Medicaid Bulletin
Advanced Medicaid Home Update
Nearly 2,900 North Carolina Medicaid providers have already certified as Advanced Medical Homes (AMHs). It is important that practices understand the meaning of this designation and the associated requirements on primary care providers (PCPs).
Clinical Coverage Policy Update
New or amended clinical coverage policies are available on NC Medicaid’s website.
SPECIAL BULLETIN: Medicaid Managed Care Provider Training Opportunity - Managed Care Transformation 101
NC Medicaid has developed a general overview and topic-based webinar series that will educate providers to effectively support their transition to Medicaid Managed Care. General webinars are designed to give providers an overview of major changes and important things to know while the focused, topical webinar series will offer a deeper dive on specific topics.
SPECIAL BULLETIN: Community Alternatives Program for Disabled Adults In-Home Aide and Oral Nutritional Supplement Rate Increase
Session Law 2017-57, Section 11H.13/(a) was amended to appropriate funding to be used to increase the rate for in-home aide services to no more than three dollars and ninety cents ($3.90) paid per 15-minute billing unit provided under the Community Alternatives Program for Disabled Adults (CAP/DA) waiver pursuant to Clinical Coverage Policy 3K-2, effective Jan. 1, 2019.
SPECIAL BULLETIN: Community Alternatives Program for Disabled Adults Waiver Application Submittal
A renewal application for § 1915 (c) Home and Community-Based Services (HCBS) waiver for the Community Alternatives Program for Disabled Adults (CAP/DA) was submitted to the Centers for Medicare & Medicaid Services (CMS) on Mar. 1, 2019 for review and approval.
Centers for Medicare and Medicaid Services (CMS) Approved the State Plan Amendment for Adult Optical Services
NC Medicaid received approval from CMS for the State Plan Amendment for Adult Optical Services. Effective Feb. 10, 2019, providers may bill for routine eye exams and visual aids for adult Medicaid beneficiaries with dates of service on or after Jan. 1, 2019.
Request for Proposal for Independent Assessment Entity for Long-Term Services and Supports
NC Medicaid has approved the release of a Request for Proposal (RFP) for an independent assessment entity (IAE) that will streamline access to Medicaid Long-Term Services and Supports (LTSS) effective July 2019. The IAE will provide beneficiaries a much-needed single point of entry for accessing Medicaid LTSS services and streamline the processes between initial contact and service enrollment.
Summary of New or Amended Clinical Coverage Policies Posted Since Jan. 1, 2019
The following new or amended clinical coverage policies are available on NC Medicaid’s website:
Optical Services are Non-Covered for Medicare Qualified Beneficiary (MQB), Family Planning Waiver (MAFD), and Program of All-inclusive Care for the Elderly (PACE)
Under the MQB Medicare Eligibility Codes, Medicaid pays only for Medicare Part B premiums or premiums, deductibles, and coinsurance for charges covered by Medicare. Routine eye exams, refraction only and visual aids are not covered by Medicare for MQB beneficiaries. Therefore, MQB beneficiaries are not eligible for Medicaid optical services.
Levoleucovorin, for intravenous use (Khapzory™) HCPCS code J3490: Billing Guidelines
Effective with date of service Dec. 17, 2018, the North Carolina Medicaid and NC Health Choice programs cover levoleucovorin for injection, for intravenous use (Khapzory) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs.
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