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

1A-31, Wireless Capsule Endoscopy 03/26/21 05/10/21
3G-1, Private Duty Nursing Age 21 and Older 03/26/21 05/10/21
10B, Independent Practitioner 03/26/21 05/10/21
10C, Outpatient Specialized Therapies (LEAs) 03/26/21 05/10/21
Prior Approval Criteria PCSK9 Inhibitors 03/29/21 05/13/21
Prior Approval Criteria Lupus Medications - Lupkynis 03/29/21 05/13/21
Prior Approval Criteria Antiparkinsons - Gocovri 03/29/21 05/13/21
Prior Approval Criteria Duchenne Muscular Dystrophy 03/29/21 05/13/21
Prior Approval Criteria Hepatitis C Virus Medications - Genotype & Labs 03/29/21 05/13/21
Prior Approval Criteria Neuromuscular Blocking Agents 03/29/21 05/13/21
9, Outpatient Pharmacy 04/27/21 05/12/21