Medicaid Bulletin

The Centers for Medicare & Medicaid Services (CMS) has granted NC Medicaid the authority to temporarily modify several Medicaid and NC Health Choice policies retroactive to March 1, 2020, and through the end of federal emergency declaration or when the flexibility is ended by the State or CMS

In response to the anticipated spread of the novel coronavirus (COVID-19) in North Carolina, NC Medicaid is adding the following diagnosis code to the list of diagnoses exempt from the annual visit limit:

In response to the anticipated spread of the novel coronavirus (COVID-19) in North Carolina, EviCore, NC Medicaid’s contracted vendor for imaging services, will auto-approve the following chest CT codes effective immediately:

The Outpatient Pharmacy point of sale (POS) adult and pediatric clinical edits for behavioral health medications will temporarily suspend effective March 23, 2020. These point of sale edits target dosages exceeding the FDA approved maximum limit and in class therapeutic duplication.  

Effective March 23, 2020, if medically necessary, outpatient Respiratory Therapy (RT) services provided through the Independent Practitioner Provider (IPP) program that typically require prior authorization (PA), may be provided to NC Medicaid and NC Health Choice beneficiaries without PA.

Effective March 23, 2020, if medically necessary, the following additional respiratory equipment and supplies that typically require prior authorization (PA) may be provided to beneficiaries without first seeking PA:

DHHS will host a question and answer webinar to discuss new guidance for all health providers related to COVID-19 on Tuesday, March 24, 2020, from 5:30-6:30 p.m.

NOTE: SPECIAL BULLETIN COVID-19 #9 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications - Defin

NOTE: SPECIAL BULLETIN COVID-19 #8 has been replaced in its entirety by SPECIAL BULLETIN #39: Face-to-Face Provider Site Visits and Fingerprinting Requirements for NC Medicaid Provider Enrollment Temporarily Suspended.

NC DHHS continues to take action to protect the health and safety of our state’s patients and providers during the novel coronavirus (COVID-19) outbreak. NC DHHS received authority under Section 1135 of the Social Security Act to waive certain federal Medicare, Medicaid, CHIP and HIPAA requirements.