Medicaid Bulletin

NC Medicaid Electronic Health Record Incentive Program Announcements

Tuesday, August 4, 2020

NC-MIPS is Open for Program Year 2020, Program Year 2020 Webinar Series and The Security Risk Analysis (SRA)

HCPCS Code (J codes) Quarterly Update July 2020

Tuesday, August 4, 2020

Effective with the date of service July 1, 2020, the Centers for Medicare and Medicaid Services (CMS) has added new HCPCS codes (J codes), deleted others, and changed the description of some existing codes.

SPECIAL BULLETIN COVID-19 #117: NCDHHS RFAs to Support Communities Hard Hit by COVID-19

Monday, August 3, 2020

NC Department of Health and Human Services has announced two Requests for Applications (RFAs) to help communities heavily affected by COVID-19.

Clinical Coverage Policies

Tuesday, July 28, 2020

The following new or amended clinical coverage policies are available on the Clinical Coverage Policies web page on NC Medicaid’s website. 

SPECIAL BULLETIN COVID-19 #116: New Webinar to Support Medicaid Providers Applying for Federal Relief Funds

Friday, July 24, 2020

Webinar for Medicaid Providers to be held July 27 at 3 p.m and Application Deadline Extended to Aug. 3.

Update of the Minimum Data Set (MDS) 3.0 Items

Tuesday, July 21, 2020

On May 15, 2020, the Centers for Medicare & Medicaid Services (CMS) updated the Minimum Data Set (MDS) 3.0 item sets (version 1.17.2) to support the calculation of Patient-Driven Payment Model (PDPM) case mix groups on all Omnibus Budget Reconciliation Act (OBRA) assessments.

SPECIAL BULLETIN COVID-19 #115: Targeted Rate Increase and Associated Requirements for Swing Bed Services

Tuesday, July 21, 2020

NC Medicaid is implementing time-limited, targeted, enhanced swing bed reimbursement rates to provide additional financial support to hospitals that provide post-acute care services to COVID-19 positive (“COVID+”) Medicaid beneficiaries and non-COVID+ Medicaid beneficiaries transferred from other acute care hospitals as part of a surge response.  

Daratumumab and Hyaluronidase-fihj Injection, for Subcutaneous Use (Darzalex Faspro™) HCPCS Code J9999: Billing Guidelines

Tuesday, July 21, 2020

Effective with date of service May 6, 2020, the Medicaid and NC Health Choice programs cover daratumumab and hyaluronidase-fihj injection, for subcutaneous use (Darzalex Faspro™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J9999 - Not otherwise classified, antineoplastic drugs.

Continuous Glucose Monitoring Systems Coverage Transition

Tuesday, July 21, 2020

Effective July 1, 2020, coverage of therapeutic Continuous Glucose Monitoring (CGM) products is transitioning from the Durable Medical Equipment (DME) Program to the Outpatient Pharmacy Point of Sale (POS) Program. 

SPECIAL BULLETIN COVID-19 #114: Hospice Room and Board Reimbursement Rate Increase and Clarification of COVID-19 Rate Billing Guidelines for Skilled Nursing Facilities and Hospice Providers

Monday, July 20, 2020

This NC Medicaid Bulletin provides an  overview of COVID-19 rate increases applicable to SNFs and Hospice providers; Hospice provider rate increase from 95% to 100% of Skilled Nursing Facility (SNF) reimbursement rates for room and board services provided in a SNF; and billing guidelines for Hospice services provided in a SNF designated as a “COVID-19 Outbreak” or “COVID-19 Response” site.

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Articles beginning January 2018 are available in the blog format.

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