Happy Tuesday! Enjoy your NCMS Morning Rounds.

August 24, 2021

Medicaid Out-of-Network Flexibilities Extended

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, NC DHHS and the prepaid health plans (PHPs) have agreed to extend the policy for out of network flexibilities to providers who have not yet contacted 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 percent of the Medicaid fee schedule;
  • delay implementation of the 90 percent rate reduction following good faith contracting provision;
  • allow beneficiaries to change their Primary Care Provider for any reason; and
  • extend flexibility for Non-Emergency Medical and Non-Emergency Ambulance Transportation providers through November 2021.

During this period, NCDHHS will allow for beneficiaries to change PHPs as needed. Additionally, PHPs will work to expedite hospital discharge to skilled nursing facilities and rehabilitation facilities to allow for increased bed capacity in the hospitals.

Medicaid has traditionally experienced high provider enrollment rates, which everyone wants to continue. Health systems and all health care professionals are strongly encouraged to continue contract negotiations with PHPs and finalize contracts as soon as possible as the NCDHHS expects this will be the final extension.

For more information on contracting with a health plan, contact them directly. Contact information is available on the Medicaid Health Plan Contacts and Resources web page.

Questions and answers relating to provider contracting deadlines are available on the Provider Contracting with Health Plans webpage.

For other questions, please contact the Provider Ombudsman at 866-304-7062.

North Carolina Medical Board Interviews Dr. Betsey Tilson, State Health Director

The latest episode of the North Carolina Medical Board (NCMB) podcast, MedBoard Matters, features an interview with Betsey Tilson, MD, MPH, State Health Director. In this episode, Dr. Tilson talks about why it’s so important to get vaccination rates up in North Carolina and how pivotal you and all health care providers are to this effort. Dr. Tilson also shares information about several tools to help shape conversations for patients who have been reluctant to get vaccinated.

Visit the NCMB podcast page to see the resource mentioned and also to listen to the latest episode.

COVID-19 Vaccines While Pregnant or Breastfeeding

On August 11, the CDC updated guidance for COVID-19 vaccines while pregnant or breastfeeding to recommend that all people aged 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future, receive the COVID-19 vaccine. Pregnant and recently pregnant people are more likely to get severely ill with COVID-19 compared with non-pregnant people. Getting a COVID-19 vaccine can protect pregnant and breastfeeding people from severe illness from COVID-19.

Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy has been growing. These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy. There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men.

For more information, please see the following resources:

To speak to someone about COVID-19 vaccination during pregnancy, you can contact MotherToBaby. MotherToBaby experts are available to answer questions in English or Spanish by phone or chat. The free and confidential service is available Monday–Friday 8am–5pm (local time).

To reach MotherToBaby:

  • Call 1-866-626-6847
  • Chat live or send an email MotherToBaby

In the News

Viral Evolution 101: Why The Coronavirus Has Changed As It Has, And What It Means Going Forward, STAT, 8-20-21

Learning Opportunity

NC Population Health Collaborative (NCPHC) Meeting: “Using REAL Data to Drive Equitable Outcomes”, September 9, 2021 | 11:00am – 1:00pm, VIRTUAL – ZOOM

Please Join us for the September NC Population Health Collaborative (NCPHC) Meeting, a panel discussion in partnership with Duke-Margolis Center for Health Policy.

Register here.

Registration is limited, so please sign up as soon as possible.

Zoom link & meeting ID will be included in your registration confirmation email.

If you have any issues connecting, please contact Ayesha Andrews at [email protected].

For more information on the North Carolina Population Health Collaborative, please contact Kristen Spaduzzi, [email protected].


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