Medicaid Bulletin

NC Medicaid reimburses for the provision of the vaccine at the same rate as Medicare and is creating an additional payment to encourage access to vaccines during the Public Health Emergency.

Effective June 8, 2021, Medicaid will pay an extra $35, in addition to the standard administration payment (approximately $40 per COVID-19 vaccine dose), for a total payment of approximately $75 for a vaccine dose administered in a patient's home.

Effective Sept. 1, 2021, the Acute Hospital Care at Home (HAH) program will be available to North Carolina hospitals that have been granted a waiver from CMS and service NC Medicaid beneficiaries. NC Medicaid is planning to implement this program to be effective Sept. 1 through Dec. 31, 2021, unless this flexibility is terminated prior to Dec. 31, 2021.

The NCTracks provider record serves as the source of truth for managed care entities.

Due to the rapid increase in COVID infection and related hospitalization occupancy, NC Medicaid is reactivating its consideration of Response Facility Designation Requests submitted by skilled nursing facilities.

NC Medicaid licensed pharmacists are authorized to order and administer REGEN-COV monoclonal antibodies and pharmacy technicians/interns may administer it, in accordance with the conditions of their licensure and/or scope of practice.

NC Medicaid is extending all current COVID-19 temporary provider rate increases through Nov. 30, 2021. While the rate increases for providers authorized under SL 2020-4 were set to expire on June 30, 2021, NC Medicaid has discretion to continue these and other temporary rate increases assuming budget availability.

NC Medicaid Managed Care launched on July 1, 2021. Within the first 90 days of launch, beneficiaries can change their prepaid health plan (PHP) for any reason. The 90-day choice period ends on Sept. 30, 2021 for beneficiaries that moved to Managed Care on July 1, 2021.

Prepaid health plans are required to pay interest and penalties to providers if they fail to accurately pay or inappropriately deny a claim.

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