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So far Erica Joyner has created 543 blog entries.

Florida

Effective October 1, 2021, any fee-for-service (FFS) claim submitted with a National Provider Identifier (NPI) for a provider not enrolled with Florida Medicaid will be denied, and the provider will not receive reimbursement for services. This includes claims that list a Referring, Ordering, Prescribing, or Attending (ROPA) provider. ROPA providers must be enrolled with Florida Medicaid following Title 42, Code of Federal Regulations, Section 455.410(b).  Starting October 1, 2021, claims will not be paid for any practitioner, group practice, facility, or pharmacy providing services to Florida Medicaid recipients based on a ROPA provider’s referral, order, prescription, or attending services, unless the ROPA provider identified by NPI on the FFS claim is actively enrolled with Florida Medicaid.

Florida Medicaid features a quick and easy, automated ROPA provider enrollment application on the Florida Medicaid Web Portal Enrollment Application Wizard page. Please visit the ROPA Provider Enrollment page of the Web Portal for updated information, including the recently created Unenrolled ROPA Provider List, ROPA Providers Frequently Asked Questions, and Quick Reference Guides on ROPA provider enrollment and claims billing.  Providers may call the Provider Services Contact Center at 1-800-289-7799, option 7, for billing assistance and option 4 for enrollment assistance.

Also in Florida, the Department of Business and Professional Regulation has proposed the below rules.

  • Proposed rule of the Department of Business and Professional Regulation would amend regulations under FAC 61N-1 regarding drug and device labeling requirements to revise the references to federal regulations incorporated by reference. Comments and hearing requests are due June 28, 2021.
  • Proposed rule of the Department of Business and Professional Regulation would amend regulations under FAC 61N-1 to update the application forms incorporated by reference for permits to be a diethyl ether manufacturer, distributor, dealer, or purchaser. Comments and hearing requests are due June 28, 2021.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2021-06-11T15:10:50-04:00June 11, 2021|Florida|

Louisiana

The Board of Pharmacy recently approved several rules effective May 20, 2021.

  • Final rule increases the amount of medication that may be dispensed under an emergency prescription to a 90-day supply. The rule also provides for special permitting of pharmacists licensed outside the state to allow participation in disaster relief.
  • Final rule establishes standards for licensure of pharmacy benefit managers engaged in certain activities. The rule establishes procedures for board review of applications for the initial issuance of the permit, the renewal of the permit, applications for the reinstatement of disciplined permits, and the permanent closure of a permit.

Also in Louisiana, the Department of Health (LDH) is reviewing the current transportation services and pharmacy benefit delivery models for its Medicaid managed care program. LDH is seeking input by June 21, 2021, on the key factors that must be considered when improving these models. This feedback can be provided at: https://ldh.la.gov/index.cfm/form/241.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2021-06-11T15:10:37-04:00June 11, 2021|Louisiana|

Minnesota

The Department of Health expects to issue guidance on how to comply with the Prescription Drug Price Transparency Act by early summer 2021, which will include technical definitions and reporting requirements for the act.  MDH will share information related to the act’s implementation and opportunities for public feedback on this page, through GovDelivery bulletins, and via State Register announcements. Stakeholders interested in receiving announcements on implementation of the act may subscribe to Prescription Drug Price Transparency updates.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

2021-06-11T15:10:14-04:00June 11, 2021|Minnesota|

Mississippi

The Division of Medicaid has issued the below final rules.

  • Final rule of the Division of Medicaid amends regulations under Title 23, Part 224, Chapter 1 to set the fees for immunizations to those in effect for the state fiscal year 2021. The rule is effective July 1, 2021.
  • Final rule of the Division of Medicaid amends regulations under Title 23, Part 200, Chapters 1, 3, and 4 to increase to 90 days the time period for providers to request an administrative review for claims. The rule also revises beneficiary cost-sharing and 340B provider requirements to comply with federal standards. The rule is effective July 1, 2021.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

2021-06-11T15:09:57-04:00June 11, 2021|Mississippi|

Missouri

Gov. Mike Parson (R) signed SB 63 into law, which makes it the 50th state to create a statewide prescription drug monitoring program. The bill establishes the Joint Oversight Task Force of Prescription Drug Monitoring, responsible for collecting and maintaining the prescription and dispensation of prescribed controlled substances to patients within the state. It also extends the expiration date of the RX Cares for Missouri Program to August 28, 2026.

