In an effort to ensure optimal access to care for Medicaid beneficiaries, to support providers during the recent COVID-19 surge, and to alleviate potential provider payment concerns, DHHS and the prepaid health plans (PHPs) have agreed to extend the policy for out-of-network flexibilities to providers who have not yet contracted with a PHP through Nov. 30, 2021. These flexibilities were originally expected to sunset on Aug. 30, 2021.
Under this policy, the PHPs have agreed to:
- Permit uncontracted, out of network providers enrolled in NC Medicaid to follow in-network provider prior authorization rules and may continue to get a prior authorization retroactively (this exception does not apply to concurrent reviews for inpatient hospitalizations, which should still occur during this time period);
- Reimburse out of network providers at the in-network rate of 100% of the Medicaid fee schedule;
- Delay implementation of the 90% rate reduction following good faith contracting provision;
- Allow beneficiaries to change their Primary Care Provider for any reason; and
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Extend flexibility for Non-Emergency Medical and Non-Emergency Ambulance Transportation providers through November 2021.
Thank you for your assistance.
Dave Richard
Deputy Secretary
NC Medicaid
Division of Health Benefits
Office: 919-855-4101
Mobile: 919-500-1596
1985 Umstead Drive, Kirby Building
2501 Mail Service Center
Raleigh, NC 27699-2501
