Proposed Medicaid Policies


NC Spending Plan for the Implementation of the American Rescue Plan Act of 2021, Section 9817 - July 12, 2021

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 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.

Submit comments for policies listed below open for public comment by emailing: medicaid.public.comment@dhhs.nc.gov.

Proposed PolicyDate PostedComment Period Ends
1N-1, Allergy Testing10/11/202411/25/2024
1N-2, Allergy Immunotherapy 10/11/202411/25/2024
8A-9, Opioid Treatment Program Service10/25/202411/23/2024
10A, Outpatient Specialized Therapies11/04/202412/19/2024
10B, Independent Practitioners (IP)11/04/202412/19/2024
PA Criteria Lyfgenia11/04/202412/19/2024
8A-2, Facility-Based Crisis Service for Children and Adolescents11/15/202412/15/2024
8A-11, Medically Monitored Inpatient Withdrawal Management Service11/15/202412/15/2024
8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers11/15/202412/15/2024
8D-2, Residential Treatment Services11/15/202412/15/2024
8H-2, 1915(i) Individual Placement & Support (IPS) for Mental Health & Substance Use11/15/202412/15/2024
8H-3, 1915(i) Individual and Transitional Support (ITS)11/15/202412/15/2024
8I, Psychological Services in Health Departments and School-Based Health Centers Sponsored by Health Departments to the under-21 Population11/15/202412/15/2024
8J, Children's Developmental Service Agencies (CDSAs)11/15/202412/15/2024
2B-2, Geropsychiatric Units in Nursing Facilities11/15/202412/15/2024
8A, Enhanced Mental Health and Substance Abuse Services11/15/202412/15/2024
8A-1, Assertive Community Treatment (ACT) Program11/15/202412/15/2024
8A-5, Diagnostic Assessment11/15/202412/15/2024
8A-6, Community Support Team (CST)11/15/202412/15/2024
8A-7, Ambulatory Withdrawal Management (WM) without Extended On-Site Monitoring 11/15/202412/15/2024
8A-8, Ambulatory Withdrawal Management with Extended On-Site Monitoring11/15/202412/15/2024
8B, Inpatient Behavioral Health Services11/15/202412/15/2024
8G, Peer Support Services11/15/202412/15/2024
8L, Mental Health/Substance Abuse Targeted Case Management11/15/202412/15/2024
8D-1, Psychiatric Residential Treatment Facilities for Children under the Age of 2111/18/202412/21/2024