Medicaid Bulletin

Providers should review Clinical Coverage Policy 2A-1 for information on Hospital Observation

Includes medical and pharmacy prior authorizations, out of network provider rates and rules, and primary care provider changes

Usage of the Nicotine Replacement Therapy Protocol is Eligible for Clinical Services Reimbursement to Pharmacies.

Members may now select to receive Tailored Care Management from a provider with Transition to Community Living Distinction.

Feedback Requested on Proposed Approach

To support the SNF and ICF-IID reporting and collection of provider healthcare assessment data.

Expanding Pilot Eligibility to Members in NC Medicaid Direct in Pilot Regions

Billing Requirements for Medicaid Direct Providers

States must revalidate the enrollment of all providers at least every five years to ensure the information on record is accurate and current.

Look for details on training in June related to these changes.