New Update on the Medicaid Transformation




House Bill 70 Delay NC HealthConnex to Certain Providers


House Bill 70 Delay NC HealthConnex for Certain Providers Passes Senate!


We have some good news to share.  On May 29, the North Carolina Senate voted 48 to 0 in support of HB 70, Delay NC HealthConnex for Certain Providers.  The version of the bill adopted by the Senate still provides for voluntary connection for certain providers, including occupational therapists.  Because the Senate version differs in some sections from the version adopted by the House, the bill now goes back to the House for concurrence.  If the House concurs with the Senate version, the bill will then move to the Governor’s office for signature.  We will continue to update NCOTA members on the progress of HB 70.  Thank you to our members for your advocacy efforts in support of HB 70.  Click here to see the latest version of HB 70 adopted by the Senate. 




DHHS Messsage on Hurricane Florence and Medicaid

On March 26 from 1:30 – 2:30 p.m., DHHS will hold a stakeholder webinar to provide the specifics of Tailored Plan eligibility criteria, enrollment processes, and transitions between Standard Plans and Tailored Plans. On March 18, 2019 DHHS released a final policy guidance paper on these key concepts. The full paper can be found at


To Register

  • Registration is required to access the webinar
  • Audio for this webinar uses computer or cell phone speakers with landline availability


Additional information may be found on the NC Medicaid transformation website at




Sep 13, 2018

Today, the North Carolina Department of Health and Human Services announced broad efforts to work with federal and county partners to provide additional flexibility to people enrolled in the Medicaid program and their health care providers during and after Hurricane Florence.
"Our highest priority is keeping people safe and healthy,” said DHHS Secretary Mandy Cohen, M.D. “We are doing everything possible to help those impacted by Hurricane Florence to continue to get the care and services they need without disruption.”
“We are immediately exercising existing authority and seeking additional authority to help minimize the impact of this disaster on people in Medicaid,” said Deputy Secretary for Medicaid Dave Richard. “We want to make it easier for people to access care, easier for doctors to provide that care, and to give our beneficiaries as much support as possible.”
To help make sure that people who are eligible for Medicaid continue to be able to enroll in the program and access services quickly, DHHS will temporarily allow self-attestation for most eligibility criteria for those impacted by the hurricane if documentation is not available. DHHS will also temporarily extend redetermination timelines for current enrollees to help prevent lapses in coverage due to the hurricane.
To help ensure a sufficient number of providers are available to serve Medicaid enrollees, DHHS is seeking temporary authority to waive some provider enrollment requirements, to waiver revalidation of providers who are impacted by the disaster, and to allow physicians and other health care professionals with out-of-state licenses to enroll and provide services. DHHS will also be seeking authority to make it easier to redirect individuals to alternative care locations when needed.
NC Medicaid will also support beneficiaries if they need additional units of service, medical supplies, specialized equipment or oral supplements to remain safe during the hurricane. DHHS is working with the Centers for Medicare and Medicaid Services to ensure that providers will be reimbursed for the services that they have provided even if it exceeds the beneficiary’s current authorization. DHHS is also working with CMS to retain additional flexibility as needed to support these beneficiaries in the most impacted areas of our state.
For more information regarding Hurricane Florence, please visit Those with non-emergency questions or concerns related to the hurricane should call 2-1-1 or visit 





Quality Payment Program 

August 2018

On July 12, 2018, CMS released a notice of proposed rulemaking (NPRM) detailing proposed changes to the Quality Payment Program (QPP), including the expansion of eligible clinician types to include occupational therapist. 

General information on the Quality Payment System: The QPP was established by Congress in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.  The QPP contains two tracks clinicians can choose to participate: the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).  Initially, the clinician types that were eligible for the first two years of participation (2017 and 2018) included physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.  For the 2019 performance year, CMS is proposing to add Occupational Therapists and other disciplines for the definition of "eligible clinician."  Public comments on the proposed rules are due no later than September 10, 2018.

Clinicians or groups who are eligible to participate in MIPS are scored based on their performance in four categories: quality, cost, improvement activities, and promoting interoperability.  

