Colorado

The Department of Health Care Policy and Financing (HCPF) announced that Adela Flores-Brennan, MA, JD is the new Medicaid Director, reporting to Executive Director Kim Bimestefer. Flores-Brennan will also assume the role of Office Director, leading our newly titled Health Policy Office (formerly Health Programs Office), which designs, maintains and oversees Health First Colorado and CHP+ medical policies and contracts. HCPF also announced the formation of a new Office of Medicaid and CHP+ Behavioral Health Initiatives and Coverage being led by Cristen Bates who will serve as Director. Bates’ office will govern HCPF’s specific behavioral health policies, benefits, special projects, and strategies that were previously part of our Health Programs Office. Bates will hold the role of Deputy Medicaid Director.

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

2022-09-16T09:55:41-04:00September 16, 2022|Colorado|

Illinois

The Illinois D&T Advisory Board will be reviewing the Biologic Modifiers at its October 20, 2022 meeting. All clinical and financial submissions are due to the Department by 3:00pm CST September 29, 2022. Please submit to: HFS.SupplementalRebaleProgram@illinois.gov. 

Also in Illinois, the Department of Healthcare and Family Services has posted a new Provider Notice regarding Sexual Assault Treatment Program Private Insurance Opt-Out Alternative Per Public Act 102-1097. 

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

2022-09-16T09:53:44-04:00September 16, 2022|Illinois|

Indiana

The Family and Social Services Administration’s (FFSA) Indiana Health Coverage Programs (IHCP) Medicaid announced that effective July 1, 2023, all managed care plans will cover both preferred and nonpreferred drugs, maintain the same clinical criteria requirements and use the same format for prior authorization (PA) as the fee-for-service (FFS) program. 

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

2022-09-16T09:52:41-04:00September 16, 2022|Indiana|

Iowa

The Department of Health and Human Services, Iowa Medicaid issued the following: 

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

2022-09-16T09:52:00-04:00September 16, 2022|Iowa|

Kentucky

The Board of Pharmacy has filed an emergency and ordinary amendment to allow pharmacists to prescribe and receive Medicaid reimbursement for Paxlovid. Specifically, the amendment removes the list of specific conditions that require a Board-approved protocol for pharmacists to be authorized to treat patients with illnesses. Instead, the regulation would allow a pharmacist to utilize any protocol approved by the board to provide treatment services. This emergency amendment will allow for any prescriber–approved protocol to be reviewed for approval by the Board of Pharmacy. If the regulation is approved, the physician Director of Medicaid Services can also sign a prescriber–approved protocol for any pharmacist to initiate the dispensing of Paxlovid for Medicaid patients. Additionally, the board approved a new board authorized protocol for Paxlovid. The emergency regulation was effective immediately, but the ordinary version must be go through the promulgation process with the Board. NACDS expects the physician community to oppose this regulation and encourages members to join us in submitting supportive comments by September 30. Further detail and contact information for comments are on the regulation webpage.

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

2022-09-16T09:50:33-04:00September 16, 2022|Kentucky|

Louisiana

The Department of Health (LDH (Louisiana, the Department of Health)) Medicaid Pharmacy Facts includes detailed information on Medicaid’s Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) coverage and reimbursements for flu and COVID booster. 

  • Effective September 15, 2022, enrolled pharmacies will be reimbursed for the influenza vaccines and administration of the vaccines when given to Medicaid recipients, who are 19 years of age and older when the administering pharmacist is an enrolled Medicaid provider. The cost of the vaccine will not be reimbursed for recipients under the age of 19, only the administration fee will be reimbursed, as these vaccines are available through the Louisiana Vaccines for Children (VFC) program. The Louisiana Board of Pharmacy rules and regulations allow a vaccinating pharmacist to administer the influenza vaccine to individuals seven years of age and older. 
  •  On September 23, 2022, with an effective date of August 31, 2022, the Louisiana Medicaid’s Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) are covering the bivalent COVID-19 vaccine booster, with Emergency Use Authorization (EUA). The federal government covers the cost of the COVID-19 vaccine. Therefore, Louisiana Medicaid will reimburse enrolled pharmacies the administration fee only. Coverage for the Pfizer, Janssen (Johnson & Johnson), and Moderna COVID-19 primary vaccine series will continue. 
  • Louisiana Medicaid is hosting a series of provider webinars regarding the upcoming Provider Enrollment deadline. 

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

2022-09-16T09:49:44-04:00September 16, 2022|Louisiana|

Mississippi

Effective July 1, 2022, the Mississippi Division of Medicaid (DOM) reestablished payment methods for the ingredient costs of prescription drugs that existed prior to the July 1, 2021 rate freeze. This change removed the freeze for dates of service on or after July 1, 2022. On 8/22/2022, Conduent will begin adjusting claims with dates of service of 7/1/2021 through 6/30/2022 to reflect the ingredient cost of the drug in effect on the claim’s date of service. 

Also in Mississippi, the Pharmacy Association will hold its 2022 Consultant Seminar on October 13, 2022, 8:00 a.m. – 5:00 p.m. Please visit their website for more information or Contact Mindy Phillips at mindy@mspharm.org if you have any questions or need assistance. 

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

2022-09-16T09:49:04-04:00September 16, 2022|Mississippi|

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