the “Be Smart” Family Planning Medicaid program since it started in October 2005, and continued with the CMS approval of the State Plan Amendment in 2014.

Appropriate maternal depression screening is necessary to ensure that postpartum depression is addressed and care is administered in a timely manner to improve quality of care and long-term outcomes for both mother and child.