Medicaid Bulletin

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.

The Centers for Medicare & Medicaid Services has granted NC Medicaid the authority to move forward with Home and Community-Based (HCBS) waiver flexibilities requested March 13, 2020. 

Private Duty Nursing - beneficiaries under 21 years of age, Private Duty Nursing - all beneficiaries and Home Health – All Beneficiaries.

To ensure beneficiaries continue to receive Medicaid and NC Health Choice services with no interruption or delays due to the COVID-19 outbreak, the disposition for three claim processing edits have been temporarily changed.