Medicaid Bulletin

Primary Care Provider Practice Reassignment for Some Beneficiaries

Thursday, April 1, 2021

NCDHHS has implemented a PCP practice reassignment process to better match beneficiaries to the PCP with whom they already have an active relationship with to help ensure the best health plan is selected during auto-enrollment.

Community Alternatives Program for Children Waiver Renewal Stakeholder Engagement

Wednesday, March 31, 2021

Upcoming stakeholder sessions are announced for the Community Alternatives Program for Children (CAP/C) waiver, which will expire on Feb. 28, 2022. By October 2021, NC Medicaid will submit a request to the Centers for Medicare and Medicaid Services (CMS) to renew the CAP/C waiver.  

Remimazolam for Injection, for Intravenous Use (Byfavo™) HCPCS Code J3490: Billing Guidelines

Tuesday, March 30, 2021

Effective with date of service Jan. 28, 2021, the Medicaid and NC Health Choice programs cover remimazolam for injection, for intravenous use (Byfavo™).

Clinical Policy 1E-7, Family Planning Services Revised Effective May 1, 2021

Tuesday, March 30, 2021

An amended version of Clinical Coverage Policy 1E-7, Family Planning Services, with an effective date of May 1, 2021, will post to the NC Medicaid Clinical Coverage Policy webpage.

Clinical Policy 1A-41: Office-Based Opioid Treatment

Tuesday, March 30, 2021

Clinical Coverage Policy 1A-41, Office-Based Opioid Treatment is being updated to add buprenorphine for the treatment of patients aged 16 years and older.

Cabotegravir and Rilpivirine Co-Packaged for IM Use (Cabenuva™) HCPCS Code J3490: Billing Guidelines

Tuesday, March 30, 2021

Effective with date of service Feb. 1, 2021, the Medicaid and NC Health Choice programs cover cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension, co-packaged for intramuscular use (Cabenuva™).

Electronic Visit Verification Implementation: Extension of Pay and Report Period

Monday, March 29, 2021

NC Medicaid will extend the pay and report period for providers subject to Electronic Visit Verification (EVV) past the original cutoff date of March 31, 2021. Medicaid will provide 30 days’ notice prior to the conclusion of pay and report.   

Electronic Visit Verification for CAP/C and CAP/DA Waiver Beneficiaries

Tuesday, March 23, 2021

This Bulletin gives guidance on the use of EVV for the Community Alternatives Programs for Children and Disabled Adults (CAP/C and CAP/DA) to ensure compliance with Section 12006 of the 21st Century Cures Act. 

SPECIAL BULLETIN COVID-19 #163: Temporary Provider Rate Increases and Clinical Policy Changes Extended

Monday, March 22, 2021

NC Medicaid is extending COVID-19 temporary provider rate increases and clinical coverage policies through June 30, 2021.

SPECIAL BULLETIN COVID-19 #162: Medicaid Rate Increases for COVID-19 Vaccine Administration Codes

Friday, March 19, 2021

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.

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