Medicaid Bulletin

To comply with a final rule issued by the Centers for Medicare and Medicaid Services (CMS), which requires additional disclosures by enrolling providers, revisions to the NC Medicaid Provider Enrollment Application are underway. This final rule, effective Nov. 4, 2019, implements statutory provisions that require providers and suppliers to disclose certain current and previous affiliations with other providers and suppliers.

In preparation for the upcoming holidays, please be aware of the change to the schedule for posting of Medicaid Bulletin articles.

NC Medicaid has updated its ICD-10 diagnosis code list.

The Community Alternatives Program for Disabled Adults (CAP/DA) unit within NC Medicaid will host an informational webinar on how to become a CAP/DA-qualified direct service provider. Becoming qualified will enable providers to render one or more of the CAP/DA services listed below* or other approved Medicaid services for a CAP/DA beneficiary.

New or amended clinical coverage policies are available on NC Medicaid’s website.

The NC Medicaid State Plan Amendment  for Peer Support Services was approved by the Centers for Medicare & Medicaid Services on Oct. 23, 2019, with an effective date of July 1, 2019.  The clinical coverage policy will be posted with an effective date of Nov. 1, 2019. 

The NC Medicaid Electronic Health Record Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use  attestations.

Effective with date of service Aug. 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover lefamulin injection, for intravenous use (Xenleta) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.

The Medicaid State Plan Amendment was approved by the Centers for Medicare & Medicaid Services with an effective date of Oct. 1, 2019. The clinical coverage policy was posted on Oct. 10, 2019 for an additional 15-day public comment period. Following the 15-day public comment period, the final Community Support Team policy will be posted with an effective date of Nov. 1, 2019.

NC Medicaid reimburses qualified providers for child medical evaluation and medical team conference services according to guidelines set forth in NC Medicaid policy 1A-5 Child Medical Evaluation and Medical Team Conference for Child Maltreatment.