Issued: October 2, 2024
The North Carolina Department of Health and Human Services has issued extension of temporary flexibilities for Medicaid services through Oct. 15, 2024. The flexibilities began Sept. 26 and were originally set to expire on Oct. 2, 2024.
The flexibilities went into effect following an executive order by Governor Roy Cooper declaring a state of emergency in anticipation of severe weather caused by the approach of Hurricane Helene. The hurricane made landfall on Sept. 26 in Florida’s Big Bend region as a Category 4 hurricane, moving through Georgia, South Carolina and Tennessee before dumping large amounts of rainfall in North Carolina’s mountain counties. Many of our communities were left underwater with widespread power outages. Recovery efforts are expected to be lengthy.
NC Medicaid is committed to North Carolina’s response to and recovery from Hurricane Helene. This bulletin describes the flexibilities for NC Medicaid and MC Medicaid Managed Care.
Bulletin link:
What is happening?
NC Medicaid has implemented flexibilities for services from Sept. 26 through Oct. 15 due to the impact of Hurricane Helene. The flexibilities pertain to both NC Medicaid Direct and NC Medicaid Managed Care (Tailored Plans and Standard Plans.) The flexibilities are laid out in this bulletin from NCDHHS.
Flexibilities include:
Reimbursement for Medically Necessary Services: NC Medicaid Direct and NC Medicaid Managed Care (Tailored Plans and Standard Plans) will reimburse providers for medically necessary drugs and services, and equipment and supplies, provided during the Hurricane Helene emergency without prior authorizations.
Medicaid PA Override: NC Medicaid enrolled pharmacy providers have been approved to override PA requirements.
Early prescription refills during the Governor’s state of emergency declaration: NC Medicaid enrolled pharmacy providers have been approved to early fill prescriptions and will follow applicable copay requirements.
What do providers need to do?
The Centers for Medicare & Medicaid Services (CMS) gave approval effective Oct. 1, 2024, for an expedited process for health care providers to become a NC Medicaid provider due to a natural disaster. This process is available to enroll with a begin date of Sept. 25, 2024. The process will remain available through Oct. 15, 2024, and is not for providers who are already enrolled with NC Medicaid.
Providers can apply to deliver services due to Hurricane Helene by accessing the Disaster Relief Provider Enrollment Application Job Aid (PRV703) located under Quick Links on the NCTracks Provider Enrollment homepage.
Providers must indicate the application is for Disaster Relief by answering “Yes” to the Disaster Relief enrollment question on the Basic Information page of the application.
Providers should check NC Medicaid eligibility in NCTracks to confirm beneficiary enrollment in NC Medicaid and to determine which health benefit the beneficiary is enrolled in: NC Medicaid Direct, Tailored Plan or Standard Plan.
Review the bulletin with the complete list and details on flexibilities here. Topics covered under the flexibilities include, but are not limited to:
- Disaster Relief Applications Available for Health Care Providers Not Currently Enrolled as a NC Medicaid Provider
- Expanded Ability for Hospital Swing Beds
- Reimbursement for medically necessary services during Hurricane Helene
- Medication PA overrides due to Hurricane Helene
- Early prescription refills during the Governor’s state of emergency declaration
- Expediting Nursing Home Admissions for Individuals Displaced due to Hurricane Helene
- Temporary PASRR Procedures Due to Hurricane Helene
- State Plan Personal Care Services
- Private Duty Nursing
- Innovations and Traumatic Brain Injury (TBI) waiver flexibility due to Hurricane Helene
- Reminder: Hospital at Home Program Remains Active
- Community Alternatives Program for Children (CAP/C) and Community Alternatives Program for Disabled Adults (CAP/DA) – Medicaid Direct only
Who can providers call if they have questions?
- Partners Provider Services: 1-877-398-4145
- NCTracks Call Center: 800-688-6696
- Provider Ombudsman: 866-304-7062, Medicaid.ProviderOmbudsman@dhhs.nc.gov