Medicaid Bulletin

Procedures for Prior Authorization of Synagis® (palivizumab) for Respiratory Syncytial Virus Season 2019-2020

Tuesday, October 1, 2019

The clinical criteria used by NC Medicaid for the 2019-2020 Respiratory Syncytial Virus (RSV) season are consistent with guidance published by the American Academy of Pediatrics (AAP): 2018 – 2021 Report of the Committee on Infectious Diseases, 31st Edition. This guidance for Synagis use among infants and children at increased risk of hospitalization for RSV infection is available online by subscription. The coverage season is Nov. 1, 2019, through March 31, 2020. Providers are encouraged to review the AAP guidance prior to the start of the RSV season.

Clarification on Family Supplementation of PCS Medicaid Benefit

Tuesday, October 1, 2019

On Jan. 29, 2013, NC Medicaid issued a memorandum giving guidance on the subject of Guidance for Family Supplementing Payment to the Medicaid Benefit. Several adult care home (ACH) providers have recently referenced this memorandum when inquiring about payment supplements specifically related to the provision of Personal Care Services (PCS) to recipients of special assistance. 

Trastuzumab-anns for Injection, for Intravenous Use (Kanjinti™) HCPCS code J9999 - Not Otherwise Classified, Antineoplastic Drugs: Billing Guidelines

Tuesday, October 1, 2019

Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover trastuzumab-anns for injection, for intravenous use  (Kanjinti™) for use in the Physician Administered Drug Program (PADP) when billed with Healthcare Common Procedure Coding System (HCPCS) code J9999 - not otherwise classified, antineoplastic drugs.

Clinical Coverage Policy Update

Tuesday, October 1, 2019

Several new or amended clinical coverage policies are available on NC Medicaid’s website.

Bevacizumab-awwb injection, for Intravenous Use (Mvasi™) HCPCS Code Q5107 - Injection, Bevacizumab, (Mvasi™), 10 mg: Billing Guidelines

Tuesday, October 1, 2019

Effective with date of service July 22, 2019, the North Carolina Medicaid and NC Health Choice programs cover bevacizumab-awwb injection, for intravenous use (Mvasi™) for adult use in the Physician Administered Drug Program when billed with HCPCS code Q5107 - Injection, bevacizumab, (Mvasi™), 10 mg.

SPECIAL BULLETIN: Community Alternatives Program for Disabled Adults Waiver Renewed by CMS

Tuesday, October 1, 2019

The Community Alternatives Program for Disabled Adults (CAP/DA) §1915(c) Home and Community-Based Services (HCBS) waiver application has been renewed by the Centers for Medicare and Medicaid Services (CMS), effective Nov. 1, 2019 through Oct. 31, 2024.

SPECIAL BULLETIN: Medicaid Bulletin Improvements: New Frequency and Format Starts October 15

Friday, September 27, 2019

Beginning Oct. 15, 2019, North Carolina Medicaid Bulletin articles will be delivered more often and in an online format. The improvements are in response to feedback from providers looking for a flexible way to receive important Medicaid information to better serve beneficiaries and more effectively operate their businesses.

SPECIAL BULLETIN: UPDATE on NC Medicaid Temporary Flexibilities due to Hurricane Dorian

Tuesday, September 24, 2019

*NOTE: THE CONTENT OF THIS BULLETIN IS AN UPDATE TO A MEDICAID SPECIAL BULLETIN PREVIOUSLY PUBLISHED ON SEPT. 5, 2019 REGARDING FLEXIBILITIES RELATED TO HURRICANE DORIAN.

This Special Bulletin includes several articles regarding Hurricane Dorian.

SPECIAL BULLETIN: Provider Contracting Deadline: Nov. 15, 2019 Questions and Answers

Monday, September 23, 2019

For inclusion in auto-enrollment, provider contracts must be signed and mailed to the health plans no later than Nov. 15, 2019. A list of questions and answers is provided for reference regarding this deadline.

SPECIAL BULLETIN: Provider Contracts Due to Health Plans by Nov 15, 2019

Monday, September 23, 2019

For inclusion in auto-enrollment, provider contracts must be signed and mailed to health plans no later than Nov. 15, 2019.

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