Medicaid Bulletin

Considering the challenges providers are facing with COVID-19 pandemic, Medicaid is extending the due date for March 31, 2020, credit balance reports by 90 days. The extension will allow providers to submit their March 31 and June 30, 2020, credit balance reports. All credit balance reports for March 31 and June 30, 2020, quarter ends will be due July 30, 2020.

Effective April 16, 2020, any Assertive Community Treatment (ACT) team or Individual Placement and Support (IPS) team that met fidelity prior to the State of Emergency related to COVID-19 will continue to meet Medicaid and State-funded services policy requirements through the end of the declared State of Emergency.

Effective April 20, 2020, NC Medicaid is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability Clinical Coverage Policy 8C: Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic. This guidance on allowing telephonic outpatient psychotherapy is in addition to the telehealth flexibilities previously added.

During the period of the State of Emergency, supervisory visits must be conducted, but may be conducted utilizing eligible technologies that allow the supervising registered nurse to remotely communicate and evaluate services rendered. Supervisory visits can be delivered via any HIPAA-compliant, secure technology with audio and video capabilities including (but not limited to) smart phones, tablets and computers.

To avoid delays in beneficiaries receiving needed private duty nursing services, NC Medicaid is temporarily approving prior authorizations that are in pending status for documentation of validation of primary insurance for 60 calendar days. This will allow for the delayed verification responses from individual third-party insurance providers to be uploaded to the prior authorizations in NCTracks. Details regarding documentation, supervisory visits and eligible remote technologies are included in this bulletin.

Congress has enacted three significant stimulus packages to help the country weather the COVID-19 pandemic, which establish a variety of funding sources to support providers, each with distinct features including which provider types are eligible, if providers must apply to be considered and if the financial benefit is a grant or a loan that must be repaid. NC Medicaid has created a summary of financial relief available by provider type.

NC Medicaid has received federal approval of flexibilities during the COVID-19 crisis for the NC Innovations Waiver for individuals with intellectual and developmental disabilities (IDD); NC Traumatic Brain Injury (TBI) Waiver for individuals who have a TBI diagnosis after age of 21; Community Alternatives Program for Disabled Adults (CAP/DA) for disabled adults and the Community Alternatives Program for Children (CAP/C) for medically fragile children.

Note: Additional Family Planning guidance may be released in the future, which would replace this bulletin.

Effective April 1, 2020, in response to the anticipated spread of coronavirus (COVID-19) in North Carolina, NC Medicaid is adding "U07.1 - 2019-nCoV Acute Respiratory Disease" as a billable diagnosis. Additionally, diagnosis code U07.1 is being added to the list of diagnoses exempt from the annual visit limit also effective April 1.  

Effective retroactive to March 10, 2020, Medicaid and NC Health Choice plans are temporarily covering weight scales and adding a purchase option for portable pulse oximeters.