NC Medicaid Updates Policies to Address COVID-19

Raleigh

NC Medicaid is implementing several policy changes in response to COVID-19 to slow the spread of the virus, support healthcare providers and protect more vulnerable North Carolinians. The policies, which will go into effect March 13, address pharmacy benefits, supplies and access to care and are designed to facilitate access for patients experiencing COVID-19 symptoms and to limit close contact for routine care, particularly for those at higher risk of severe illness.

People at higher risk of severe illness are adults over 65 years of age, those with underlying health conditions including heart disease, lung disease or diabetes, and people with weakened immune systems.

Policy updates include:

Supporting Access to Care

Home Visits. Medicaid has existing clinical policies to reimburse for home visits. Providers are encouraged to conduct home visits, especially for vulnerable populations and group living. 

Co-pays. Providers are reminded that co-pays are not required at the time of the office visit; a Medicaid patient should never be turned away for inability to pay a co-pay.

Virtual Consultation. Providers will be able to bill Medicaid for evaluations provided virtually by telephone for established patients who:

  • Are actively experiencing mild symptoms of COVID-19 (fever, cough, shortness of breath) or to assess prior to going to the emergency department, urgent care or other health care facility.
  • Need routine, uncomplicated follow up and who are not currently experiencing symptoms of COVID-19.
  • Would benefit from behavioral health assessment and management.

Limiting In-Person Pharmacy Interactions

Supply Quantity. Medicaid beneficiaries will be able to access longer supply of prescribed medicine.

  • Beneficiaries will be allowed to obtain a 90-day supply of prescribed medicine, excluding controlled substances, for both generic and brand-name drugs. NC Medicaid has removed the 30-day wait requirement to qualify for a 90-day supply.
  • Early refills will be allowed to coordinate care. 
  • Beneficiaries can receive an extended 14-day emergency supply of medicines that require a prior authorization (up from a 3-day supply).
  • Providers are encouraged to write prescriptions for a 90-day supply and pharmacies are encouraged to fill 90 day supplies whenever possible

Access to Needed Medicines. NC Medicaid will be tracking pharmaceutical supplies to respond quickly to modify the Preferred Drug List for Medicaid as needed.

Accessing Medical Supplies

  • Providers of medical equipment and supplies may be reimbursed for providing masks to ill patients who require frequent transportation or attend public places for treatment such as dialysis.
  • Providers will not need prior authorization in order to initiate new orders for oxygen and related respiratory supplies.
  • If medically necessary, oxygen equipment and supplies, respiratory assist devices, CPAPs and ventilators that typically require prior authorization may be provided to beneficiaries without first seeking prior authorization.

These new Medicaid policies will go into effect March 13. Additional details and guidance will be available online at www.medicaid.ncdhhs.gov/coronavirus.

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