Clinical review is not required for North Carolina Medicaid and NC Health Choice hospice services until after the completion of the first and second 90-day benefit period.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective July 1, 2019, NC Medicaid will make changes to the North Carolina Medicaid and NC Health Choice Preferred Drug List.
Registration is open for the July 2019 instructor-led provider training courses. Slots are limited.
Due to the implementation of Centers for Medicare and Medicaid Services (CMS) FY 2016 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Final Rule, NC Medicaid made policy and system changes to allow for the use of two-tier hospice fee schedules effective Jan. 1, 2016.
Effective with date of service April 4, 2019, the North Carolina Medicaid and NC Health Choice programs cover coagulation factor Xa (recombinant), inactivated-zhzo lyophilized powder for solution for intravenous injection (Andexxa) for use in the Physician Administered Drug Program when billed with HCPCS code J3590 - Unclassified biologics.
New or amended clinical coerage policies are available on NC Medicaid's website.
The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.
NC Medicaid has received approval from the Centers for Medicare and Medicaid Services (CMS) to increase rates for Evaluation and Management (E&M) procedure codes, as defined in Section 1202 of the Affordable Care Act (ACA) and paid to primary care physicians, nurse practitioners and physician assistants. In addition to the ACA primary care practitioners, obstetricians and gynecologists will also be included as primary care physicians.
The Contract for Prepaid Health Plan Services (the State Contract) between the Department of Health and Human Services (the Department) and the selected Medicaid Managed Care plans (i.e., Prepaid Health Plans or PHPs) indicates that contracts between PHPs and providers shall comply with the terms of the State Contract and must be approved by the Department.
The Division of Health Benefits (NC Medicaid) has received approval from the Centers for Medicare & Medicaid Services (CMS) to increase the rate for code T2003 Non-Emergency Transportation, Encounter/Trip for Ambulance Non-Emergency Medical Transportation (NEMT) Services.