Medicaid Bulletin

Emapalumab-lzsg Injection, for Intravenous Use (Gamifant™) HCPCS code J9210: Billing Guidelines

Tuesday, June 16, 2020

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.

SPECIAL BULLETIN COVID-19 #99: North Carolina General Assembly Mandates Temporary 5% Rate Increase for Certain Medicaid Providers

Monday, June 15, 2020

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. 

SPECIAL BULLETIN COVID-19 #100: Hospice Provider COVID-19 Rate Structure Clarifications

Monday, June 15, 2020

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. 

SPECIAL BULLETIN COVID-19 #98: COVID-19 Knowledge Center Now Available: A Convenient Way for Providers to Find Information

Thursday, June 11, 2020

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.

SPECIAL BULLETIN COVID-19 #97: Webinar Update for Behavioral Health and I/DD Providers

Wednesday, June 10, 2020

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.

Trastuzumab-dttb for Injection, for Intravenous Use (Ontruzant®) HCPCS Code Q5112: Billing Guidelines

Tuesday, June 9, 2020

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.

Tailored Care Management Update

Tuesday, June 9, 2020

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. 

SPECIAL BULLETIN COVID-19 #96: Clinician and Laboratory Guidance Including Testing and Supplies

Tuesday, June 9, 2020

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.

New Information Required in Applications for Individual Providers Enrolling in Medicaid and NC Health Choice

Monday, June 8, 2020

Effective July 26, 2020, changes will be made to initial enrollment, re-enrollment, re-verification applications and manage change requests (MCRs) for individual providers (excluding disaster relief and Out of State Lite providers). The updates include the addition of a new page, as well as additional exclusion sanction questions. 

SPECIAL BULLETIN COVID-19 #95: HIV Case Management Policy Allowances

Friday, June 5, 2020

NC Medicaid will allow temporary changes to Clinical Coverage Policy 12B for Written Physician Orders, Use of Remote Technology and Signature Requirements. 

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