Medicaid Bulletin

Medicaid Bulletin Monthly Digest

Medicaid Bulletin Archive

Articles beginning January 2018 are available in the blog format.

Updated: Federally Qualified Health Centers and Rural Health Clinics Reimbursement Methodology Changes Approved
Standard Plans will begin to reimburse the APM rate for claims with a date of service on or after Aug. 1, 2024.
Opill to be Covered Without a Prescription
Effective Aug. 1, 2024, over the counter oral contraceptive Opill will be available without a prescription, at no cost.
New Prior Authorizations Required for Substance Use Disorder Prescriptions
Providers need to submit new prior authorizations (PA) for services subject to 42 Code of Federal Regulations (CFR) Part II.
NC Medicaid to Add Coverage for Obesity Management Medications
Effective Aug. 1, 2024, NC Medicaid will cover obesity management medications for beneficiaries 12 years of age and older.
Updates to Clinical Coverage Policy 10A: Outpatient Specialized Therapies
Effective Dec. 1, 2023, updates increased treatment visit limits for beneficiaries aged 21 and older. The home health ordering practitioner reference was also updated.
Tailored Care Management Provider Manual Updates
Includes information on new policies, tools and guidance, as well as several clarifications
New Covered CPT Codes for Genetic Testing
Effective June 1, 2024, CPT codes are newly eligible for coverage.
Tobacco-Related Policy Requirements Delayed until July 1, 2025
Impacts NC Medicaid Managed Care Standard Plans, Behavioral Health and Intellectual/Developmental Disabilities Tailored Plans and LME/MCOs.
1915(b)(3) Service Transition for TP Eligible Members
Providers should work with the Tailored Plans and Tailored Care Managers to support Medicaid beneficiaries transitioning to 1915(i) services.
NC Managed Care Capitation Rates – Updated Care Management Assumptions for SFY 2025

This bulletin applies to NC Medicaid Managed Care Standard Plans.