Medicaid Bulletin

To avoid delays in beneficiaries receiving needed private duty nursing services, NC Medicaid is temporarily approving prior authorizations that are in pending status for documentation of validation of primary insurance for 60 calendar days. This will allow for the delayed verification responses from individual third-party insurance providers to be uploaded to the prior authorizations in NCTracks. Details regarding documentation, supervisory visits and eligible remote technologies are included in this bulletin.

Congress has enacted three significant stimulus packages to help the country weather the COVID-19 pandemic, which establish a variety of funding sources to support providers, each with distinct features including which provider types are eligible, if providers must apply to be considered and if the financial benefit is a grant or a loan that must be repaid. NC Medicaid has created a summary of financial relief available by provider type.

NC Medicaid has received federal approval of flexibilities during the COVID-19 crisis for the NC Innovations Waiver for individuals with intellectual and developmental disabilities (IDD); NC Traumatic Brain Injury (TBI) Waiver for individuals who have a TBI diagnosis after age of 21; Community Alternatives Program for Disabled Adults (CAP/DA) for disabled adults and the Community Alternatives Program for Children (CAP/C) for medically fragile children.

Note: Additional Family Planning guidance may be released in the future, which would replace this bulletin.

Effective April 1, 2020, in response to the anticipated spread of coronavirus (COVID-19) in North Carolina, NC Medicaid is adding "U07.1 - 2019-nCoV Acute Respiratory Disease" as a billable diagnosis. Additionally, diagnosis code U07.1 is being added to the list of diagnoses exempt from the annual visit limit also effective April 1.  

Effective retroactive to March 10, 2020, Medicaid and NC Health Choice plans are temporarily covering weight scales and adding a purchase option for portable pulse oximeters.

An update to COVID-19 guidance for North Carolina clinicians and laboratories includes updated laboratory testing guidance; updated criteria for submission of specimens to the North Carolina State Laboratory of Public Health (NCSLPH); and replacement of information that is not North Carolina-specific with links to relevant CDC guidance.

NC Medicaid has implemented flexibilities on how Medicaid providers deliver and beneficiaries receive Medicaid services in the wake of COVID-19. Utilization and prior approval limits for specific State Plan Medicaid services will be relaxed for all Medicaid beneficiaries impacted by COVID-19 including individuals participating in the NC Innovations Waiver and the NC TBI Waiver. 

This SPECIAL BULLETIN COVID-19 #49 replaces SPECIAL BULLETIN #42: Telehealth Clinical Policy Modifications - Postpartum Care. Please note billing guidance change to postpartum care visits, which can be billed separately OR as part of a pregnancy package code.

NC Medicaid has added coverage for providers to help their patients engage in Remote Physiologic Monitoring (RPM), providing the opportunity to improve management of diseases and engage patients in their own care.