Medicaid Bulletin

Effective with date of service Sept. 11, 2020, the Medicaid and NC Health Choice programs cover infliximab-axxq for injection, for intravenous use (Avsola) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5121 - Injection, infliximab-axxq, biosimilar, (avsola), 10 mg.

Effective with date of service Aug. 6, 2020, the Medicaid and NC Health Choice programs cover belantamab mafodotin-blmf for injection, for intravenous use (Blenrep™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

The US Department of Health and Human Services announced an additional funding opportunity for Medicaid/CHIP providers to apply for federal Provider Relief Funds. The application period runs through Nov. 6, 2020.

NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series, The Security Risk Analysis (SRA) and Program Year 2021 Announcements.

The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.

North Carolina Department of Health and Human Services (DHHS) developed a program to reimburse primary care providers (PCP) with federal funds for providing medical care for COVID-19 related services to uninsured North Carolina residents. 

NC DHHS awarded a contract to Sandata Technologies, LLC on Sept. 24, 2020, and will implement services for Electronic Visit Verification (EVV) statewide on Jan. 1, 2021. EVV is a method used to verify visit activity for services delivered as part of home- and community-based service programs. EVV offers a measure of accountability to help ensure that individuals who are authorized to receive services in fact receive them.

North Carolina’s Breast and Cervical Cancer Control Program has changed the criteria to allow additional providers who screen and diagnose women for breast and cervical cancer to refer to Breast and Cervical Cancer Medicaid.

As NC Medicaid moves forward with its planned implementation of NC Medicaid Managed Care, it is important for enrolled providers to act now to thoroughly review their individual and organization provider enrollment record in NCTracks.

NC Medicaid has received federal approval of additional flexibilities during the COVID-19 pandemic for the NC Innovations Waiver, for individuals with intellectual and developmental disabilities (IDD).