In The States – Page 18 – Weekly news about states

New York

On September 5, Governor Hochul signed into law the Retail Workers Safety Act, which requires employers to implement policies and training programs to prevent workplace violence. It requires a retail store with 500 or more employees to install panic buttons in all New York locations. The Department of Labor would be required to create a model workplace violence prevention training program, policy, and guidance document to be utilized by employers. The law is effective March 4, 2025, however the section requiring panic buttons would take effect January 1, 2027.

On September 13, 2024, the New York Pharmacy Conference held its regular meeting. The meeting included updates from Donate Life New York State, the Comprehensive Contraceptive Coverage Act, and Expansion of Collaborative Drug Therapy Management to offsite practices, and a legislative update from Assemblyman John McDonald. The next meeting of the conference will be held on Friday December 13, 2024, at 10 AM.

On September 18, 2024, the New York Department of Health held their monthly pharmacy industry call regarding NYRx, the Medicaid Fee-For-Service Program. This month’s call included updates on Blood Glucose Test Strip Coverage Policy and Covid Tests Coverage Policy Update.

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

Michael Silber2024-09-19T10:46:14-04:00September 19, 2024|New York|

Ohio

The Board of Pharmacy published the following final rules:

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

Michael Silber2024-09-19T10:45:39-04:00September 19, 2024|Ohio|

Oregon

The Prescription Drug Affordability Board (PDAB) moved its next meeting from September 18 to October 2 due to unforeseen scheduling issues and lack of a quorum. The agenda has been updated to reflect this change. Please note the “Medicare MFP modeling presentation and SB 192 upper payment limit discussion” by PDAB staff and Myers and Stauffer on the agenda. You must register in advance of the meeting to participate.

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

Michael Silber2024-09-19T10:44:57-04:00September 19, 2024|Oregon|

Tennessee

Effective October 1, 2024, over the Counter (OTC) COVID-19 testing kits will no longer be covered under TennCare’s pharmacy benefit due to the end of the COVID-19 Public Health Emergency. Beginning October 1, 2024, Covid Test Kits will remain a covered benefit under the medical benefit.

Effective September 1, 2024, TennCare began reimbursing pharmacy providers through the OptumRx Pharmacy Point of Sale System (POS) for the administration of newly FDA approved COVID-19 vaccines for the 2024-2025 Formulas. Per FDA guidance, previous versions of COVID-19 vaccines are no longer recommended or authorized for use. CoverKids and CoverRx claims also follow this FDA guidance.

Claims for COVID-19 vaccines are exempt from co-pays and script limits for all TennCare enrollees.

COVID vaccine claims for dual eligible members (Both Medicare and Medicaid eligible) will receive NCPDP Reject 65 “Patient has Medicare Coverage, Bill Medicare.”

Please note for TennCare members, effective October 1, 2024, the Covid-19 vaccine reimbursement will change to include only the cost of the vaccine plus the Professional Dispensing Fee (PDF). The $40 administration fee will be discontinued. Therefore, the Incentive Amount Submitted (NCPDP Field 483-E3) is no longer required for claim submission. If you have a TennCare Medicaid ID, you may contract with the individual Managed Care Organization(s) to bill for ancillary services. Please contact the designated health plan Provider Services for assistance.

Also in Tennessee, prior authorization requirements can be bypassed for certain medications when specific medical conditions exist. The submitted claim should include a Diagnosis Code Qualifier (Field # 492- WE) of “02,” indicating ICD-10, as well as the appropriate Diagnosis Code (Field # 424-DO). See a list of the preferred agents and the clinical criteria here, and see the list of Tennessee OptumRx Provider Liaisons here.

Finally in Tennessee, the Tennessee Pharmacists Research and Education Foundation (TPREF) is proud to offer an ACPE-accredited OSHA training webinar that meets all of OSHA’s annual training requirements, with ten sessions offered between September 25 and October 23. Register for one of the sessions!

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

Michael Silber2024-09-19T10:44:17-04:00September 19, 2024|Tennessee|

Texas

The Texas Pharmaceutical Initiative (TPI) Board is meeting on September 23.

Also in Texas, Speaker Dade Phelan (R) appointed Rick Perry (R), former Governor of Texas and Secretary of Energy under the Trump Administration, as a senior advisor to his leadership team.

Also in Texas, the Department of State Health Services (DSHS) resolved the issue of providers receiving errors when submitting Unsolicited Vaccine Updates (VXU) messages through data exchange for influenza vaccines. The seasonal influenza vaccines for 2024–2025 have been updated in ImmTrac2 as of Aug 30, 2024. Please refer to the Fall Season Respiratory Vaccine Codes | Immunization Information Systems (IIS) | CDC for the correct codes to report for influenza 2024–2025 vaccines to ImmTrac2.

