Medicaid Bulletin

The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website.

North Carolina Department of Health and Human Services (DHHS) developed a program to reimburse primary care providers (PCP) with federal funds for providing medical care for COVID-19 related services to uninsured North Carolina residents. 

NC DHHS awarded a contract to Sandata Technologies, LLC on Sept. 24, 2020, and will implement services for Electronic Visit Verification (EVV) statewide on Jan. 1, 2021. EVV is a method used to verify visit activity for services delivered as part of home- and community-based service programs. EVV offers a measure of accountability to help ensure that individuals who are authorized to receive services in fact receive them.

North Carolina’s Breast and Cervical Cancer Control Program has changed the criteria to allow additional providers who screen and diagnose women for breast and cervical cancer to refer to Breast and Cervical Cancer Medicaid.

As NC Medicaid moves forward with its planned implementation of NC Medicaid Managed Care, it is important for enrolled providers to act now to thoroughly review their individual and organization provider enrollment record in NCTracks.

NC Medicaid has received federal approval of additional flexibilities during the COVID-19 pandemic for the NC Innovations Waiver, for individuals with intellectual and developmental disabilities (IDD).

The North Carolina Department of Health and Human Services and North Carolina AHEC are offering two monthly evening webinar series to help prepare providers, practice managers and quality managers engage with NC Medicaid. 

Amended policies will post to the NC Medicaid Clinical Coverage Policies website with an effective date of Oct. 1, 2020. 

Effective with date of service Aug. 13, 2020, the Medicaid and NC Health Choice programs cover tafasitamab-cxix for injection, for intravenous use (Monjuvi®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Strong infection prevention and control practices are critical to reducing the transmission of COVID-19 within long-term care facilities. NC DHHS is reiterating its expectation that providers participate in the infection prevention and control activities.