Clinical Policy and Programs
Patti Forest, MD, MBA- Acting Assistant Director for Clinical Policy and Programs
Phone - (919) 855-4260
Fax - (919) 733-2796
Mark W. Casey, DDS, MPH -
Dental Director
Phone - (919) 855-4280
Fax - (919) 715-2738
Patti Forest, MD, MBA - Medical Director
Phone - (919) 855-4290
Fax - (919) 715-7679
Clinical Policy and Programs Mission
The mission of Clinical Policy and Programs Section is to structure benefits available to Medicaid clients in a manner that promotes access to medically necessary and cost-effective care.
Clinical Policy and Programs Section :
The Clinical Policy and Programs Section of the Division of Medical Assistance is responsible for the overall administration of programs and clinical services covered in the North Carolina Medicaid Program. The section's staff develops clinical coverage policies and procedures, administers those policies and procedures, manages associated programs and contracts and provides related educational activities. Clinical Policy coordinates with other sections within the Division who are responsible for determining eligibility, reimbursement and monitoring program integrity of all covered services. Clinical Policy also provides program information to Medicaid recipients, service providers, and the general public. Below are the major program categories within the Clinical Policy and Programs Section:
Practitioners/Clinics - Physicians, Chiropractors, Podiatrists, Clinics, Laboratories/X-ray, Ambulance, Dialysis, Nurse Practitioners/Certified Nurse Midwives, Anesthesia, Baby Love/Child Service Coordination , Family Planning, Telemedicine, Illegal Aliens
Facility/Community Care - Hospitals, Nursing Facilities, Adult Care Homes, Transplant Services, Home Health , Private Duty Nursing, Personal Care Services, Hospice, CAP/Disabled Adults, CAP/Children, Home Infusion Therapy, HIV Case Management
Durable Medical Equipment
Optical
Hearing Aids
Behavioral Health/Specialized Therapies - Mental Health/Developmental Disabilities/Substance Abuse Services (MH/DD/SAS), CAP/MR/DD, Residential Treatment (Residential Child Care, Psychiatric Residential Treatment Facilities), Development Evaluation Centers/Childrens Developmental Service Agencies, Outpatient Specialized Therapies, Independent Practitioners, Local Education Agencies (LEAs), Psychological Services in Health Departments and School Based Health Centers Sponsored by Health Departments to the Under 21 Population
Outpatient Pharmacy Program (Outpatient Pharmacy Program)
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