To view the CY 2019 Physician Fee Schedule proposed rule

For a fact sheet on the CY 2019 Quality Payment Program proposed rule





NCBOT OTA Supervision Changes

July 2018

As of July 1st 2018, NCBOT has officially changed the supervision requirements for OTAs. Historically close supervision has been required for OTA's during their first year of practice. The Board now requires general supervision for all levels of OTA practice, including entry level. However, practitioners remain responsible for maintaining standards of practice as outlined in our Code of Ethics including ensuring safe and effective service delivery of occupational therapy services and fostering professional competence and development. 
The new rules can be found here


House Bill 967-Telemedicine Policy

Legislative Update 



Update on Telemedicine Policy Bill:
House 967 Telemedicine Policy:  This bill started out as a bill to expand opportunities in the area of telehealth for providers listed in Chapter 90 of the North Carolina General Statutes, like occupational therapists.  The bill, however, was changed to a study bill before being adopted by the House of Representatives.  The Senate did not vote on HB 967 before adjourning.  NCOTA plans to closely monitor the progress of telehealth initiatives and advocate for expanded telehealth opportunities for occupational therapists.   
Update on Medicaid Transformation:
House Bill 156 Medicaid PHP Licensure and Transformation Modifications:  This bill, adopted by the General Assembly, puts in statute elements of the Medicaid transformation plan championed by the North Carolina Department of Health and Human Services.  The proposed transformation plan will bring physical health services into a capitated managed care approach similar to the current MCO model. House Bill 156 requires the Department of Health and Human Services to submit a report by October 1, 2018, to the Joint Legislative Oversight Committee on Medicaid and NC Health Choice containing proposed additional needed legislative changes and sets forth a time frame within which the Department of Health and Human Services must issue requests for proposals.


House Bill 403 Medicaid and Behavioral Health Modifications:  This bill, adopted by the General Assembly, sets in motion the development of the tailored plans, an integral part of the Medicaid Transformation plan developed by the Department of Health and Human Services. Details on the implementation of tailored plans can be found in the implementation plan link below.  


Department of Health and Human Services Implementation Plan for Tailored Plans


Pursuant to House Bill 403, the North Carolina Department of Health and Human Services issued this Implementation Plan for Behavioral Health and Individuals with Developmental Disabilities Tailored Plans to the NC Joint Legislative Oversight Committee on Medicaid and NC Health Choice on June 22. 




Advocacy Update

This is a website that is helpful with finding out proposed plans, policies, manuals and public comments regarding Medicaid Managed Care. This link includes DHHS Medicaid Managed Care policy papers focused on specific subjects in relation to the proposed Medicaid and NC Health Choice care program designs. Topics include:

Supporting provider transitions

Prepaid Health Plans

Behavioral Health and IDD Plans

Clinical Coverage policies

And others

[email protected] is an email that is helpful for any questions




AOTA's Message Regarding OTA Payment Changes in Budget Bill

Click here to read the official statement


Our advocacy is working!


On February 9, 2018, the president signed into law a bill that repeals the cap on Medicare part B outpatient therapy services; this has been 20 years in waiting! This therapy cap created significant barriers for our client’s with chronic, long-term conditions and clients that required ongoing services.  This cap previously caused many of our clients financial hardships for paying out of pocket after meeting their cap or if they could not afford services possibly permanent and debilitating injuries. We can now treat based on Medical Necessity!


 AOTA President, Amy Lamb issues a public statement:

January 11, 2018

Capitol Hill

A cap on Medicare outpatient therapy services went into effect on January 1st after Congress failed to act at the end of 2017. This $2,010 cap for occupational therapy services applies to all patients being reimbursed for outpatient, Part B therapy services, except for those provided at Hospital Outpatient Departments/Clinics (HOPD). The law applying the cap to HOPDs expired December 31, 2017. The Medicare therapy cap will in many cases deny access to medically necessary occupational therapy services for the most vulnerable Medicare beneficiaries

Please contact your Members of Congress to end the cap once and for all, and to provide a pathway to therapy services for all Medicare beneficiaries.

Last year, Congress drafted bi-partisan legislation to permanently repeal the therapy cap and replace it with a targeted review of claims.  However, the exceptions process expired at the end of 2017, and Congress failed to enact any legislation that would keep the cap from taking effect in 2018.  Congress must take action soon to prevent beneficiaries from hitting the cap and to end this policy.


AOTA has consistently reached out to the Center for Medicare and Medicaid Services (CMS) officials for guidance on how to handle claims approaching or exceeding the current cap, but has received no answer as of the publication of this article. Until we receive further guidance, AOTA recommends that therapy professionals issue a mandatory Medicare notice, called an Advanced Beneficiary Notice of Non-Coverage or “ABN,” to all Medicare beneficiaries they treat who reach the $2,010 cap.  The ABN is issued in situations where Medicare payment is expected to be denied.  Because Congress didn’t extend the exceptions process permitting the attachment of a KX modifier or the manual medical review process, it is your duty to notify your patients that their therapy services may be limited.


With this impending crisis, you must contact your members of Congress and ask them to take action to ensure all beneficiaries can receive the therapy services they need. Therapy can't wait.