Tennessee
Applications for TPA executive officers, society leaders, and committee members are being accepted through Dec. 15. Volunteer or nominate a colleague to serve.
Also in Tennessee, the Tennessee Department of Health (TDH) is required by the Centers for Disease Control and Prevention (CDC) to audit providers of COVID-19 vaccines. The Tennessee Pharmacists Association requested a checklist for those who have been selected for an audit, and one was prepared by TDH. Please review the checklist and the Routine and Emergency Vaccine Management Plan in their entirety.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Board of Pharmacy proposed and adopted several rules at their November meeting.
Also in Texas, the Health and Human Services Commission (HHSC) revised the Medicaid preferred drug list effective December 3, 2021.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The State Department of Health’s (DOH) December 7th COVID-19 partner call the Health Care Authority and the Office of the Insurance Commissioner will present information on reimbursement for patient counseling on COVID-19 vaccines, and provider billing and reimbursement for COVID-19 vaccines.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
West Virginia
The Legislative Rule Making Committee will be considering the PBM rule as approved by the agency on December 8. You can link to the agenda here. NACDS is currently analyzing the rule and will follow up with members operating in the state via email. In the meantime, please share any concerns you may have with the rule with Jill McCormack as soon as possible.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Arkansas
The Division of Medical Services is holding a virtual rulemaking hearing on October 20th to consider proposed rules to allow six refills per month, add certain medications that do not count toward the monthly prescription cap, and allow up to nine medically necessary prescriptions per month for Living Choices Assisted Living Program clients. The rule also would specify that clients must pay for their own medications beyond the maximum benefit, remove the extension of benefits provisions, and revise refill requirements.
Also in Arkansas, Gov. Asa Hutchinson (R) announced on November 15th that individuals over 18 are eligible for the booster shot.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The following documents were recently posted on the Medi-Cal Rx Web Portal:
- 45-day Pharmacy Provider Notice – Note: Magellan Medicaid Administration, Inc. encourages pharmacies to submit test transactions prior to the transition, effective January 1, 20221, and is offering a testing window October 11 through November 30.
- User Administration Console (UAC) Registration and Sign-In Troubleshooting
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Colorado
On October 31st, Gov. Jared Polis (D) issued an Executive Order directing vaccine providers such as retail pharmacies, including those that operate under the fed retail pharmacy vaccine program, to drop existing CDC parameters around boosts eligibility, allowing all access to booster shots.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Illinois
The Department of Healthcare and Family Services has posted Updated Medicaid Preferred Drug Lists.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Louisiana
The Department of Health (LDH) LDH recommends COVID-19 booster shots for all fully vaccinated Louisianans ages 18 and older.
Also in Louisiana, longtime Board of Pharmacy president Carl Aron, an independent pharmacist from Monroe, announced his retirement at the November 17th meeting. The Board elected Marty McKay as president.
Finally in Louisiana, the Department of Health (LDH) announced a billing update for COVID-19 vaccines for 5-11 years old, third dose and booster shots.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Mississippi
The Division of Medicaid (DOM) is ending coverage of the Temporary Telehealth Procedure Codes effective Friday, Nov. 20, 2021, which aligns with the end of Mississippi’s COVID-19 State of Emergency.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
New Jersey
Governor Phil Murphy (D) signed into law A-1259 / S-249 which requires pharmacy benefits managers providing services within the Medicaid program to disclose certain information to the Department of Human Services. Program to require the pharmacy benefits manager to disclose to the department: (1) all sources and amounts of income, payments, and financial benefits received by the pharmacy benefits manager in relation to the provision and administration of pharmacy benefits management services on behalf of the managed care organization, including, but not limited to, any pricing discounts, rebates of any kind, inflationary payments, credits, clawbacks, fees, grants, chargebacks, reimbursements, or other benefits; (2) all ingredient costs and dispensing fees or similar payments made by the pharmacy benefits manager to any pharmacy in connection with the contract or other arrangement; and (3) the pharmacy benefits manager's payment model for administrative fees. Information reported by pharmacy benefits managers under the bill will be confidential and will not be subject to disclosure under the "Open Public Records Act."
This law goes into effect immediately.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Ohio
The Ohio Department of Medicaid's (ODM) next generation managed care program will go live July 1, 2022. At that time, they will introduce new programs, services, and managed care entities (MCEs). In preparation for the next generation program, ODM is encouraging providers to contact the next generation MCEs that they are interested in contracting with to begin the process to join their provider networks. Provider contracting contact information for the next generation MCEs can be found on the Resources for Providers webpage of the next generation Ohio Medicaid website. Contracting must be completed by February 15, 2022, to be included in the Next Generation Managed Care Provider Directory on day 1 of member transition enrollment.
Also in Ohio, ODM has announced that the supplemental tiered dispensing fee quarterly payment to pharmacies that planned to be disbursed in the first two weeks of November has been delayed pending CMS approval. NACDS will keep members updated as new information becomes available.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Oklahoma
The Board of Pharmacy received updated information from the Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) regarding how to submit DEA 106 forms. Please send all DEA 106 forms for OBNDD via email to losstheftcds@obn.ok.gov.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Minnesota
The Administrative Law Judge assigned to the PBM rulemaking process, Kimberly Middendorf, has concluded her review of the Department of Commerce’s proposed rule and SONAR, as well as all comments, responses, and rebuttals from members of the public, and on Friday issued a “Report of the Administrative Law Judge. Judge Middendorf’s report is available for review on the Commerce website (scroll down to Report of the Administrative Law Judge).
