The first weeks of school have brought more COVID cases among school children. This rapid spread can lead to quarantines when schools don’t have strong mask requirements in place. School districts should follow the CDC’s recommendation and require masks and keep other important safety measures in place as we continue battling the pandemic. There has been a sharp increase in COVID-19 clusters among school sports teams. Between July 1 and September 2, 2021, clusters among school sports teams accounted for 45% of all clusters

 in North Carolina middle and high schools, despite most school sports activities not beginning until August. For the week ending Sept. 4, children age 17 and under made up 31% of the state’s new COVID-19 cases. That is the highest percentage since the pandemic began. School sports teams are urged to follow NCDHHS guidance for youth sports. 

Testing is Widely Available: Anyone who has symptoms of or has been exposed to COVID-19 should get tested as soon as possible. To find a testing site in your community, go to ncdhhs.gov/GetTested.

People  who  are  not  experiencing  serious symptoms should not go to the emergency department for routine COVID-19 testing.   

Prior Authorizations Covered When Beneficiary Transitions to NC Medicaid Direct

In its Aug. 4, 2021 Medicaid bulletin, Prior Authorizations Covered When a Beneficiary Transitions to NC Medicaid Direct [medicaid.ncdhhs.gov], the Department outlined its intended long-term design to transfer most Standard Plan prior authorizations (PA) to NC Medicaid Direct for impacted beneficiaries. Providers are encouraged to review this Bulletin to confirm which PA types are included in this long-term design. 

A Medicaid beneficiary enrolled in a Standard Plan Prepaid Health Plan (PHP) may be later identified as a member of a Medicaid population that is exempt or excluded from Standard Plan enrollment. This will result in a beneficiary’s disenrollment from the PHP and return to NC Medicaid Direct.  A PHP may be currently waiving PA requirements for some or all of its covered services. If a PHP member is moved back to NC Medicaid Direct, the beneficiary may not have a PA transferred for a service that requires an authorization in NC Medicaid Direct. The absence of a PA may result in service disruption upon a beneficiary’s return to NC Medicaid Direct. 

To ensure beneficiaries and providers do not experience service disruption in the scenario previously outlined, a provider may be required to submit a prior authorization request to the applicable NC Medicaid Direct vendor in order to continue services to the beneficiary. To support providers through this process, the Department will allow retroactive review of prior authorization requests for beneficiaries who have been moved back to NC Medicaid Direct from a Standard Plan.  For more information, please refer to the Medicaid bulletin Interim Process for Submitting Prior Authorization Requests for Beneficiaries Disenrolled to NC Medicaid Direct [medicaid.ncdhhs.gov].