Medicaid Bulletin

This Bulletin updates rates previously published in SPECIAL BULLETIN COVID-19 #152 and SPECIAL BULLETIN COVID-19 #160. Effective March 15, 2021, NC Medicaid is aligning reimbursement for COVID-19 vaccine administration with the CMS increased Medicare rate of $40 per dose.

To support the DHHS goals to achieve health equity, NC Medicaid is introducing an enhanced payment to Carolina Access primary care practices serving beneficiaries from areas of the state with high poverty rates.

DHHS is releasing an addendum to the Tailored Care Management Provider Manual on community inclusion that addresses the in-reach and transition requirements for Advanced Medical Home Plus practices and Care Management Agencies delivering Tailored Care Management.

It has come to the attention of NC Medicaid that Edit 02088, which enforces a rule that coverage of procedure code G9919 for Healthy Opportunities Screening, Assessment and Referrals (HOSAR) positive screenings, be limited to providers affiliated with Carolina Access II based on the rendering provider NPI. 

The implementation date of Electronic Visit Verification for LME-MCOs has been extended to June 30, 2021.

Key Dates for Transitioning to Medicaid Managed Care, PHP Quick Reference Guides Created, Provider Contracting Reminders, Provider Playbook Updates, Medicaid Contacts Reference Guide for Beneficiaries, Help Center, Webinars, Virtual Office Hours, Meet and Greet Sessions. 

Beginning April 1, 2021, NC Medicaid will begin strictly applying its timeline business rules for the receiving, processing and closing out referral requests.

The five-year cost of dispensing (COD) survey has been completed for NC pharmacies.

The U.S. Food and Drug Administration has issued an Emergency Use Authorization for the unapproved products, bamlanivimab and etesevimab to be administered together for qualifying patients. 

Janssen COVID-19 vaccine is authorized for use under an Emergency Use Authorization (EUA) for active immunization to prevent coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 18 years of age and older.