To find an article that ran between 2010 and 2013.

  1.  Find the issue in which your article ran using the Tables of Content
  2. Use the "Archive" to access that issue.

Click here to comment on a PROPOSED new or amended policy

For archived versions of clinical coverage policies, please contact Richard K. Davis

These letters are for use by county Departments of Social Services. If you have a question regarding Medicaid eligibility, contact your county Department of Social Services.

DSS Letter Archive

2016 State Plan for Medical Assistance                 

ACA Pseudo Medicare Fee Schedule - Jan. 1, 2014; Jan. 1, 2013

  • WEBINAR - Preadmission Screening and Resident Review (PASSR) - An Overview
  • Adult Care Home FL-2
  • Request for Services (DMA 3051)
  • Request for Services Instructions (DMA 3051)
  • Adult Care Home Personal Care Physician Authorization and Care Plan (DMA 3050)
  • Instructions - Adult Care Home Personal Care Physician Authorization and Care Plan (DMA 3050)

Adult Care Home Daily Reimbursement Rates - Jan. 13, 2013

  • 1N-1, Allergy Testing
  • 1N-2, Allergy Immunotherapy
  • Medical Request for Prior Approval (372-118)
  • State-to-State Ambulance Transportation Addendum

15, Ambulance Services

Ambulance Fee Schedule - May 6, 2014

Ambulatory Surgical Center Fee Schedule

  • 1L-1, Anesthesia Services
  • 1L-2, Moderate (Conscious) Sedation, AKA Procedural Sedation and Analgesia (PSA)

Anesthesiology Fee Schedule and Base Units

  • Medicaid and NC Health Choice DMA Annual Report - SFY 2015
  • Medicaid Annual Report Tables - SFY 2016 through 2010

April 1999 - Special Medicaid Bulletin - Modifiers

April 2010 Medicaid Bulletin

April 2011 Medicaid Bulletin

April 2012 - SPECIAL BULLETIN - 1915 b/c Medicaid Waiver Expansion Update

April 2012 Medicaid Bulletin

April 2013 - SPECIAL BULLETIN - Criteria for Determining if Adult Care Home Residents Count Toward Institutions for Mental Disease (IMD) Threshold

SPECIAL BULLETIN - Cutoff Dates for Transition from Legacy Claims Processing and Payment Systems to NCTracks

April 2013 - SPECIAL BULLETIN - Termination of Western Highlands Network Management of the 1915 b/c Waivers

April 2015 - SPECIAL BULLETIN - House Bill 5 Temporary Funding for Group Homes and Special Care Units

  • 13A, Cochlear and Auditory Brainstem Implant External Parts Replacement and Repair
  • 13B, Soft Band and Implantable Bone Conduction Hearing Aid External Parts Replacement and Repair

Auditory Implant Sound Processor Request for Prior Approval

August 2010 Medicaid Bulletin

August 2011 Medicaid Bulletin

August 2012 Medicaid Bulletin

August 2013 Medicaid Bulletin

B Waiver Update to Include TBI

  • MH/SA Targeted Case Management Letter of Attestation of Recipient Eligibility
  • Certification of Need: Medicaid Inpatient Psychiatric Services Under Age 21
  • Certification of Need: Psychiatric Residential Treatment Facility Service Under Age 21
  • Criterion V Request Form
  • Instructions for Use of Service Needs/Discharge Planning Status Form
  • 8A, Enhanced Mental Health and Substance Abuse Services  
  • 8A-1, Assertive Community Treatment (ACT) Program
  • 8A-2, Facility-Based Crisis Service for Children and Adolescents
  • 8B, Inpatient Behavioral Health Services
  • 8C, Outpatient Behavioral Health Services Provided by Direct-Enrolled Providers
  • 8D-1, Psychiatric Residential Treatment Facilities for Children under the Age of 21
  • 8D-2, Residential Treatment Services
  • 8E, Intermediate Care Facilities for Individuals with Intellectual Disabilities

Billing Codes for Nurse Practitioner and Physicians Assistants Services Previously Denied

  • 1G-1, Burn Treatment
  • 1G-2, Skin Substitutes
  • Messages to CAP/C Stakeholders
  • CAP/C Listening Sessions Presentation
  • CAP/C Work Group Agendas, Presentations and Handouts


CAP/DA Lead Agency List 
  • 1R-1, Phase II Outpatient Cardiac Rehabilitation Programs
  • 1R-4, Electrocardiography, Echocardiography, and Intravascular Ultrasound

CCNC/Carolina ACCESS Teaching Tool - June 1, 2016

Chiropractic Services Fee Schedule - Jan. 1, 2014

1F, Chiropractic Services
Chiropractic Services ICD-9 codes in effect through September 30, 2015

NC Health Choice Chiropractic Services

  • CAP/C Critical Incident Report (DMA-3201)
  • CAP/C FL-2 Discrepancy Resolution Form
  • CAP/C Participation Notice (DMA-3057)
  • CAP/C Physician's Form (DMA-3063)
  • CAP/C Referral Form
  • Verification of Employment for CAP/C
  • CAP/C Service Authorization Discontinuation Notice
  • CAP/C Participation Discontinuation Notice
  • Self-Assessment Tool - DMA 3072
  • Individual Risk Agreement - DMA 3073
  • Notice of Approval of Service Request - DMA 3504
  • CAP for Children (CAP/C) fee schedule - April 1, 2013
  • CAP CHOICE fee schedule - Julay 1, 2012
  • CAP for Disabled Adults (CAP/DA) fee schedule - July 1, 2012


  • 3A, Home Health Services
  • 3B, PACE (Program of All-Inclusive Care for the Elderly)
  • 3D, Hospice Services
  • 3G, Private Duty Nursing
  • 3H-1, Home Infusion Therapy
  • 3K-1, Community Alternatives Program for Children (CAP/C) Waiver
  • 3K-2, Community Alternatives Program for Disabled Adults (CAP/DA)
  • 3L, State Plan Personal Care Services (PCS)
  • Carolina ACCESS Office Visit Enrollment Form
  • CA Medical Exemption Request (DMA-9002)
  • CA Hospital Admitting Agreement/Formal Arrangement
  • Medical Record Release for WIC Referral
  • Provider Confidential Information and Security Agreement
  • WIC Exchange of Information for Women (with instructions)
  • WIC Exchange of Information for Infants and Children (with instructions)
  • Community Care of North Carolina: A Member Handbook - Oct. 2014 - English
  • Community Care of North Carolina: A Member Handbook - Oct. 2014 - Spanish

December 2010 Medicaid Bulletin

December 2011 - SPECIAL BULLETIN -  NCECS Web Tool Instruction Guide

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