Medicaid Bulletin

Effective with date of service June 17, 2020, the Medicaid and NC Health Choice programs cover mitomycin for pyelocalyceal solution (Jelmyto™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Effective with date of service June 19, 2020, the Medicaid and NC Health Choice programs cover lurbinectedin for injection, for intravenous use (Zepzelca™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Effective with date of service June 26, 2020, the Medicaid and NC Health Choice programs cover bimatoprost implant, for intracameral administration (Durysta™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.

A memo regarding North Carolina’s Design for State-Funded Services Under Behavioral Health and Intellectual/Developmental Disability Tailored Plans white paper has been released.

The North Carolina Department of Health and Human Services Division of Health Benefits (DHB) is continuing to implement previously-announced temporary 5% provider rate increases to select Medicaid providers (see COVID-19 Special Bulletin #99) to maintain access to care for Medicaid beneficiaries. 

NC Medicaid is implementing additional rate increases to continue helping Local Health Departments (LHDs) to serve Medicaid beneficiaries during the COVID-19 public health emergency.

The North Carolina Office of the State Auditor (OSA) has begun the Single State Audit for State fiscal year (SFY) 2020.

During the recent State fiscal year (SFY) 2019 Single State Audit, OSA reviewed claims documentation to ensure payments were made for Medicaid-covered services and to ensure claims followed proper coding and billing rules. 

Effective Sept. 1, 2020, NC Medicaid will begin reimbursing COVID-19 testing costs for uninsured individuals enrolled in the NC Medicaid Optional COVID-19 Testing (MCV) program. This option was made available to all states through Section 6004(a)(3) of the Families First Coronavirus Response Act (FFCRA). Testing providers are encouraged to download paper applications to be completed, collected and mailed to NC Medicaid at the address on the form.

Executive Order 156 and a State Health Director Memo have extended, but not waived, North Carolina proof-of-immunization documentation deadlines for school and child-care facilities. Additionally, the Executive Order also extends the deadline to submit a school health assessment for children entering North Carolina public school for the first time.