Proposed Medicaid Clinical Coverage Policies

NCGS §108A-54.2 requires that the Department of Health and Human Services consult with and seek the advice of the North Carolina Physician Advisory Group and other professional societies and organizations in developing new or amended Medicaid clinical coverage policies. Additionally, the law requires the Department to publish proposed new and amended clinical coverage policies on the Department's Web site and accept oral and written comments. All consultations and comments are considered. The Department has delegated to the DMA Division Director the authority to make the final decisions regarding clinical coverage policies.

The following proposed new or amended Medicaid clinical coverage policies are available for review. Comments on proposed polices may be submitted by clicking the envelope next to each proposed policy. Comments and questions not specificially related to the proposed policy should not be sent to this Web address. The initial comment period for each proposed policy is 45 days. An additional 15-day comment period follows if a proposed policy is substantively revised as a result of the initial comment period.

Proposed Policy	Date Posted	Have Comments?	Comment Period End Date
Botulinum Toxins Types A (Botox) and B (Myobloc) [Amendment to current policy (prior approval criteria were posted previously); comments will be accepted only on the highlighted and/or struck-through sections]	7/15/2008		8/29/2008
The following service definitions are part of the Community Alternatives Program for persons with mental retardation and/or developmental disabilities (CAP/MR-DD):
Adult Day Health	7/3/2008		8/17/2008
Augmentative Communication	7/3/2008		8/17/2008
Behavioral Consultants	7/3/2008		8/17/2008
Community Networking	7/3/2008		8/17/2008
Community Transition Supports	7/3/2008		8/17/2008
Crisis Respite	7/3/2008		8/17/2008
Crisis Services	7/3/2008		8/17/2008
Day Supports	7/3/2008		8/17/2008
Home and Community Supports	7/3/2008		8/17/2008
Home Modifications	7/3/2008		8/17/2008
Home Supports	7/3/2008		8/17/2008
Individual Caregiver Training	7/3/2008		8/17/2008
Individual Goods and Services	7/3/2008		8/17/2008
Long-Term Vocational Supports	7/3/2008		8/17/2008
Personal Care Services	7/3/2008		8/17/2008
Personal Emergency Response System	7/3/2008		8/17/2008
Residential Supports	7/3/2008		8/17/2008
Respite	7/3/2008		8/17/2008
Specialized Consulting Services	7/3/2008		8/17/2008
Specialized Equipment & Supplies	7/3/2008		8/17/2008
Supported Employment	7/3/2008		8/17/2008
Transportation	7/3/2008		8/17/2008
Vehicle Adaptations	7/3/2008		8/17/2008

Clinical Coverage Policies and Provider Manuals

All documents above are in PDF format. The free Adobe Acrobat Reader (minimum 4.0) is required to view and print PDF files.

Updated July 15, 2008