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So far Michael Silber has created 2157 blog entries.

Florida

Gov. Ron DeSantis (R) released his Focus on Florida’s Future Budget recommendations for Fiscal Year 2024-25. The proposed budget comes in at $114.4 billion, which is a $4.6 billion decrease compared to the state’s FY 2023-24 budget. Governor DeSantis’ Focus on Florida’s Future Budget supports more than $1.1 billion in tax relief and the renewal of four traditional sales tax holidays as well as more than $153 million from the nationwide Opioid Settlement Agreement to continue support for the Office of Opioid Recovery, an accredited Graduate Medical Education program to increase the number of psychiatric residents and for other initiatives that support education, treatment and prevention for individuals with substance use disorders. The full budget highlights are available online.   

Also in Florida, the Agency for Health Care Administration (Agency) has filed six (6) new Durable Medical Equipment and Medical Supply Services Coverage Policies for adoption in the Florida Administrative Code (F.A.C.). These new policies took effect on January 10. Please visit the Agency’s website at  Adopted Rules – Main Page (myflorida.com) for details on the new Durable Medical Equipment and Medical Supply Services Coverage Policies. 

Finally in Florida, the Agency for Health Care Administration (Agency) has been working on modifying the way diabetic supplies are provided to Floridians served through the State’s Medicaid program by transitioning reimbursement for diabetic supplies from the durable medical equipment (DME) fee schedule to the pharmacy point of sale system. The Agency plans to release the Preferred Product List as referenced in proposed rule 59G-4.002, along with a resource toolkit to assist providers with billing for diabetic supplies through the pharmacy point of sale system. Until further direction is given, the Agency will continue to reimburse DME providers for all currently available diabetic supplies listed on the Durable Medical Equipment and Medical Supply Services Provider Fee Schedule using the existing reimbursement process.  

All interested parties should continue to check the Agency’s Pharmacy Policy webpage periodically and read all Agency alerts that are sent out regarding these changes. Interested Parties may also email the Agency at PharmacyPolicy@ahca.myflorida.com with any questions.  

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

2024-01-12T12:02:29-05:00January 12, 2024|Florida|

Georgia

The Legislature convened on January 8. Legislation regarding reimbursement and scope issues that carried over from the 2023 session are expected to be heard during the 2024 session. 

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

2024-01-12T12:01:38-05:00January 12, 2024|Georgia|

Idaho

On April 6, 2023, Gov. Brad Little (R) signed HB 71, the Vulnerable Child Protective Act prohibiting puberty blockers, cross-sex hormones, and sex reassignment surgeries for children under the age of 18 when administered or performed for the purpose of changing the appearance of a child’s sex with exemption for medically necessary uses of these drugs and procedures. On December 26, 2023, in a preliminary order, U.S. District Judge B. Lynn Winmill issued an order enjoining enforcement of HB 71 pending the outcome of litigation initiated by families filing a suit challenging the state law; Judge Winmill wrote that the 14th Amendment of the U.S. Constitution’s guarantees of equal protection and due process give parents the right to get gender-affirming care for their children.   

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

2024-01-12T12:01:08-05:00January 12, 2024|Idaho|

Illinois

The Department of Healthcare and Family Services (HFS) has issued a Provider Notice regarding Respiratory Syncytial Virus (RSV) vaccines for Medicaid customers. Additional information on other Provider Notices regarding these vaccines are available online.  

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for Medicaid Fee-for-Service claims, or the appropriate Medicaid Managed Care program. 

Also in Illinois, the Department of Healthcare and Family Services (HFS) continues to prepare for the release of the new over-the-counter (OTC) birth control pill, Opill, which is anticipated in early 2024. Opill will be covered by HFS under both the Medicaid Fee-for-Service (FFS) and Managed Care programs without a prescription for women aged 18 years and older. 

