New or amended clinical coverage policies are available on NC Medicaid’s website.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
The NC Medicaid State Plan Amendment for Peer Support Services was approved by the Centers for Medicare & Medicaid Services on Oct. 23, 2019, with an effective date of July 1, 2019. The clinical coverage policy will be posted with an effective date of Nov. 1, 2019.
The NC Medicaid Electronic Health Record Incentive Payment System is only accepting Program Year 2019 Stage 3 Meaningful Use attestations.
Effective with date of service Aug. 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover lefamulin injection, for intravenous use (Xenleta) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
The Medicaid State Plan Amendment was approved by the Centers for Medicare & Medicaid Services with an effective date of Oct. 1, 2019. The clinical coverage policy was posted on Oct. 10, 2019 for an additional 15-day public comment period. Following the 15-day public comment period, the final Community Support Team policy will be posted with an effective date of Nov. 1, 2019.
NC Medicaid reimburses qualified providers for child medical evaluation and medical team conference services according to guidelines set forth in NC Medicaid policy 1A-5 Child Medical Evaluation and Medical Team Conference for Child Maltreatment.
NC Medicaid has updated its ICD-10 diagnosis code list. Diagnosis code K35.891 (other acute appendicitis without perforation, with gangrene) has been added as an acceptable ICD-10 diagnosis code effective Oct. 1, 2018.
A new or amended clinical coverage policy regarding facility-based crisis management for children and adolescents is available on NC Medicaid’s website.
Unpaid medical bills and current medical expenses count toward NC Medicaid applicants’ deductibles. Private Duty Nursing (PDN) services qualify as a medical expense and may be used toward meeting this deductible.
As NC Medicaid’s managed care launch date approaches, Advanced Medical Home (AMH) providers who believe they are not ready to meet program requirements to perform at the tier level to which they attested may now submit a request to change their AMH Tier status from Tier 3 to Tier 2. The AMH Tier 3 providers may not downgrade lower than AMH Tier 2.