Medicaid (Vol.2)
DMA Director Encourages CCNC
DMA Director Craigan Gray, MD, MBA, JD, said at October's Community Care meeting while Medicaid 'is removing $1.5 billion from the health care economy in North Carolina' through budget cuts, Gray sees this as an opportunity to fundamentally change the delivery of health care for Medicaid recipients in ways that can build for the future of health care in North Carolina. 'Every program is on the table,' he told Community Care leaders, and he urged them to view this as an opportunity to 'do what we've always wanted to do.' He said Community Care's leaders should value the model it has developed and how that model can lead the nation for reforming Medicaid.
Update on Prior Authorization for Non-Emergency Imaging, Specialized Therapies
Following utilization reviews, Medicaid will require Prior Authorization for non-emergency outpatient high-tech radiology and ultrasound procedures as well as specialized therapies, such as PT, OT, Speech therapy and Respiratory therapy. The November DMA Medicaid Bulletin (http://www.dhhs.state.nc.us/dma/bulletin/1109bulletin.htm), outlines the new requirements.
As reported in the last special edition of the Community Care Chronicle, MedSolutions, the new prior approval fiscal agent for certain radiology procedures, including CT, MR, PET scans, and ultrasounds, has contacted providers about their services. Please refer providers to the December Medicaid bulletin (http://www.ncdhhs.gov/dma/bulletin/1209bulletin.htm#radiopa) for the latest updates and to view populations exempt from the PA process. Providers who have questions also can call DMA's Practitioner and Clinic Services at 910-355-1883.
As of December 1, 2009, PA for outpatient specialized therapies (occupational therapy, physical therapy, speech therapy, respiratory therapy, and audiology services) will once again be required for recipients under 21 years of age. Effective with date of service January 1, 2010, PA for outpatient specialized therapies will also be required for recipients 21 years of age and older. Prior authorization will be required for all therapy treatments regardless of the setting. The Carolinas Center of Medical Excellence (CCME) will introduce a new prior authorization web site where providers can access detailed information and instructions for registering and submitting requests. All requests must be submitted via the CCME web site (http://www.medicaidprograms.org/nc/therapyservices/pages/home.aspx).
Prior authorization is not required for dually eligible Medicaid/Medicare recipients. In addition, for Local Education Agencies (LEAs), the prior authorization is deemed met by the UEP process.
New Name for Fiscal Agent
In August 2008, Hewlett-Packard (HP) acquired EDS, fiscal agent for the N.C. Medicaid Program, and as a result, EDS is changing its name to HP Enterprise Services.
North Carolina Medicaid providers will not be affected by this change and will probably notice very few changes. Providers will begin to see the HP logo or the HP Enterprise Services name on correspondence and forms. The mailing address is not changing but providers should address the mail to HP Enterprise Services. E-mail correspondence will come from an '@hp.com' e-mail address rather than an '@eds.com' e-mail address. Also, providers will hear the HP name when contacting the Raleigh call center. The Medicaid Bulletin states: 'Think of it as a sports team changing jerseys. The same players are on the field working hard to deliver the outstanding Medicaid services you've come to expect from a trusted business ally.' Providers can contact HP Enterprise Services at 1-800-688-6696 or 919-851-8888.
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