Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Bulletins published prior to January 2019

Articles since January 2018 are available in the blog format below.

Approved PHP Provider Contract Templates as of June 21, 2019

Monday, July 1, 2019

The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.

Romosozumab-aqqg injection, for subcutaneous use (Evenity™) HCPCS code J3590: Billing Guidelines

Monday, July 1, 2019

Effective with date of service April 11, the North Carolina Medicaid and NC Health Choice programs cover romosozumab-aqqg injection, for subcutaneous use (Evenity) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.

Updates to NC Medicaid Electronic Health Record (EHR) Incentive Program

Monday, July 1, 2019

NC-MIPS is Open for Program Year 2019. The NC Medicaid EHR Incentive Payment System (NC-MIPS) is only accepting Program Year 2019 Stage 3 Meaningful Use (MU) attestations.

Trastuzumab and hyaluronidase-oysk injection, for subcutaneous use (Herceptin Hylecta™) HCPCS code J9999: Billing Guidelines

Monday, July 1, 2019

Effective with date of service April 5, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab and hyaluronidase-oysk injection, for subcutaneous use (Herceptin Hylecta) for use in the Physician Administered Drug Program when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Clinical Coverage Policy Update

Monday, July 1, 2019

New or amended clinical coerage policies are available on NC Medicaid's website.

Updates to Clinical Coverage Policy 10B: Independent Practitioners

Monday, July 1, 2019

On June 1, 2019, an amended version of Clinical Coverage Policy 10B, Independent Practitioners, was posted to the North Carolina Medicaid website. The following updates were made in accordance with State Plan Amendment (SPA) NC 18-0005 which allowed an expansion of the universe of documentation that a Local Education Agency (LEA) can use as a basis for providing school-based health services from beyond a student beneficiary’s Individualized Education Program (IEP) to also include the Individual Family Service Plan (IFSP), Individual Health Plan (IHP), Behavior Intervention Plan (BIP) or 504 Plan.

NCTracks Provider Training Available in July

Monday, July 1, 2019

Registration is open for the July 2019 instructor-led provider training courses. Slots are limited.

Reminders on Hospice Policy

Monday, July 1, 2019

Clinical review is not required for North Carolina Medicaid and NC Health Choice hospice services until after the completion of the first and second 90-day benefit period.   

North Carolina Medicaid and NC Health Choice Preferred Drug List (PDL) Changes

Monday, July 1, 2019

Effective July 1, 2019, NC Medicaid will make changes to the North Carolina Medicaid and NC Health Choice Preferred Drug List.

Hospice Payment Reform Update

Monday, July 1, 2019

Due to the implementation of Centers for Medicare and Medicaid Services (CMS) FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Final Rule, NC Medicaid made policy and system changes to allow for the use of two-tier hospice fee schedules effective Jan. 1, 2016.

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