In The States – Page 215 – Weekly news about states

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’ Ben Pearlman at 617-515-2603.

Michael Silber2021-11-19T12:11:36-05:00November 19, 2021|New Jersey|

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.

Michael Silber2021-11-19T12:10:43-05:00November 19, 2021|Ohio|

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.

Michael Silber2021-11-19T12:09:50-05:00November 19, 2021|Oklahoma|

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.

Michael Silber2021-11-19T12:09:11-05:00November 19, 2021|Minnesota|

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.

Michael Silber2021-11-19T12:08:31-05:00November 19, 2021|Rhode Island|

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.

Michael Silber2021-11-19T12:07:58-05:00November 19, 2021|South Carolina|

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.

Michael Silber2021-11-19T12:07:12-05:00November 19, 2021|Washington|

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.

Michael Silber2021-11-12T09:13:41-05:00November 12, 2021|Alabama|

California

The following documents were recently posted on the Medi-Cal Rx Web Portal: 

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.

Michael Silber2021-11-12T09:13:06-05:00November 12, 2021|California|