Medicaid Bulletin

Effective March 27, 2020, North Carolina Medicaid is requiring prior approval for hydroxychloroquine and chloroquine containing products. Prior approval is required to ensure beneficiaries continue to have access to these medications for maintenance of their autoimmune conditions, for treatment of malaria, and for treatment of extraintestinal amebiasis.  

To offset potential hardships due to COVID-19, for NC Medicaid and Health Choice providers who were due to re-verify their enrollment between the dates of March 1, 2020 and June 30, 2020, NCTracks has reset your re-verification due date to Sept. 13, 2020. 

The Centers for Medicare & Medicaid Services (CMS) has granted NC Medicaid the authority to temporarily modify several Medicaid and NC Health Choice policies retroactive to March 1, 2020, and through the end of federal emergency declaration or when the flexibility is ended by the State or CMS

In response to the anticipated spread of the novel coronavirus (COVID-19) in North Carolina, NC Medicaid is adding the following diagnosis code to the list of diagnoses exempt from the annual visit limit:

In response to the anticipated spread of the novel coronavirus (COVID-19) in North Carolina, EviCore, NC Medicaid’s contracted vendor for imaging services, will auto-approve the following chest CT codes effective immediately:

The Outpatient Pharmacy point of sale (POS) adult and pediatric clinical edits for behavioral health medications will temporarily suspend effective March 23, 2020. These point of sale edits target dosages exceeding the FDA approved maximum limit and in class therapeutic duplication.  

Effective March 23, 2020, if medically necessary, outpatient Respiratory Therapy (RT) services provided through the Independent Practitioner Provider (IPP) program that typically require prior authorization (PA), may be provided to NC Medicaid and NC Health Choice beneficiaries without PA.

Effective March 23, 2020, if medically necessary, the following additional respiratory equipment and supplies that typically require prior authorization (PA) may be provided to beneficiaries without first seeking PA:

DHHS will host a question and answer webinar to discuss new guidance for all health providers related to COVID-19 on Tuesday, March 24, 2020, from 5:30-6:30 p.m.

NOTE: SPECIAL BULLETIN COVID-19 #9 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #34: Telehealth Clinical Policy Modifications - Defin