Medicaid Bulletin

Strong infection prevention and control practices are critical to reducing the transmission of COVID-19 within long-term care facilities. NC DHHS is reiterating its expectation that providers participate in the infection prevention and control activities. 

This bulletin replaces SPECIAL BULLETIN COVID-19 #119 in its entirety.

The North Carolina Department of Health and Human Services announced the launch of a COVID-19 Exposure Notification app called SlowCOVIDNC. The app will help North Carolinians slow the spread of the virus by alerting them when they may have been exposed to someone who has tested positive for COVID-19.

To begin the preparation for the renewing of the CAP/C waiver, NC Medicaid is soliciting comments, recommendations, and suggestions in the areas of access, flexibilities of home and community-based services, and operational efficiencies. An open public comment period begins Sept. 22, 2020. 

Effective with date of service July 27, 2020, the Medicaid and NC Health Choice programs cover inebilizumab-cdon injection, for intravenous use (Uplizna™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3590 - Unclassified biologics.

To ensure the waiver enrollment administrative processes are executed as approved in each waiver application, until the award of a contract to an external CIAE vendor, NC Medicaid will implement an internal independent assessment review process. This internal independent assessment process will begin in October 2020 with a go-live date of Oct. 19, 2020.   

North Carolina Medicaid has received calls concerning claim denials for some services provided by nurse practitioners (NPs) and physician assistants (PAs).

CMS and the American Medical Association have released a CPT code for an antigen test designed to detect proteins from the virus that causes COVID-19 in respiratory specimens. NC Medicaid is adding this CPT code to NCTracks for medically necessary laboratory testing effective Sept. 1, 2020.

Guidelines for Evidenced-Based Synagis® Prophylaxis, Prior Approval Requests, Dose Authorization, Pharmacy Distributor Information, Provider Information, Submitting a Request to Exceed Policy and Technical Support.

Effective Sept. 1, 2020, the North Carolina Medicaid and NC Health Choice Programs will cover Oncotype Dx and EndoPredict genomic tests used for breast cancer treatment as part of Clinical Coverage policy 1S-7, Gene Expression Profiling for Breast Cancer.