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Rhode Island
The Department of Health has extended (60 days) the Emergency Regulation requiring immunization against COVID-19 for all workers in licensed health care facilities and other practicing health care providers.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
South Carolina
The South Carolina Pharmacy Association is hosting their 19th Annual SE Women of Pharmacy Leadership Conference. You are invited to register for this event at the member rate using the discount code "STATE". Click here for more information and register. Early Bird registration rates and hotel block are open from now until November 28, 2021. After this date, or after the block is filled, rooms are subject to prevailing rates and availability, and general registration rates will apply.
Also in South Carolina, the Department of Health and Human Services (SCDHHS) will operate on an updated schedule for Healthy Connections Medicaid claims submission and payments for one week in November 2021 to accommodate the 2021 Thanksgiving holiday. Thursday, Nov. 25, 2021, and Friday, Nov. 26, 2021, have been designated as South Carolina state holidays. Due to the holidays, claims must be submitted by 5 p.m. on Saturday, Nov. 20 to be included with the payment scheduled for Friday, Nov. 26. Payments will run on Monday, Nov. 22 and electronic remittance advice will be available on Tuesday, Nov. 23. Payments will be dated Friday, Nov. 26.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Washington
The State Department of Health (DOH) announced that as of early November, more than 10 million doses of COVID-19 vaccine have been administered since distribution began in mid-December 2020.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Alabama
Effective December 28, 2021, the Alabama Medicaid Agency will replace Claim Adjustment Reason Code (CARC) 45 with a new code to ensure compliance with the Committee on Operating Rules for Information Exchange (CAQH CORE) combinations reported on the X12 835 Electronic Remittance Advice (RA). The new CARC is as follows:
CARC (96) – (non-covered charge(s)) with an appropriate Recipient Advice Remark Code (RARC) for the situation.
UPDATE: These changes are currently available in our test environment for Provider and Vendor testing. Testing should be completed by December 24, 2021. The updated reporting will be implemented for claims appearing on the January 7, 2022 check write going forward.
Also in Alabama, effective December 28, 2021, Alabama Medicaid will implement changes to the 271 Eligibility and Benefit Response transaction to ensure compliance with the Committee on Operating Rules for Information Exchange (CAQH CORE) for "Normalizing" the last name, which means removing all special characters, punctuation, upper case letters, suffixes, and prefixes to increase the chances of a match.
UPDATE: These changes are currently available in our test environment for Provider and Vendor testing. Testing should be completed by December 24, 2021.
Providers with questions concerning the upcoming change can submit them via the following email address: interChange_testing@DXC.com.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
California
The following documents were recently posted on the Medi-Cal Rx Web Portal:
- Introduction to Medi-Cal Rx Education & Outreach Team
- User Administration Console (UAC) Registration – Alternate Address
- Medi-Cal Rx Provider Training Details
Also in California, Magellan informed NACDS and the California Retailers Association that many pharmacies have "requested" a PIN to register for the Medi-Cal Rx Provider Portal but less are activating their accounts. As we get closer to the January 1, 2022, start date for Medi-Cal Rx, Magellan wants to make sure pharmacies are not only registered but have activated their accounts and are testing the provider portal.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Delaware
The Delaware Division of Professional Regulation is proposing to amend the Uniform Controlled Substances Act regulations to make the provisions on expiration and partial filling of controlled substance prescriptions consistent with federal standards. The rule would make technical revisions. A hearing is scheduled for Dec. 1, 2021, in Dover.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
Kentucky
An RX Fraud Alert has been issued by the Office of Inspector General, Division of Audits & Investigation. The office has seen a huge uptick in prescriber identity theft and forged (C-V) Promethazine with codeine prescriptions across the Commonwealth. They encourage pharmacies to reach out to their Drug Enforcement and Professional Practices Branch with questions, concerns, or fraud reports at 502-564-7985.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Maryland
The State Health Information Exchange, CRISP (Chesapeake Regional Information System for our Patients) now allows pharmacists access to clinical data for patient treatment and clinical care coordination. It also allows pharmacists to see alerts in the Prescription Drug Monitoring Program (PDMP) like nonfatal overdoses and deceased patient notifications. To access this information, the pharmacy must complete the CRISP Participation Agreement and review additional policies and procedures. For information about the CRISP participation agreement and how to sign, click here. Pharmacies should also contact CRISP outreach at support@crisphealth.org.
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Nebraska
Effective November 9, the Department of Health and Human Services published the COVID Ad-Hoc Fee Schedule Booster – Pediatric Vaccine Update.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
New Hampshire
The New Hampshire Board of Pharmacy is proposing to readopt amendment regulations under NHAR Ph 807 and 808 to revise the registered pharmacy technician duties to remove the restriction that a certified pharmacy technician may not perform data entry of prescription medication orders. The rule also would remove the requirement that pharmacy technicians fulfill Pharmacy Technician Certification Board or National Healthcare Association certification. A hearing is scheduled for Nov. 17, 2021, in Concord.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.
New Jersey
The New Jersey Board of Pharmacy is proposing to adopt regulations under NJAC 13:39-1 to require pharmacy permit holders and registered pharmacists-in-charge to implement a continuous quality improvement program to prevent prescription errors.
For more information, please contact NACDS’ Mike Sargent at 207-272-6435.