HFS requires pharmacies to submit all claims, including those for OTC medications, with a prescriber National Provider Identifier (NPI) in the Prescriber ID field (411-DB). For Opill, pharmacies may bill using the Department of Public Health standing order prescriber NPI for hormonal contraceptives.    

Questions regarding this notice may be directed to a pharmacy consultant in the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS claims, or the appropriate Medicaid Managed Care program. 

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

2024-01-12T11:59:54-05:00January 12, 2024|Illinois|

Iowa

The Department of Health and Human Services, Iowa Medicaid posted INFORMATIONAL LETTER NO. 2543-MC-FFS: Amerigroup Iowa, Inc. Rebranding to Wellpoint Iowa, Inc. 

Also in Iowa, on January 3, 2024, Wellpoint released Clinical UM Guideline (Guideline #CG-DME-42) regarding the use of continuous glucose monitoring devices (CGMs). Also review the Iowa Administrative Code and Department of Human Services Medical Equipment and Supply Dealer Provider Manual for related information; see pages 39-40. Please contact the following for assistance: Angela Dillon or Joely Anderson. 

Also in Iowa, in response to complaints by Iowa pharmacies, Andria Seip, Senior Health Policy Specialist, Iowa Insurance Division, sent a memo on January 4, 2024, to PBMs (Pharmacy Benefit Managers) licensed in the state that contracts requiring reimbursement models using “effective rates” are considered prohibited under Iowa Code section 510B.8C.  

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

2024-01-12T11:58:17-05:00January 12, 2024|Iowa|

Kentucky

The Medicaid Advisory Committee approved several motions suggested by the Pharmacy Technical Advisory Committee (PTAC), that NACDS serves on, to improve access to pharmacy vaccines in the Medicaid program: 

  • A written communication will be delivered to pharmacies clarifying that, per the rule passed last year, enrollment in VFC (Vaccines for Children) program is not required and claims will be reimbursed. 
  • They will work with PTAC to change policy to allow pharmacies to bill for vaccines in Medicaid FFS (Fee-for-Service).  
  • They will work with PTAC on a statewide protocol for pharmacists to administer HPV (HUMAN PAPILLOMA VIRUS) vaccines to increase adolescent vaccination rates. 

Members are encouraged to share their thoughts and suggestions on these proposed policy changes with NACDS’ Jill McCormack.  

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

2024-01-12T11:56:35-05:00January 12, 2024|Kentucky|

Louisiana

On January 7, Gov. Jeff Landry (R) was sworn into office, replacing former Gov. John Bel Edwards (D), who had reached his term limit. Ralph Abraham, MD, a physician, was appointed head of the Louisiana Department of Health. NACDS and our in-state partner, the Louisiana Alliance for Retail Pharmacies (LARP), have requested a meeting. 

Also in Louisiana, the new Legislature elected last Fall was sworn in on January 8. Currently, Republicans hold a supermajority in both Houses. 

Also in Louisiana, NACDS’ in-state partner, the Louisiana Alliance of Retail Pharmacies (LARP), submitted a comment letter to the Board of Pharmacy at the December 28, 2023, public hearing raising concerns about a proposed rule on product integrity that implements temperature control measures for shipments of prescription drugs to patients. Specifically, the proposed rule change would require ALL home delivery medications, including room temperature medications, to be sent in temperature-controlled packaging from pharmacies to patients.  

Also in Louisiana, the Department of Health (LDH) issued an Informational Bulletin 23-22 to Medicaid providers reminding them that RSV vaccines that have been covered since August 3, 2023, must have the correct CPT codes 90380 and 90381.  

Finally in Louisiana, in late December 2023, the Centers for Medicare & Medicaid Services (CMS) approved the state plan amendment (SPA) to increase the dispensing fee for local pharmacies only from $10.99 to $11.81. The increased fee applies to Medicaid Fee-for-Service pharmacy claims and Medicaid Managed Care local pharmacy claims, retroactive to the date of service of October 1, 2023. 

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

2024-01-12T11:55:53-05:00January 12, 2024|Louisiana|
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