Medicaid Bulletin

Session Law 2018-5 Sec.11H.4 (see Appendix A) instructed the NC Department of Health and Human Services (DHHS) to submit to Centers for Medicare and Medicaid Services (CMS) for the necessary authority to establish Medicaid reimbursement for ambulance transports of Medicaid beneficiaries in behavioral health crisis to behavioral health clinics or other alternative locations effective July 1, 2019.

The Department of Health and Human Services (DHHS) will extend open enrollment for Medicaid beneficiaries and move to a statewide transition to managed care on Feb. 1, 2020.

Hematopoietic Stem Cell Transplantation (HSCT) clinical coverage policies have been revised. The revisions, which will become effective Oct. 1, 2019 are outlined below:

North Carolina’s state-designated health information exchange, NC HealthConnex, was created in 2015 by the North Carolina General Assembly to help bridge the gap between distinct electronic health record systems and health care networks to support whole patient care. With over seven million unique patient records and growing, NC HealthConnex is working to connect the state’s health care providers to deliver a holistic view of a patient’s record.

The North Carolina Division of Health Benefits (DHB) would like to reiterate the 340B provider and claim submission requirements for both the outpatient pharmacy and Physician’s Drug Program (PDP). 

Effective with date of service June 11, 2019, the North Carolina Medicaid and NC Health Choice programs cover polatuzumab vedotin-piiq for injection, for intravenous use (Polivy) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Supporting beneficiaries in their transition between the current fee-for-service delivery system and NC Medicaid Managed Care is called transition of care. The transitional period surrounding the launch of Medicaid Managed  Care is referenced as crossover.

A fully detailed outline of the influenza vaccine and reimbursement guidelines for 2019-2020 for North Carolina Medicaid and NC Health Choice was distributed in a Medicaid Special Bulletin on Aug. 27, 2019.

Effective with date of service Aug. 1, 2019, the North Carolina Medicaid and NC Health Choice programs cover infliximab-abda for injection, for intravenous use (Renflexis) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg.

The Department of Health and Human Services (DHHS) recently launched an online “Provider Playbook” as part of its commitment to ensure providers have resources to help Medicaid beneficiaries transition smoothly to Medicaid Managed Care. This new Provider Playbook is a collection of information and tools specifically tailored to providers.