Medicaid Bulletin

NC Medicaid has implemented COVID-19 rate increase functionality to reimburse hospice care provided in a skilled nursing facility (SNF) designated as a “SNF COVID-Outbreak site” or “SNF COVID-Response site” in a ratio consistent with how hospice care is reimbursed in all other SNFs. 

Medicaid and NC Health Choice providers now have a single source to find answers to questions about COVID-19. The online resource is a collection of Medicaid and behavioral health COVID-19 information, including answers to questions received in the COVID-19 mailbox, during webinars, from COVID-19 Special Medicaid Bulletins and other sources.

Panelists will present a structured PowerPoint presentation focused on Appendix K and Retention Payments for the Innovations Waiver on Thursday, June 11, 2020, at 3 p.m.

Effective with date of service April 15, 2020, the Medicaid and NC Health Choice programs cover trastuzumab-dttb for injection, for intravenous use (Ontruzant®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5112 - Injection, trastuzumab-dttb, biosimilar, (Ontruzant®), 10 mg.

In December 2019, DHHS released the draft Tailored Care Management Provider Manual and application questions for providers interested in becoming Advanced Medical Home Plus practices or Care Management Agencies. The Department received many thoughtful comments on the draft Provider Manual and has made several updates.

North Carolina is experiencing increased community transmission of COVID-19 in many areas of the state, particularly among our historically marginalized populations, especially our Latinx community. Pre-symptomatic and asymptomatic spread is playing an important role. Updated clinician and laboratory testing guidance and a new resource on community testing in historically marginalized populations are available.

Effective July 26, 2020, changes will be made to initial enrollment, re-enrollment, re-verification applications and manage change requests (MCRs) for individual providers (excluding disaster relief and Out of State Lite providers). The updates include the addition of a new page, as well as additional exclusion sanction questions. 

NC Medicaid will allow temporary changes to Clinical Coverage Policy 12B for Written Physician Orders, Use of Remote Technology and Signature Requirements. 

Beginning June 2020, the Remittance Advice will include a detailed explanation of any refund (Lump Sum / Miscellaneous Payment) issued to the provider. This message will be on the Financial Transactions page.

NC Medicaid is temporarily increasing the number of therapeutic leave days for Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IIDs) from 60 days to 120 days. This is a change from the previous increase to 90 days. NC Medicaid continues to waive the requirement of approval needed for more than 15 consecutive days per Clinical Coverage Policy 8E.