Medicaid Bulletin

SPECIAL BULLETIN COVID-19 #81: Hospice Clinical Coverage Policy: Changes due to CMS Amendment and Other Flexibilities

Monday, May 4, 2020

On March 30, 2020, the Centers for Medicare & Medicaid Services (CMS) announced an amendment of 42 CFR 440.70 that included two policy changes that affect hospice services for Medicaid during the COVID-19 pandemic. Effective March 30, 2020, NC Medicaid is adjusting hospice requirements currently in Clinical Coverage Policy 3D, Hospice Services to align with these recent CMS regulatory changes. 

SPECIAL BULLETIN COVID-19 #75: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Behavioral Health Service Flexibilities – Innovations and TBI Waivers Appendix K and Developmental Disability State Funded Benefit Plans

Friday, May 1, 2020

Effective April 30, 2020, NC Medicaid in partnership with the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability (I/DD) Clinical Coverage Policies to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic. 

SPECIAL BULLETIN COVID-19 #76: Telehealth and Virtual Patient Communications Clinical Policy Modifications - Behavioral Health Service Flexibilities – (b)(3) Services

Friday, May 1, 2020

Effective April 30, 2020, NC Medicaid in partnership with the DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS), is temporarily modifying its Behavioral Health and Intellectual and Developmental Disability (I/DD) Clinical Coverage Policies to better enable the delivery of care to NC Medicaid, NC Health Choice and State-funded individuals in response to the COVID-19 Pandemic. 

SPECIAL BULLETIN COVID-19 #77: Telehealth and Virtual Patient Communications Clinical Policy Modifications – End Stage Renal Disease Services

Friday, May 1, 2020

NC Medicaid has temporarily modified its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and Health Choice beneficiaries.

SPECIAL BULLETIN COVID-19 #78: Telehealth and Virtual Patient Communications Clinical Policy Modifications – Hybrid Telemedicine with Supporting Home Visit

Friday, May 1, 2020

Update (May 8, 2020) 

  • Bulletin #78 includes information that Local Health Department (LHDs), Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes and Rural Health Clinics (RHCs) may use, as outlined in “Telemedicine with Supporting Home Visit” below, hybrid telemedicine with supporting home visit model when the telemedicine visit is rendered by an eligible provider. 
  •  Section “C. Coding Guidance” includes instructions that providers should choose the most appropriate code based on the complexity of the services provided. 

SPECIAL BULLETIN COVID-19 #79: Telehealth and Virtual Patient Communications Clinical Policy Modifications – Skilled Nursing Facilities

Friday, May 1, 2020

NOTE: SPECIAL BULLETIN COVID-19 #79 has been replaced in its entirety by SPECIAL BULLETIN COVID-19 #103. This Bulletin clarifies that skilled nursing facilities (SNF) are eligible originating sites for telemedicine visits and enables such facilities to bill for a facility fee when a beneficiary located in a SNF receives care via telemedicine from an eligible remote provider.  

SPECIAL BULLETIN COVID-19 #80: NC Medicaid Temporarily Increasing Flexibility and Reimbursement Rates for Primary and Specialty Care Providers

Friday, May 1, 2020

NC Medicaid is temporarily adding Telemedicine and Telepsychiatry clinical coverage codes for specialty providers and increasing reimbursement rates for telephonic visits and primary care medical home per member per month fees to help primary and specialty care providers continue to serve patients during the COVID-19 emergency.

SPECIAL BULLETIN COVID-19 #70: Addition of Mailing and Delivery Fees to Retail Pharmacy Claims

Thursday, April 30, 2020

Effective April 27, 2020, prescriptions for NC Medicaid and NC Health Choice beneficiaries are eligible for the addition of a mailing or delivery fee via the guidelines below. NC Medicaid encourages beneficiaries to request, and pharmacy providers to mail or deliver prescriptions to beneficiaries, during the COVID-19 pandemic to achieve better social distancing within their community.

SPECIAL BULLETIN COVID-19 #71: Extension of Temporary Suspension of Level I and Level II Assessments for New Nursing Home Admissions

Thursday, April 30, 2020

NC Medicaid temporarily suspended the requirement of Level I and Level II Preadmission Screening and Resident Reviews (PASRRs) for new nursing home admissions as well as the requirement of a PASRR number on the prior approval (PA).  The temporary suspension was due to COVID-19 and was in effect from March 25 – April 24, 2020, as noted in SPECIAL BULLETIN COVID-19 #15: Medicaid and NC Health Choice Temporary Flexibilities - 1135 Waiver Provisions.

SPECIAL BULLETIN COVID-19 #72: Additional Home Health Clinical Coverage Policy Provisions

Thursday, April 30, 2020

NC Medicaid has adjusted home health requirements currently in Home Health Clinical Coverage Policy No: 3A to align with a CMS regulatory change focused mostly on changes to the Medicare policy addressing COVID-19.

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