Michael Silber, Author at In The States

Indiana

The Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning (OMPP) is hosting an informational online seminar on the PathWays for Aging program on September 12 at 9:00 am. The presentation by OMPP staff will provide a post-implementation update of the PathWays program which launched on July 1, 2024. The online seminar will be recorded and posted on the PathWays stakeholder engagement website. You can view the online seminar on Zoom or the FSSA YouTube page at the time of the event.

Also in Indiana, FFSA pharmacy updates were approved by Drug Utilization Review Board at the August 2024 meeting.

Finally in Indiana, the Health Coverage Programs (IHCP) posted a bulletin reminding providers of administrative review requirements for fee-for-service prior authorization.

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

Michael Silber2024-09-05T10:00:42-04:00September 5, 2024|Indiana|

Iowa

The Department of Health and Human Services (HHS) announced the intent to award a Managed Care Organization (MCO) contract to Iowa Total Care. The new Iowa Medicaid contract period begins July 1, 2025, with no change in operations. This RFP and resulting contract aligns all three MCO contracts (Iowa Total Care, Molina, and Wellpoint Iowa, Inc.) to provide health care services to Iowans to the same contract cycle. All three MCO contracts will have a final contract end date of June 30, 2031.

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

Michael Silber2024-09-05T10:00:05-04:00September 5, 2024|Iowa|

Louisiana

Medicaid issued a bulletin revising the launch date for its Medicaid Provider Enrollment Rebaseline, which means new managed care organization (MCO) credentialed providers that have not enrolled with Medicaid will receive an invitation letter to enroll through the web portal. The invitation letter will provide specific provider information along with detailed instructions needed for the enrollment process.

Also in Louisiana, Medicaid issued a revised bulletin with contact information outlining the available options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCOs) and the state’s fee-for-service claims processor, Gainwell Technologies. Unless explicitly notated, providers should first seek resolution with the MCO or Gainwell directly, prior to engaging the Department of Health or other third parties.

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

Michael Silber2024-09-05T09:59:35-04:00September 5, 2024|Louisiana|

Maine

On September 5, the Board of Pharmacy held its regular meeting. The agenda included licensure by endorsement and a central fill data collection pilot project.

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

Michael Silber2024-09-05T09:58:59-04:00September 5, 2024|Maine|

Maryland

The Prescription Drug Affordability Board (PDAB) has rescheduled its September 23 Board meeting for September 10. Registration is required to participate. The Board welcomes public comment and input on all its work. Additional information about providing public comment can be found on the Board Meetings page of the PDAB’s website.

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

Michael Silber2024-09-05T09:58:31-04:00September 5, 2024|Maryland|

Massachusetts

The Board of Pharmacy issued notice that licensing of non-resident pharmacies will become available in the coming months. At least one pharmacist at each non-resident pharmacy must hold a Massachusetts pharmacist license. (This pharmacist does not have to be the store’s pharmacist-in-charge.) In preparation for non-resident pharmacy licensing, it is strongly recommended to begin the licensing process for the pharmacists as the process can take 30-60 days. Applications and instructions can be found online. Please see the FAQ document for other information regarding non-resident pharmacy licensing.

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

Michael Silber2024-09-05T09:57:42-04:00September 5, 2024|Massachusetts|

Michigan

The Department of Health and Human Services issued a final bulletin related to the end of COVID flexibilities for OTC (Over-the-Counter) COVID tests and pharmacies as labs.

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

Michael Silber2024-09-05T09:56:38-04:00September 5, 2024|Michigan|

Missouri

Effective September 6, 2024, brand name Adderall XR^® will no longer be preferred on the MO HealthNet Preferred Drug List (PDL). Dextroamphetamine/Amphetamine ER capsules (generic Adderall XR^®) is currently a preferred agent on the PDL and will continue to remain a preferred agent. Please reference the List of Preferred & Non-Preferred Products, as well as the ADHD, Amphetamines Long Acting PDL edit for more information. Maximum Allowable Cost (MAC) rates will apply to brand and generic products. Providers who dispense the brand product without a prior authorization (based on medical necessity) will receive MAC reimbursement.

Also in Missouri, on August 29, the Medicaid Audit & Compliance (MMAC) launched the new secure Provider Communications Portal, which is an efficient method for providers and MMAC to communicate and exchange information and records.

Finally in Missouri, effective August 29, MO HealthNet expanded coverage of Continuous Glucose Monitors (CGMs) to participants currently diagnosed with Gestational Diabetes allowing this vulnerable population to obtain a CGM without prior authorization. Claims for a CGM will auto-approve if the participant has had a gestational diabetes diagnosis billed to MO HealthNet recently or if the pharmacy submits the appropriate gestational diabetes diagnosis code with the claim. Any MO HealthNet participant who currently utilizes insulin can also obtain a CGM without prior authorization.

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

Michael Silber2024-09-05T09:53:49-04:00September 5, 2024|Missouri|

Nebraska

The Board of Pharmacy posted the agenda (revised August 29, 2024) for its September 9 meeting.

Also in Nebraska, new income guidelines increased the number of families who could qualify for the Women, Infants and Children (WIC) supplemental nutrition assistance program. The WIC program is a federally funded program and is an equal opportunity provider. The maximum income allowed for participation in WIC increased. Some families not eligible for the program in the past may now be eligible. Nebraska WIC serves every county in the state with 13 main agencies and over 100 sites.

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

Michael Silber2024-09-05T09:53:10-04:00September 5, 2024|Nebraska|

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