Maryland

The Prescription Drug Affordability Board (PDAB) announced the June virtual meeting of its Stakeholder Council, scheduled for 2:00 pm on June 24. The agenda and other meeting materials will be available on the Stakeholder Council page of the PDAB’s website prior to the scheduled meeting. To register for the June 24 virtual meeting, please click on this link and enter the required information. After registering, you will receive a confirmation email containing details about joining the meeting. Also, to register for oral public comment and for additional information concerning public comments, please refer to the Stakeholder Council page.

Also in Maryland, please visit the Prescription Drug Affordability Board’s, Cost Review Study Process page on the Board’s website to learn more about the comment period for “Board Selected Drugs for Cost Review.” The 60-day comment period will close on July 22, 2024.  

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

2024-06-06T16:03:16-04:00June 6, 2024|Maryland|

Massachusetts

MassHealth published its June All Provider Bulletin 391” with orders ALL 361, ALL 376 and ALL 380 announcing the start dates for enforcing the ordering, referring and prescribing (ORP) requirements. With the exception of the information in the bulletin, all information in ALL 361, ALL 376 and ALL 380 remains in effect. Opportunity for payment of claims initially denied due to unenrolled ORP provider as described in ALL 376, billing providers should take certain steps to avoid claim denials due to unenrolled ORP providers. If a claim is denied because of an unenrolled or unauthorized ORP provider on or after June 9, 2024, the claim will be placed in suspense status. The claims system will continue to check to see if the ORP provider has enrolled with MassHealth for up to 90 days after the first date of service on the claim. Once the ORP provider is enrolled, the claim will then be payable. This will allow billing providers time to follow the steps related to unenrolled ORP providers outlined in ALL 376. If the ORP provider is not enrolled by 90 days from the first date of service on the claim, the claim will be denied. Also, effective June 9, 2024, billing providers can resubmit claims that were previously denied due to an unenrolled or unauthorized ORP provider if the first date of service on the claim is no earlier than September 1, 2023. If the ORP provider is enrolled with MassHealth within 90 days of the first date of service on the claim, the claim will be payable. 

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

2024-06-06T16:02:46-04:00June 6, 2024|Massachusetts|

Michigan

Pharmacy Controlled Substance Administrative Rules have been revised and changes are effective as of May 31, 2024. One amendment of note is the removal of Gabapentin, meaning it is no longer classified as a controlled substance in the state. A prescriber without a controlled substance license can now prescribe Gabapentin, and Gabapentin no longer needs to be included in reporting to the Michigan Automated Prescription System (MAPS).

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

2024-06-06T16:02:13-04:00June 6, 2024|Michigan|

Missouri

The Department of Social Services, MO HealthNet Division (MHD), reminded covered entities to comply with all the Health Resources and Services Administration (HRSA) 340B Program rules, including the exclusion of using 340B stock for inpatient administration and the prohibition of duplicate discounts.

Also in Missouri, to raise awareness about Project Hep Cure, Josh Moore, the Director of Pharmacy at MO HealthNet, sent a message to healthcare providers on how to help cure Missourians of the disease. 

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

2024-06-06T16:01:43-04:00June 6, 2024|Missouri|

Oklahoma

The legislature adjourned sine die on May 30.

SB 232, legislation allowing pharmacists to screen and treat for minor ailments and other conditions, dispense hormonal contraceptives without a prescription and increase the pharmacy technician ratio from two to three, died due to the early adjournment of the legislature.

Two PBM reform bills that pharmacies supported because they enhanced the Attorney General’s enforcement authority, addressed MAC pricing and audits, were enacted into law. SB 1670 / HB 3376 

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

2024-06-06T16:01:02-04:00June 6, 2024|Oklahoma|

Oregon

The Board of Pharmacy will meet on June 12-14. The agenda and meeting materials are available online.  

Also in Oregon, the following individuals have been appointed to the Board of Pharmacy: Amy Kirkbride with Kaiser Permanente, Victoria Kroeger with Walgreens and Ana Pinedo.

Finally in Oregon, the Division of Financial Regulation announced this proposed rulemaking. These proposed rules implement 2023 Oregon Enrolled SB 797, Oregon Laws 2023, chapter 113, which requires certain health insurance policies to provide coverage for prosthetic and orthotic devise as defined in the bill. 

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

2024-06-06T16:00:05-04:00June 6, 2024|Oregon|

South Carolina

The Department of Health and Human Services (SCDHHS) regularly offers free Healthy Connections Medicaid training to enrolled Healthy Connections Medicaid providers and their billing agents. These recurring trainings are conducted by SCDHHS’ contracted vendors. Information about the upcoming June-August 2024 training is listed below.

Medicaid eLearning Provider Workshops
SCDHHS’ contracted vendor provides web-based training, presentations and other materials on a variety of topics to ensure enrolled providers have an understanding of processes and programs.

To register for a workshop or find additional training resources, please visit www.medicaidelearning.com or call the Provider Service Center (PSC) at (888) 289-0709. The PSC’s hours of operation are 7:30 am-5:00 pm Monday-Thursday and 8:30 am-5:00 pm Friday. 

Also in South Carolina, with the conclusion of the federal PHE in 2023, the South Carolina Department of Health and Human Services (SCDHHS) is required to resume the provider revalidation process. SCDHHS will restart this process in June 2024.

In order to revalidate or renew the provider enrollment record with the state Medicaid agency, an enrollment revalidation application must be submitted. The provider revalidation process is designed to confirm or update a provider’s demographic and other information including National Provider Identifier, mailing address and service location address(es). There are no exemptions from revalidation.

Consistent with federal regulations (42 CFR §455.414), state Medicaid agencies must complete revalidation of enrollment for all providers, regardless of provider type, at least every five years. However, provider types designated by either CMS or SCDHHS as “high-risk” providers are required to revalidate every three years. High-risk providers include durable medical equipment (DME), home health agencies, targeted case management, rehabilitative behavioral health services and licensed independent practitioner rehabilitative services. High-risk providers may also require a physical site visit or fingerprint-based criminal background check (FCBC). For more information on high-risk providers, please review the Provider Enrollment and Screening Requirements FAQs.  

Impacted providers will receive an official revalidation notification letter in the mail. The notification contains a unique revalidation number necessary to begin and complete the revalidation process. To avoid risk of termination from the Healthy Connections Medicaid program, providers must complete the revalidation process. The first step in the revalidation process is completing the online enrollment revalidation application within 30 days. Providers will be notified when the cohort window is open for their specific provider type to begin the process. Providers must not attempt to begin the revalidation process until they have received notification. 

Provider revalidation for cohort one begins June 17, 2024. The revalidation window for cohort two and future cohorts will be announced in subsequent provider bulletins that will be published approximately 30 days prior to the start of the respective revalidation windows.

A list of providers scheduled for revalidation will be published on the SCDHHS’ website as each cohort’s revalidation period begins. 

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

2024-06-06T15:58:51-04:00June 6, 2024|South Carolina|
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