Temporary NC Medicaid Directives to Increase Beneficiary Access to Services during Hurricane Florence

Reimbursement for Medically Necessary Services during Hurricane Florence

North Carolina Medicaid and NC Health Choice will reimburse providers for medically necessary drugs and services, and equipment and supplies, provided during the Hurricane Florence emergency without prior approval (PA) starting Sept. 14 through Sept. 21, 2018. Medical documentation must support medical necessity.

In addition, beneficiaries who have been evacuated out-of-state (OOS), voluntarily or involuntarily, can receive medical care if needed and Medicaid and NC Health Choice will reimburse the OOS provider without prior approval. OOS providers must enroll as North Carolina Medicaid providers in an abbreviated, expedited process (OOS Lite) here: https://www.nctracks.nc.gov/content/public/providers/provider-enrollment.html .

Providers are encouraged to obtain a prior approval if it is possible to do so (and normally required for the service). All claims are subject to audit.

Expediting Nursing Home Admissions for Individuals Displaced due to Hurricane Florence

Providers should upload the signed Physician Signature form with their portal submissions to NCTracks. NCTracks is designed to receive long term care PA information in the FL2 format. NC Medicaid has temporarily suspended the requirement of a Pre-Admission Screening and Annual Resident Review (PASSR) number on the PA. Providers should add numbers 8888 in the PASRR number field and add a note on their portal submissions stating that the PASRR is unavailable due to Hurricane Florence emergency placement. In addition, providers should add all the pertinent information about the recipient’s levels of care needs in their portal submission.

Lastly, the Medicare requirement of 3-day qualifying hospital stay is waived for Medicaid beneficiaries who require a short-term stay in a Nursing Facility due to care needs or shelter needs related to Hurricane Florence for the period Sept. 12 through Sept. 26, 2018.

Critical Access Hospital (CAH) Bed Limit Lifted During Hurricane Florence

As outlined in 42 CFR 485.620(a), Condition of Participation: Number of Beds and Length of Stay, “Except as permitted for CAH having distinct part units under 42 CFR 485.647, the CAH maintains no more than 25 inpatient beds. Inpatient bed may be used for either inpatient or swing-bed services.”

For dates Sept. 14 through Sept. 21, 2018, Medicaid is lifting the limit of 25 beds to accommodate the needs of beneficiaries and providers due to the anticipated impact of Hurricane Florence.

Unless otherwise noted, these exceptions are in effect for dates of service from Sept. 14 through Sept. 21, 2018. After the storm has passed, the State will evaluate the need to extend the exceptions and will publish any changes.