As a result of PBM legislation enacted in 2021, the NYS Department of Financial Services is developing regulations, and the Department is seeking public comment on a series of issues.
Below are the three upcoming Public Notices with links for more details related to:
PBM Services to Medicare Part D Plans, Comments due August 1, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-02” included in the subject line. Failure to include “PBM2022-02” in the subject line may result in your comment not being considered. The deadline for responses is August 1, 2022.
Reporting Requirements for PBMs (Pharmacy Benefits Managers), Comments due August 5, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-03” included in the subject line. Failure to include “PBM2022-03” in the subject line may result in your comment(s) not being considered. The deadline for responses is August 5, 2022.
Practice of Patient Steering by PBMs due August 19, 2022
View the Request for Public Comments (PDF) Responses should be emailed to PBM@dfs.ny.gov, with “PBM2022-04” included in the subject line. Failure to include “PBM2022-04” in the subject line may result in your comment not being considered. The deadline for responses is August 19, 2022.
For more information about these Public Notices and DFS (Department of Financial Services) efforts to implement the law, please click here.
Also in New York, the Office of the Medicaid Inspector General (OMIG) published a Proposed Rule Making in the State Register related to Medicaid Program Fraud, Waste and Abuse Prevention with the stated purpose to establish requirements for providers to detect and prevent fraud, waste, and abuse in the Medicaid Program.
The full text of the proposed rule can be found here. Public comments are due within 60 days from when published on July 13, 2022. To read the new sections added to OMIG regulation through this rulemaking in their entirety, please click here.
In particular, the proposed rulemaking would repeal and add a new 18 NYCRR Part 521 to implement statutory changes resulting from the recommendations of the Medicaid Redesign Team II as adopted in the State Fiscal Year 2020-2021 Enacted Budget (Chapter 56 of the Laws of 2020, Part QQ) and to make other conforming changes related to:
(1) Provider Compliance Programs,
(2) Medicaid Managed Care Plan fraud, waste, and abuse prevention programs under the Medical Assistance (Medicaid) program, and
(3) The Obligation to report, return and explain Medicaid overpayments through OMIG’s Self-Disclosure Program.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.