Medicaid Bulletin

In May 2020, CMS updated the Minimum Data Set (MDS) 3.0 item sets to support calculation of Patient-Driven-Payment-Model (PDPM) case mix groups on OBRA assessments. In October 2020, NC Medicaid began requiring the completion and submission of the 28 MDS item set fields associated with PDPM on all OBRA nursing home comprehensive (NC) and quarterly (NQ) MDS assessment submissions.

Effective with date of service Jan. 1, 2023, the American Medical Association (AMA) has added new CPT codes, deleted others, and changed the descriptions of some existing codes. For complete information regarding all CPT codes and descriptions, refer to the 2023 edition of Current Procedural Terminology, published by the AMA.

Last days for providers to have fully executed contracts with Tailored Plans to be included in the beneficiary choice period and auto-assignment.

Highlighting coverage, rate and resource changes in 2022

Beneficiaries can apply for various benefits, view case details, renew their Medicaid and update their information

Documents modifying the Skilled Nursing Facilities Provider Assessment and temporary COVID-19 add-on, and SNF per diem rates are impacted.

Changes requirement to “comprehensive annual exam or annual assessment” prior to providing family planning and related services.

Effective with date of service Oct. 19, 2022, Medicaid and NC Health Choice cover Sodium Thiosulfate injection, for intravenous use (Pedmark).

Effective with date of service Nov. 15, 2022, Medicaid and NC Health Choice cover Eflapegrastim-xnst injection, for subcutaneous use (Rolvedon).

When the service location field is not completed, the Alt EVV vendor will receive an exception notice.