Medicaid Bulletin

NOTE: SPECIAL BULLETIN COVID-19 #22 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #143: CAP/C and CAP/DA Home- and Community-Based Services Flexibilities Update for Beneficiaries Enrolled in 1915(c) Waivers

The Centers for Medicare & Medicaid Services (CMS) have approved Appendix K flexibilities mentioned below. - April 9, 2020

NC Medicaid has implemented flexibilities on how Medicaid providers and beneficiaries may access and receive Medicaid services in the wake of COVID-19. Prior approval and service utilization limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19, including individuals participating in the Community Alternatives Program (CAP) waivers.

NOTE: SPECIAL BULLETIN COVID-19 #21 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #36: Telehealth Clinical Policy Modifications - Outpatient Specialized Therapies and Dental Services

NOTE: SPECIAL BULLETIN COVID-19 #20 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #35: Telehealth Clinical Policy Modifications - Enhanced Behavioral Services

This Bulletin provides information to local Departments of Social Services (DSS) and NEMT providers on NC Medicaid’s requirements for NEMT services, the recommended safety procedures and protocols to help reduce the spread of COVID-19 and guidance. 

Effective March 27, 2020, North Carolina Medicaid is requiring prior approval for hydroxychloroquine and chloroquine containing products. Prior approval is required to ensure beneficiaries continue to have access to these medications for maintenance of their autoimmune conditions, for treatment of malaria, and for treatment of extraintestinal amebiasis.  

To offset potential hardships due to COVID-19, for NC Medicaid and Health Choice providers who were due to re-verify their enrollment between the dates of March 1, 2020 and June 30, 2020, NCTracks has reset your re-verification due date to Sept. 13, 2020. 

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: