Michael Silber, Author at In The States

Alaska

The Centers for Medicare & Medicaid Services (CMS) approved an extension effective March 26, 2024, through December 31, 2028, for a 1115 “Behavioral Health Reform” demonstration project. This approval continues the state’s existing authority to receive federal financial participation (FFP) for providing clinically appropriate substance use disorder (SUD) treatment services for short-term residents in residential and inpatient treatment settings that qualify as an institution for mental diseases (IMD), as well as provides additional services to enhance the comprehensive and integrated behavioral health system for children, youth and adults with serious mental illness (SMI), severe emotional disturbance (SED) and/or SUDs (Substance Use Disorders).

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

Michael Silber2024-04-04T10:45:38-04:00April 4, 2024|Alaska|

Arizona

On March 29, Gov. Katie Hobbs (D) signed SB 1165 (Chapter 51), legislation outlining specified provisions an auditing entity must comply with when conducting a wholesale invoice audit and prohibits an auditing entity from retroactively reducing the amount of a claim unless specified criteria apply.

Also in Arizona, on April 2, Gov. Katie Hobbs (D) signed SB 1021, legislation removing the requirement that health professional groups proposing to increase the scope of practice of a state-regulated health profession must complete a statutory sunrise review.

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

Michael Silber2024-05-08T17:14:10-04:00April 4, 2024|Arizona|

Arkansas

The Insurance Commissioner issued Directive 1-2024 suspending for 60 days the technical filing requirements, audits and recoupments related to claims for providers impacted by the Change Healthcare data breach.

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

Michael Silber2024-04-04T10:42:22-04:00April 4, 2024|Arkansas|

California

The Board of Pharmacy posted the following to its website:

Licensing Committee Meeting – April 10 – Note: inclusion of technician, central fill and standard of care agenda items.

- Agenda

Enforcement and Compounding Committee Meeting – April 11

- Agenda

Legislation/Regulation Committee Meeting – April 11

- Agenda

Also in California, the Board of Pharmacy is conducting an occupational analysis (OA) of the pharmacy technician profession in California. The survey is a part of the OA, which identifies competencies that will provide the basis for developing future licensure examinations in California. The survey weblink will be available 24/7 and must be completed by April 15.

Finally in California, the Department of Health Care Services posted the following alerts, weekly notices, and monthly bulletin on the Medi-Cal Rx Web Portal. 

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

Michael Silber2024-04-04T10:40:35-04:00April 4, 2024|California|

Colorado

The state legislature is grappling with a $170 million budget shortfall as the state’s constitution requires a balanced budget.

Also in Colorado, the Department of Health Care Policy and Financing (HCPF) reminded providers, including pharmacists, that they can deliver some laboratory testing services through a CLIA Certificate of Waiver. All claims for laboratory services must have the NPI (national provider identifier) of the provider who ordered the items to be indicated on the claim. The Billing Manual and more information on SUD (substance use disorder) benefits is available online.

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

Michael Silber2024-04-04T10:39:02-04:00April 4, 2024|Colorado|

Delaware

On April 1, the State Senate approved SB 194, an Act to Amend the Pharmacy Practice Act. This bill allows pharmacists, under protocol approved by the Department of Public Health, to provide HIV pre-exposure and post-exposure prophylaxis treatments. The proposal now moves to the House where NACDS will continue to support passage.

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

Michael Silber2024-04-04T10:38:27-04:00April 4, 2024|Delaware|

Florida

South Florida Community Care Network, LLC d/b/a Community Care Plan (Community Care Plan) currently provides behavioral health services. Beginning May 1, 2024, referrals, coordination and rendering of these services will also be provided by Ontrak Health. Members can receive behavioral health services from providers in Community Care Plan and Ontrak Health’s network. Community Care Plan is an SMMC (Statewide Medicaid Managed Care) plan operating in region 10.

For dates of service beginning May 1, 2024, Ontrak Health’s network providers should bill Ontrak Health for services rendered to Community Care Plan members. Community Care Plan’s network providers should continue to bill Community Care Plan for behavioral health services. Providers participating in both Community Care Plan and Ontrak Health’s network should use a unique Ontrak Health ID number when submitting their claims. Ontrak Health will be providing additional information for providers including the billing process.

Questions related to this transition may be directed as follows:

Community Care Plan Member Services: 1-866-899-4828
Community Care Plan Provider Services: 1-855-819-9506
Ontrak Health Provider Services: 1-855-840-3627

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

Michael Silber2024-04-04T10:37:58-04:00April 4, 2024|Florida|

Idaho

NACDS sent a letter to Gov. Brad Little (R) encouraging him to sign HB 596, legislation to further regulate PBMs (Pharmacy Benefit Manager) (Pharmacy Benefit Manager) in the state and, on April 1, the Governor signed the bill and issued this transmittal letter. The bill includes provisions that would prohibit the use of “spread pricing.” HB 596 also provides other vital reforms, including requiring 100% pass-through of manufacturer rebates to plan sponsors to keep patient premiums low, requiring that in-network pharmacies receive reasonable dispensing fees and implementing full disclosure and transparency requirements between the PBM (Pharmacy Benefit Manager) and the health plan, payor, and pharmacy.

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

Michael Silber2024-04-04T10:37:21-04:00April 4, 2024|Idaho|

Indiana

The Family and Social Services Administration’s Health Coverage Programs (IHCP) issued Bulletin BT202436 with pharmacy updates approved at the March meeting of the Drug Utilization Board.

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

Michael Silber2024-04-04T10:36:15-04:00April 4, 2024|Indiana|

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