Medicaid Bulletin

Redistributing Previously Approved Shared Private Duty Nursing Hours Among Service Providers without a New CMS-485 or PDN Ordering Provider Order, Effective September 1, 2026

Beginning Nov. 1, 2026, Pharmacy Claims for controlled substances will be denied without an active certification on their NCTracks provider enrollment record.

This bulletin reflects revised effective dates and applies to all research‑based behavioral health treatment providers in NC Medicaid Managed Care and NC Medicaid Direct.

This fall, care managers, caregivers and providers supporting high‑risk Medicaid beneficiaries are invited to join a three‑part webinar series focused on preparing for, responding to and recovering from extreme weather events.

Recent updates have been made to the new NC Medicaid 1915(i) Assessment form.

Categorical Risk Level Subject to Bump-Up for Certain Providers.

This bulletin replaces in full the December 2025 Utilization Management by Managed Care Plans Aligned with Food and Drug Administration Labeling bulletin.

The revised NC Medicaid 1915(i) assessment must be used starting Oct. 1, 2026, and includes a new companion guide.

Effective July 24, 2026, Basaglar® U-100 KwikPen® moved to Preferred status due to reported shortage of Lantus SoloStar pen.

Reminders for NC Medicaid Managed Care, NC Medicaid Direct and Medicare.