Effective with date of service April 23, 2020, the Medicaid and NC Health Choice programs cover sacituzumab govitecan-hziy for injection, for intravenous use (Trodelvy™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.
Medicaid Bulletin
Medicaid Bulletin Monthly Digest
Articles beginning January 2018 are available in the blog format.
Effective with date of service April 7, 2020, the Medicaid and NC Health Choice programs cover meloxicam injection, for intravenous use (Anjeso™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs.
Effective with date of service Dec. 28, 2019, the Medicaid and NC Health Choice programs cover emapalumab-lzsg injection, for intravenous use (Gamifant™) for use in the Physician Administered Drug Program (PADP) outpatient hospital setting (only) when billed with HCPCS code J9210 - Injection, emapalumab-lzsg, 1 mg.
Per Section 4.6 of the North Carolina General Assembly’s recently approved Session Law 2020-4 (House Bill 1043), NC Medicaid is implementing a 5% rate increase for all Fee-For-Service (FFS) Medicaid providers who had not yet received a 5% increase during the COVID-19 public health emergency.
NC Medicaid has implemented COVID-19 rate increase functionality to reimburse hospice care provided in a skilled nursing facility (SNF) designated as a “SNF COVID-Outbreak site” or “SNF COVID-Response site” in a ratio consistent with how hospice care is reimbursed in all other SNFs.
Medicaid and NC Health Choice providers now have a single source to find answers to questions about COVID-19. The online resource is a collection of Medicaid and behavioral health COVID-19 information, including answers to questions received in the COVID-19 mailbox, during webinars, from COVID-19 Special Medicaid Bulletins and other sources.
Panelists will present a structured PowerPoint presentation focused on Appendix K and Retention Payments for the Innovations Waiver on Thursday, June 11, 2020, at 3 p.m.
Effective with date of service April 15, 2020, the Medicaid and NC Health Choice programs cover trastuzumab-dttb for injection, for intravenous use (Ontruzant®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5112 - Injection, trastuzumab-dttb, biosimilar, (Ontruzant®), 10 mg.
In December 2019, DHHS released the draft Tailored Care Management Provider Manual and application questions for providers interested in becoming Advanced Medical Home Plus practices or Care Management Agencies. The Department received many thoughtful comments on the draft Provider Manual and has made several updates.
North Carolina is experiencing increased community transmission of COVID-19 in many areas of the state, particularly among our historically marginalized populations, especially our Latinx community. Pre-symptomatic and asymptomatic spread is playing an important role. Updated clinician and laboratory testing guidance and a new resource on community testing in historically marginalized populations are available.