NCAPA Responds to the DMA’s Request for Input

by Sarah Wolfe, Assistant Vice-President, McGuire Woods Consulting 

Last month, the North Carolina Department of Health and Human Services’ Division of Medical Assistance (DMA) reached out to stakeholder groups, requesting input on various clinical coverage policies. State law requires that the Department consult with and seek advice from the NC Physician Advisory Group and other professional organizations when amending or developing new Medicaid clinical coverage policies.

Thanks to the assistance of several subject matter experts within the membership, NCAPA was able to submit public comments to DMA on the following clinical coverage policies.

• After reviewing Clinical Coverage Policy 1H – Telemedicine and Telepsychiatry, Samantha Rogers, PA-C, NCAPA President and practices gerontology within internal medicine at Wake Forest University Baptist Medical Center, provided feedback that PAs should be included under the list of providers who can provide telepsychiatry professional services under Medicaid (page 6 – 6.0 Providers Eligible to Bill for the Procedure, Product, or Service). Additionally, Ms. Rogers located several places where the PA profession was misspelled (physician’s assistants instead of physician assistants).
• Elyse Watkins, DHSc, PA-C, assistant professor at High Point University’s PA program, provided feedback on Clinical Coverage Policy 1E-7 – Family Planning Services. After reviewing the policy in its current form, Ms. Watkins provided comments and proposed several changes and clarifications to the policy, including that PAs should be named under 3.2.1 Specific Criteria Covered by Medicaid FP, NCHC and “Be Smart” (page 5).
• DMA also reached out to NCAPA in order to receive input on what NCAPA believes should be covered under a yet-to-be-developed clinical coverage policy on genetic testing for susceptibility to breast and ovarian cancer. April Stouder, PA-C, and Kim Nolte, PA-C, who practices gynecologic oncology at Duke University Medical Center, provided information on what limitations to the services, and what evidence-based medical literature, should be considered when defining the service.