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So far Michael Silber has created 1944 blog entries.

Oregon

The Board of Pharmacy will meet on June 12-14. The agenda and meeting materials are available online.  

Also in Oregon, the following individuals have been appointed to the Board of Pharmacy: Amy Kirkbride with Kaiser Permanente, Victoria Kroeger with Walgreens and Ana Pinedo.

Finally in Oregon, the Division of Financial Regulation announced this proposed rulemaking. These proposed rules implement 2023 Oregon Enrolled SB 797, Oregon Laws 2023, chapter 113, which requires certain health insurance policies to provide coverage for prosthetic and orthotic devise as defined in the bill. 

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

2024-06-06T16:00:05-04:00June 6, 2024|Oregon|

South Carolina

The Department of Health and Human Services (SCDHHS) regularly offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming June-August 2024 training is listed below.

Medicaid eLearning Provider Workshops
SCDHHS’ contracted vendor provides web-based training, presentations and other materials on a variety of topics to ensure enrolled providers have an understanding of processes and programs.

To register for a workshop or find additional training resources, please visit www.medicaidelearning.com or call the Provider Service Center (PSC) at (888) 289-0709. The PSC’s hours of operation are 7:30 am-5:00 pm Monday-Thursday and 8:30 am-5:00 pm Friday. 

Also in South Carolina, with the conclusion of the federal PHE in 2023, the South Carolina Department of Health and Human Services (SCDHHS) is required to resume the provider revalidation process. SCDHHS will restart this process in June 2024.

In order to revalidate or renew the provider enrollment record with the state Medicaid agency, an enrollment revalidation application must be submitted. The provider revalidation process is designed to confirm or update a provider’s demographic and other information including National Provider Identifier, mailing address and service location address(es). There are no exemptions from revalidation.

Consistent with federal regulations (42 CFR §455.414), state Medicaid agencies must complete revalidation of enrollment for all providers, regardless of provider type, at least every five years. However, provider types designated by either CMS or SCDHHS as “high-risk” providers are required to revalidate every three years. High-risk providers include durable medical equipment (DME), home health agencies, targeted case management, rehabilitative behavioral health services and licensed independent practitioner rehabilitative services. High-risk providers may also require a physical site visit or fingerprint-based criminal background check (FCBC). For more information on high-risk providers, please review the Provider Enrollment and Screening Requirements FAQs.  

Impacted providers will receive an official revalidation notification letter in the mail. The notification contains a unique revalidation number necessary to begin and complete the revalidation process. To avoid risk of termination from the Healthy Connections Medicaid program, providers must complete the revalidation process. The first step in the revalidation process is completing the online enrollment revalidation application within 30 days. Providers will be notified when the cohort window is open for their specific provider type to begin the process. Providers must not attempt to begin the revalidation process until they have received notification. 

Provider revalidation for cohort one begins June 17, 2024. The revalidation window for cohort two and future cohorts will be announced in subsequent provider bulletins that will be published approximately 30 days prior to the start of the respective revalidation windows.

A list of providers scheduled for revalidation will be published on the SCDHHS’ website as each cohort’s revalidation period begins. 

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

2024-06-06T15:58:51-04:00June 6, 2024|South Carolina|

Texas

The Prescription Monitoring Program’s (PMP) Advisory Committee will meet via Zoom on June 27.

Also in Texas, the Health and Human Services Commission’s (HHSC) Vendor Drug Program (VDP) is hosting a Hepatitis C educational webinar on June 13. 

Finally in Texas, the Texas Pharmaceutical Initiative (TPI) Board’s next meeting will be held on June 11 at 10:00 am.  

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

2024-06-06T15:56:58-04:00June 6, 2024|Texas|

Vermont

As the Department of Vermont Health Access (DVHA) has previously reported, Change Healthcare (CHC), which operates Vermont’s Medicaid pharmacy claims system, experienced a significant cybersecurity issue on February 21. The cybersecurity incident impacted enrolled pharmacy providers’ ability to process and submit claims for Medicaid services. In response to the outage, Vermont Medicaid is temporarily increasing the Professional Dispensing Fee for retail pharmacies.  

Vermont Medicaid will provide an enhanced Professional Dispensing Fee for prescribed drugs to account for the manual and time-consuming procedures pharmacies had to perform due to the Change Healthcare outage. The Professional Dispensing Fee for pharmacy claims of $11.13 will increase by $3.26 per claim to $14.39, from June 3, 2024, to June 30, 2024. This change will be automatically implemented for pharmacy claims, excluding specialty drug and 340B drug claims. Providers are not required to enroll or apply for the enhanced professional dispensing fee. Standard payment of covered outpatient drugs, including over the counter (OTC) drugs, billed to DVHA on a primary basis and dispensed by an enrolled pharmacy is detailed in the Pharmacy Provider Manual. All manuals and rules are available online 

This change is one of several temporary flexibility and changes being made to support providers impacted by the Change Healthcare cybersecurity incident. Additional information on these changes can be found in Global Commitment Register 24-029 Change Healthcare Outage—Medicaid Response. Please contact the Change Healthcare Pharmacy Help Desk with any questions at 1-844-679-5362. 

For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.

2024-06-06T15:55:26-04:00June 6, 2024|Vermont|

Washington

The Health Care Authority (HCA) will change to a new pharmacy point-of-sale system on June 8. The system will be off from midnight until 3:30 pm on June 8-9. HCA will notify providers once the new system is running and can adjudicate claims. At 5:00 pm on June 6, pharmacy prior authorization faxes will cease being accepted. HCA will start accepting prior authorization faxes again on June 10. HCA’s ProviderOne Point of Sale (POS) Replacement Project provided an updated payer sheet.

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

2024-06-06T15:32:03-04:00June 6, 2024|Washington|

Alaska

HB 226D, comprehensive legislation pharmacies supported to ensure patient choice of pharmacy, improve transparency and accountability in pharmacy benefit management and enhance the standards for pharmaceutical care across the state, passed the legislature. The bill is awaiting transmittal to Gov. Mike Dunleavy’s (R) office to be signed into law.

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

2024-05-30T10:27:34-04:00May 30, 2024|Alaska|

California

The Department of Health Care Services posted the following alerts and weekly report on the Medi-Cal Rx Web Portal. 

 Also in California, on May 28, the article titled Change Healthcare Cybersecurity Issue Update” was posted to the Medi-Cal News area on the Medi-Cal Provider website.

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

2024-05-30T10:27:08-04:00May 30, 2024|California|
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