Finally in Texas, the Senate Health and Human Services Committee held a hearing focused on expanding access to healthcare services and NACDS submitted a support letter.

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

Michael Silber2024-09-19T10:43:39-04:00September 19, 2024|Texas|

Vermont

The Board of Pharmacy will be holding its regularly scheduled meeting on September 25, 2024, at 9:00 am. The meeting will be hybrid and recorded.

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

Michael Silber2024-09-19T10:42:45-04:00September 19, 2024|Vermont|

Alabama

Mandatory provisions of the Affordable Care Act require the Medicaid Agency (Medicaid) to select and provide oversight for a Medicaid Recovery Audit Contractor (RAC) to perform provider audits. Alivia Analytics, LLC (Alivia) was selected to be Medicaid’s RAC effective October 1, 2024. The RAC program is designed to improve payment accuracy by identifying under and overpayments in Medicaid. The Medicaid RAC program is separate from the Medicare RAC overseen by the Centers for Medicare and Medicaid Services.

Reviews will be conducted by Alivia staff to include a medical director, certified professional coders and experienced clinicians. Audits will be conducted by Alivia using a “top down” approach where data analysis, through data mining, is applied against the universe of paid claims to identify patterns of utilization or billing which look atypical based on Medicaid and/or national standards. Following the high-level claims analysis, Alivia may expand its review by requesting clinical records and/or other documents in accordance with state and federal regulations.

Alivia has been informed of the critical role that all providers play in a successful Medicaid program and requires that auditors be professional, objective and consistent in performing all required audits/reviews.

Providers are reminded that the Alabama Administrative Code, the Provider Manual and their Provider Agreements require compliance with requests for medical records for Medicaid program audits.

Questions regarding the audits should be directed to Jamie Cousins, RAC Program Manager, at (334) 353-8025 or Yulonda Carter, Recipient Review Associate Director, at (334) 242-5161.

Also in Alabama, the State Board of Pharmacy will transition to a new database in October of this year. The new system and the renewal process will look different. The changes will ultimately be positive but require you to create a new account to renew licenses, permits and registrations.

Finally in Alabama, as a reminder, 2024 is a year for pharmacist license renewals and pharmacy permit renewals.

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

Michael Silber2024-09-05T10:05:19-04:00September 5, 2024|Alabama|

Alaska

The Board of Pharmacy adopted regulation changes in August related to pharmacy technicians, collaborative practice authorities, sterile pharmaceutical guidelines, manufacturer license requirements, PDMP registration, alternative to probation program and definitions. The regulation changes were reviewed and approved by the Department of Law, signed and filed by the Office of the Lieutenant Governor on August 29, 2024, and are effective on September 28, 2024. The filed version of the regulations will be posted in Register 251, October 2024 of the Alaska Administrative Code.

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

Michael Silber2024-09-05T10:04:11-04:00September 5, 2024|Alaska|

California

Last week, the State Assembly passed an amended version of SB 966, PBM Reform legislation, and the State Senate concurred with the amended version. Upon passage, the bill was ordered to “engrossing and enrolling” after which it will be presented to Gov. Gavin Newsom (D) for signature. The governor has until September 30 to act. The bill requires PBMs to apply for a licensure from the California Department of Insurance by January 1, 2027; clarifies the State Attorney General retains all authorities to maintain or restore competitive, fair and honest markets and prosecute state and federal antitrust and unfair competitive violations; prohibits retroactive fees; and would allow a pharmacy that is not owned by the PBM to participate in a PBM network as a preferred provider if the pharmacy is willing to accept the same terms and conditions. NACDS sent a letter to Gov. Gavin Newsom (D) urging him to sign SB 966 to help preserve and expand patient access to pharmacists, pharmacies of all sizes and the Californians they serve.

Also in California, last week, AB 3063 passed the state legislature and was ordered to “engrossing and enrolling” after which it will be presented to Gov. Gavin Newsom (D) who has until September 30 to act. This legislation states the addition of a flavoring agent to a conventionally manufactured product is not considered compounding if certain conditions are met. It also requires the addition of the flavoring agent to be documented in the prescription record.

Also in California, the Department of Health Care Services posted the following alerts and weekly notice and monthly bulletin on the Medi-Cal Rx Web Portal. Please note the MAIC 30-day pharmacy provider notice; rates will be effective October 1, 2024, and were to be posted to the Mercer Medi-Cal Rx website no later than September 1, 2024.

Finally in California, the Board of Pharmacy posted the agenda and meeting materials for the Full Board Meeting on September 12, 2024. Please note the discussion and action related to awarding a contract for medication error reporting.

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

Michael Silber2024-09-05T10:03:41-04:00September 5, 2024|California|