Michael Silber, Author at In The States

Illinois

The April 4, 2024, provider notice includes an update to pharmacies on billing for the COVID-19 vaccine administration fee. This update applies only to the Medicaid fee-for-service program for dates of service beginning September 11, 2023, through December 31, 2023.

A September 28, 2023, provider notice stated the Department of Healthcare and Family Services (HFS) was still finalizing programming for the administration fee for the COVID-19 vaccine, and providers could not include administration fee charges on their claims at that time. Pharmacies could still provide COVID-19 vaccinations and submit claims to HFS for reimbursement for the cost of the vaccine and a professional dispensing fee, without an administration fee.

HFS has completed part of the programming for pharmacies to receive the applicable administration fee for COVID-19 vaccines. Pharmacies can now void and rebill claims that were initially submitted without the administration fee for dates of service beginning September 11, 2023, through December 31, 2023. Pharmacies must use “MA” in the Professional Service Code Field, in addition to identifying the administration fee.

Claims with dates of service beginning January 1, 2024, must continue to be billed without an administration fee until further notice.

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565.

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

Michael Silber2024-04-11T14:42:12-04:00April 11, 2024|Illinois|

Indiana

The Family and Social Services Administration’s (FSSA) Indiana Health Coverage Programs (IHCP) announced a Roadshow at six locations throughout the state to be held April 30 through June 6, 2024. Providers are encouraged to come prepared with any policy-related questions. Please do not bring actual claims or claim-related questions to the event.

Also in Indiana, IHCP issued a bulletin BT202434 detailing the program beginning on May 1, 2024, that will align the fee-for-service continuity of care with managed care.

Finally, the Office of Medicaid Policy and Planning (OMPP) is hosting an informational webinar on the PathWays for Aging program April 18. OMPP staff will provide an overview of the PathWays program which is set to launch on July 1, 2024.

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

Michael Silber2024-04-11T14:41:20-04:00April 11, 2024|Indiana|

Kentucky

Gov. Andy Beshear (D) signed HB 274, sponsored by pharmacist Rep. Danny Bentley (R). The bill authorizes pharmacists to order and administer vaccines to patients aged 5 years and older under a prescriber-approved protocol. The law takes effect 90 days after the General Assembly adjourns sine die. This date will officially be set by the attorney general after April 15.

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

Michael Silber2024-04-11T14:40:52-04:00April 11, 2024|Kentucky|

Louisiana

The Department of Health (LDH) provided new Policy memos on a variety of subjects:

Also in Louisiana, the PBM (Pharmacy Benefit Managers) Monitoring Advisory Council met on April 11 to discuss these agenda items. The draft minutes from the February 7 meeting are available.

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

Michael Silber2024-04-11T14:40:10-04:00April 11, 2024|Louisiana|

Maine

Office of MaineCare Services provided this notice regarding claims filed by Pharmacy Providers during the outage period (February 21 through March 26). In collaboration with Optum Change Healthcare, Maine has updated the technical instructions to reflect recent feedback received from pharmacy providers about claims denials.

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

Michael Silber2024-04-11T14:39:17-04:00April 11, 2024|Maine|

Minnesota

On April 12, the House Health and Finance Policy Committee will hear HF 3902, legislation that would increase the Medicaid Fee-for-Service Professional Dispensing Fee from $10.77 to $11.55 to match the most recent state cost of dispensing survey. Companion legislation in the Senate has already been heard and laid over for possible inclusion in the House Health Omnibus bill.

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

Michael Silber2024-04-11T14:38:49-04:00April 11, 2024|Minnesota|

Mississippi

Save the date for the Mississippi Pharmacists Association’s Back to the Basics Consultant Seminar on April 18, 2024. Class offerings include “Consulting 101/Pharmacology,” “Appendix PP,” “Mental Health,” “Antibiotic Stewardship” and more. Attendees may receive eight hours of continuing pharmacy education (CPE).

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

Michael Silber2024-04-11T14:38:16-04:00April 11, 2024|Mississippi|

Nevada

The agenda and meeting materials for the Board of Pharmacy’s April 17 – 18 meeting in Reno are available.

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

Michael Silber2024-04-11T14:37:44-04:00April 11, 2024|Nevada|

New York

The State Medicaid Pharmacy Benefit Program, NYRx, issued guidance for billing of long acting injectables for mental health and substance abuse treatment.

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

Michael Silber2024-04-11T14:36:39-04:00April 11, 2024|New York|

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