Effective with date of service Feb. 3, 2020, the Medicaid and NC Health Choice programs cover antihemophilic factor (recombinant), glycopegylated-exei lyophilized powder for solution, for intravenous use (Esperoct®) for use in the Physician Administered Drug Program when billed with HCPCS code J7199 - Hemophilia clotting factor, not otherwise classified.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
NC Medicaid has implemented flexibilities on how Medicaid providers 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. Medicaid is hosting two webinars to further discuss the flexibilities.
Effective March 10, 2020, the Division of Health Benefits (DHB) implemented a 5% rate increase for certain Medicaid provider groups listed in the Bulletin. DHB will systematically reprocess claims submitted with dates of service beginning March 10, 2020, through the implementation date of the rate increase.
*This Bulletin has been updated in SPECIAL BULLETIN COVID-19 #175: Updated Guidance for Non-Emergency Medical Transportation - Aug. 19, 2021
On March 10, 2020, Governor Roy Cooper issued an executive order declaring a State of Emergency for North Carolina to respond to COVID-19. In addition, the Department of Health and Human Services made several recommendations to slow the spread of COVID-19 and reduce the number of people infected.
Updated April 22, 2020: Link to downloadable list of enrollmed DMEPOS providers added. Effective March 30, 2020 NC Medicaid and NC HealthChoice coverage was added for HCPCS code A4670 – automatic blood pressure monitor.
NOTE: SPECIAL BULLETIN COVID-19 #28 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications - Definitions, Eligible Providers, Services and Codes.
PACE organizations are responsible for providing all required Medicare and Medicaid covered services to its PACE participants. This responsibility also extends to the participants’ home setting. Due to the COVID-19 pandemic, NC Medicaid recognizes that PACE organizations will need to adjust business operations and the methods utilized to address the needs of PACE participants.
Effective March 30, 2020 NC Medicaid is temporarily modifying the Home Infusion Therapy Clinical Coverage Policy No.: 3H-1 to better enable the delivery of remote care to Medicaid members. These temporary changes will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded. This expansion of home infusion therapy serves to allow beneficiaries to receive services in the home rather than in a dedication infusion center to reduce potential exposure to COVID-19.
Effective March 25, 2020, due to drug shortages in the marketplace, the NC Medicaid and NC Health Choice PDL Category of “Respiratory: Beta-Adrenergic Handheld, Short Acting” has changed.