Proposed Medicaid and NC Health Choice Policies

NCGS §108A-54.2 requires that the Department of Health and Human Services consult with and seek the advice of the North Carolina Physician Advisory Group and other professional societies and organizations in developing new or amended Medicaid clinical coverage policies. The law requires the Department to publish proposed new and amended clinical coverage policies on the Department's website and accept oral and written comments. All consultations and comments are considered. The Department has delegated to the Division of Health Benefits Division Director the authority to make the final decisions regarding clinical coverage policies.

Comments submitted to this website may be considered public record and may be disclosed to parties requesting such records, including the identifiable information that you provide in your comment.  You may submit your comment without providing any identifiable information.  Voluntarily providing identifiable information does not mean that you will be contacted about your comment.

The following proposed new or amended Medicaid and NC Health Choice clinical coverage policies are available for review. Comments on proposed polices may be submitted by clicking the email link next to each proposed policy. Comments and questions not specifically related to the proposed policy should not be sent to this Web address. The initial comment period for each proposed policy is 45 days. An additional 15-day comment period follows if a proposed policy is modified as a result of the initial comment period. If the adoption of a new or amended medical coverage policy is necessitated by an act of the General Assembly or a change in federal law, then the 45- and 15-day time periods shall instead be 30- and 10-day time periods.

Proposed Policy Date Posted Submit Comments

Comment Period Ends

1H Telehealth, Virtual Patient Communications and Remote Patient Monitoring  7/1/20 8/15/20
1H Telemedicine and Telepsychiatry 7/1/20 8/15/20
1A-24, Diabetes Outpatient Self - Management Education 7/29/20 9/12/20
1A-34, Dialysis Services 7/29/20 9/12/20
1D-4, Core Services Provided in Federally Qualified Health Centers and Rural Health Clinics 7/29/20 9/12/20
1-I, Dietary Evaluation & Counseling and Medical Lactation Services 7/29/20 9/12/20
1M-2, Childbirth Education 7/29/20 9/12/20
1M-3, Health & Behavior Intervention  7/29/20 9/12/20
3A, Home Health Services 7/29/20 9/12/20
3D, Hospice Services 7/29/20 9/12/20
3G-1, Private Duty Nursing for Beneficiaries Age 21 and Older 7/29/20 9/12/20
3G-2, Private Duty Nursing for Beneficiaries Under 21 Years of Age 7/29/20 9/12/20
3H-1, Home Infusion Therapy 7/30/20 9/13/20
4B, Orthodontic Services 7/30/20 9/13/20
5A-2, Respiratory Equipment and Supplies 7/30/20 9/13/20
5A-3, Nursing Equipment and Supplies 7/30/20 9/13/20
8A, Enhanced Mental Health and Substance Abuse Services 7/30/20 9/13/20
8A-2, Facility - Based Crisis Management  for Children and Adolecsents 7/30/20 9/13/20
8C, Outpatient Behavioral Health Services 7/30/20 9/13/20
8E, Intermediate Care Facilities for Individuals with Intellectual Disabilities 7/30/20 9/13/20
8F, Research - Based Behavioral Health Treatment for ASD 7/30/20 9/13/20
8G, Peer Support Services 7/30/20 9/13/20
8J, Children's Developmental Services Agencies 7/30/20 9/13/20
9, Outpatient Pharmacy Program 7/30/20 9/13/20
10C, Local Education Agencies 7/30/20 9/13/20
10D, Independent Practitioners Respiratory Therapy Services 7/30/20 9/13/20
8A-6, Community Support Team 7/31/20 8/30/20
8B, Inpatient Behavioral Health Services 7/31/20 8/30/20
8L, Mental Health/ Substance Abuse Targeted Case Management 7/31/20 8/30/20
8A-1, Assertive Community Treatment Program 7/31/20 8/30/20
4A, Dental Services 7/31/20 9/14/20
8P, North Carolina Innovations 8/4/20 9/18/20
1E-5, Obstetrical Services 8/4/20 9/18/20
1E-6, Pregnancy Medical Home 8/4/20 9/18/20
Prior Approval Criteria Treatment for Movement Disorders 8/5/20 8/20/20
1E-7, Family Planning 8/7/20 9/22/20
Prior Approval Criteria Epidiolex 8/7/20 8/22/20