Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Comprehensive Clinical Assessment Requirements
A psychiatric diagnostic interview (Current Procedural Terminology 90792) may qualify as a Comprehensive Clinical Assessment if it meets all requirements.
UPDATED: NC Medicaid Rate Reductions – Effective Oct. 1, 2025
This bulletin replaces in full NC Medicaid Rate Reductions – Effective Oct. 1, 2025, published Sept. 25, 2025.
Assessment Rate Adjustment for Skilled Nursing Facility Providers
Effective Oct. 1, 2025, NC Medicaid adjusted the provider assessment rates.
Providers with License Limitations or Non-Practice Agreements Ineligible for NC Medicaid Participation
Important changes effective Oct. 1, 2025, for providers with any form of license limitation.
Cost of Dispensing Survey
The five-year cost of dispensing survey has been completed for North Carolina pharmacies.
Flexibilities to Ensure Continuity of Care and Ease Provider Administrative Burden at Children and Families Specialty Plan Launch
Includes medical and pharmacy prior authorizations, out-of-network provider rates and rules and primary care provider changes.
Primary Care Provider/Advanced Medical Home Auto-Assignment Fact Sheet Now Available
The fact sheet outlines the key responsibilities of practices receiving auto-assigned members.
Discontinuation of Coverage: Xifaxan (Rifaximin)
Effective Oct. 1, 2025, NC Medicaid will no longer cover the prescription drug Xifaxan (Rifaximin).
Reminder: Hospital at Home Program Ended on Sept. 30, 2025
Providers can no longer bill NC Medicaid for Hospital at Home for dates of service on or after Oct. 1, 2025.
NC Medicaid Temporary Flexibilities Due to Hurricane Humberto and Tropical Storm Invest 94L (Potential Imelda)
Flexibilities effective Sept. 26, 2025, for NC Medicaid beneficiaries due to Hurricane Humberto and Tropical Storm Invest 94L (Potential Imelda).