Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.
Webinar for Medicaid Providers to be held July 27 at 3 p.m and Application Deadline Extended to Aug. 3.
On May 15, 2020, the Centers for Medicare & Medicaid Services (CMS) updated the Minimum Data Set (MDS) 3.0 item sets (version 1.17.2) to support the calculation of Patient-Driven Payment Model (PDPM) case mix groups on all Omnibus Budget Reconciliation Act (OBRA) assessments.
NC Medicaid is implementing time-limited, targeted, enhanced swing bed reimbursement rates to provide additional financial support to hospitals that provide post-acute care services to COVID-19 positive (“COVID+”) Medicaid beneficiaries and non-COVID+ Medicaid beneficiaries transferred from other acute care hospitals as part of a surge response.
Effective with date of service May 6, 2020, the Medicaid and NC Health Choice programs cover daratumumab and hyaluronidase-fihj injection, for subcutaneous use (Darzalex Faspro™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Effective July 1, 2020, coverage of therapeutic Continuous Glucose Monitoring (CGM) products is transitioning from the Durable Medical Equipment (DME) Program to the Outpatient Pharmacy Point of Sale (POS) Program.
This NC Medicaid Bulletin provides an overview of COVID-19 rate increases applicable to SNFs and Hospice providers; Hospice provider rate increase from 95% to 100% of Skilled Nursing Facility (SNF) reimbursement rates for room and board services provided in a SNF; and billing guidelines for Hospice services provided in a SNF designated as a “COVID-19 Outbreak” or “COVID-19 Response” site.
On July 17, 2020, the Centers for Medicare & Medicaid Services announced that the deadline for Medicaid/CHIP providers to submit their financial data to apply for federal Provider Relief Funds has been extended to Aug. 3, 2020.
The Centers for Medicare & Medicaid Services (CMS) recently approved North Carolina’s Medicaid Disaster 1115 Waiver. The waiver includes several provisions that allow flexibility for long-term services and supports (LTSS) to maintain services for beneficiaries and financial relief for home and community-based service (HCBS) providers.