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:

Proposed Policy Date Posted Comment Period Ends
9, Outpatient Pharmacy  04/30/2024 06/14/2024
PA Criteria GLP1 04/30/2024 06/14/2024
PA Criteria Opioid Dependency  04/30/2024 06/14/2024
1S-4 Genetic Testing (Terminate Policy)  05/03/2024 06/17/2024
1S-5 Genetic Testing for Susceptibility to Breast and Ovarian Cancer (BRCA) (Terminate Policy) 05/03/2024 06/17/2024
1S-7 Gene Expression Profiling for Breast Cancer (Terminate Policy) 05/03/2024 06/17/2024
1S-9 Genetic Testing for Diagnosis and Treatment (New Policy) 05/07/2024 06/21/2024
1S-10 Genetic Testing- Carrier and Prenatal (New Policy) 05/03/2024 06/17/2024
1S-11 Genetic Testing- Gene Expression (New Policy) 05/03/2024 06/17/2024
1S-12 Genetic Testing- Next Generation Sequencing (NGS) (New Policy) 05/03/2024 06/17/2024
2B-1, Nursing Facility Services 05/20/2024 06/04/2024