Also in Missouri, the Department of Social Services, MO HealthNet Division, issued two new proposed rules requesting comments by July 1, 2021. Both are currently in effect as emergency rules expiring February 24, 2022.

  • Proposed rule removes obsolete provisions and references new provisions establishing the payment methodology for covered entities under the 340B drug pricing program that choose to carve in Medicaid.
  • Proposed rule establishes the payment methodology for covered entities under the 340B drug pricing program that chooses to carve in Medicaid.

Also in Missouri, the Board of Pharmacy issued a final rule effective June 30, 2021, removing the limit on the number of intern pharmacist practice hours that may be earned per week.

Also in Missouri, the Department of Commerce and Insurance issued a proposed rule to establish the license application process and a $1,000 application fee for pharmacy benefit managers. The rule replaces a September 15, 2020, proposed rule. Comments are due on June 16th, and a public hearing will be held on June 17, 2021.

Also in Missouri, the Board of Pharmacy is soliciting comments on two proposed rules:

  • Proposed rule rescinds regulations regarding pharmacy operating procedures during declared disasters. A concurrent proposed rule would readopt the provisions to address both disasters and state/federal emergencies. Comments are due June 16, 2021.
  • Proposed rule adopts regulations establishing guidelines for temporary pharmacy operations during an emergency or declared disaster. The rule would replace pharmacy disaster operation procedures that are proposed for repeal concurrently.

Also in Missouri, the Board of Pharmacy recently approved two final rules 20 CSR 2150-5.025 and 20 CSR 2220-6.050 which allows pharmacy technicians to administer vaccines under the supervision of a state-licensed pharmacist according to a written protocol with a licensed physician who is actively engaged in the practice of medicine. The rule is issued in response to the COVID-19 pandemic effective July 30, 2021.

Lastly in Missouri, the Department of Social Services, MO HealthNet Division issued three final rules effective July 30, 2021.

  • Final rule adds an exception to the 31-day supply maximum restriction on medications reimbursed by the division on behalf of participants eligible for the fee-for-service programs, and an exception to allow for a 90-day supply requirement for select medications established in a concurrent rule. The rule also replaces references to “recipient” and “patient” with “participant.”
  • Final rule adopts a 90-day supply requirement per dispensing on select medications reimbursed by the division on behalf of participants eligible for Medicaid fee-for-service programs.
  • Final rule revises the amount of the professional dispensing fee reimbursable for MO HealthNet covered prescriptions by pharmacy providers.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2021-06-11T15:09:45-04:00June 11, 2021|Missouri|

Montana

SB 395 Chapter Number: 501, establishing licensure, reporting, marketing, and advertising, network adequacy requirements, and 340B related provisions for PBMs, was signed by Gov. Greg Gianforte (R) on May 12, 2021.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

2021-06-11T15:09:28-04:00June 11, 2021|Montana|

Nebraska

Effective July 1, 2021, the METAVIR fibrosis score required for coverage by Nebraska Medicaid will be changed to F0. The current prior authorization criteria require a METAVIR fibrosis score of at least F2. These changes mean that patients with a METAVIR fibrosis score of F0 may have their prescribed antiviral medications to treat hepatitis C be covered by Nebraska Medicaid. Prior authorization for Hepatitis C antiviral medications will continue to be in place. See Provider Bulletin 21-11 for additional details.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

2021-06-11T15:09:16-04:00June 11, 2021|Nebraska|

Ohio

This week the full Senate passed their budget bill by a party-line vote. The passed version appropriates $5 million for Fiscal Year 2022 and $10.15 million for Fiscal Year 2023, plus Federal Medical Assistance Percentages to fund the Managed Care Supplemental Dispensing Fee. NACDS worked in partnership with the Ohio Council of Retail Merchants to advocate that funding for this program continue. It is not included in the competing versions of the budget as proposed by the Governor and the House. We will continue to champion this line item as budget negotiations continue over the next two weeks.

For more information, contact NACDS’ Jill McCormack at 717-592-8977.

2021-06-11T15:09:02-04:00June 11, 2021|Ohio|

Oklahoma

HB 2677, amending the audits and administrative appeals procedures, was signed by Gov. Kevin Stitt (R) on May 4, 2021.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

2021-06-11T15:08:51-04:00June 11, 2021|Oklahoma|
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