Additional Considerations
Adjustment of PHP contracts to cover RBC molecular antigen testing is a short-term investment. NC Medicaid can look to Blue Cross NC’s medical policy for language regarding the scope of coverage. Blue Cross NC recommends two FDA-approved panel test systems— BLOODchip® ID CORE XT™ by Grifols Diagnostic Solutions Inc. and PreciseType® HEA Test by Immuncor, Inc.—that are appropriate for patients with SCD who require frequent transfusions.265
3.4 Transcranial Doppler Ultrasonography NC Medicaid should facilitate annual transcranial doppler ultrasonography (TCD) screening for children with SCD aged 2 to 16. Implementation: • NC Medicaid should remove prior authorization requirements for TCD. • NC Medicaid should reimburse PHPs to coordinate care between radiologists and SCD clinics and training of SCD clinical staff to perform TCD screening. Background
Annual TCD screening is standard for children with SCD aged 2 to 16. TCD identifies those individuals who need transfusions, which in turn reduces their risk of stroke.266 If left untreated, approximately 11 percent of children with SCD will experience a stroke by age 20, a rate 250 times higher than the child population at large.267 Nationally, TCD screening rates among Medicaid patients are under 40 percent.268 Patient-related barriers to annual TCD screenings include inadequate transportation, duration of clinic visits, missed appointments, lack of awareness of the need for annual screenings, and mistrust of the procedure.269 Provider-related barriers include lack of awareness that TCD should begin at age 2, expectations that children will be uncooperative, lack of motivation, and poor coordination.270 North Carolina Context
As of February 2021, NC Medicaid covers TCD screening, however, the screening requires prior authorization, even for children.271 This prior authorization requirement results in an unnecessary barrier and burden to care. In many clinics, TCD screenings are managed
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