In The States – Page 77 – Weekly news about states

Iowa

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

INFORMATIONAL LETTER NO. 2502-MC – Your Medicaid Clients May Receive a Visit from their Managed Care Organization (MCO) – Effective Immediately

INFORMATIONAL LETTER NO. 2472-MC-FFS – Telehealth Services – Place of Service (POS) Codes – Effective Upon Receipt

Also in Iowa, the Department of Health and Human Services (HHS) and the Iowa Department of Education received approval from the U.S. Department of Agriculture, Food and Nutrition Service to issue Summer 2023 Pandemic Electronic Benefits Transfer (P-EBT) for eligible school-age Iowa children.  This program provides $120 per eligible child, issued on new P-EBT cards to be received by October 4. Approximately 240,000 Iowa children are eligible for this benefit, totaling $28 million in food assistance. 

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

Michael Silber2023-09-22T14:29:23-04:00September 22, 2023|Iowa|

New York

Effective September 11, 2023, the New York State Department of Health that NYRx, the Medicaid Pharmacy Fee-For-Service program will provide reimbursement for qualified and enrolled pharmacies for COVID-19 vaccines and administration as approved by the FDA or authorized for emergency use. Billing codes and other guidance provided in the annoucement.

On September 12th, the New York State Education Department withdrew the proposed central fill pharmacy regulations. The Department and the New York Board of Pharmacy will convene stakeholders and restart the regulatory process. NACDS and members had been actively advocating for a change and delay in the proposed regulations, that amongst its provisions would have created a new central fill pharmacy registration class, prohibited central fill pharmacies from being open to the public, require that central fill pharmacies only prepare, and fill prescriptions sent from an originating pharmacy, prohibited direct-to-patient central fill models, and required the originating pharmacy to obtain consent from the patient in writing before a prescription may be prepared by a central fill pharmacy. A broad coalition of pharmacy interests are unified in opposition and pushed for support for delayed consideration. NACDS also previously submitted a letter during the public comment period.

On September 20th, the New York State Department of Health held their monthly industry call for NYRx, the Medicaid fee-for-service program. The Education and Outreach team for NYRx holds virtual office hours on Tuesdays and Thursdays, 12-1pm eastern.

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

Michael Silber2023-09-22T14:28:29-04:00September 22, 2023|New York|

South Carolina

Effective October 1, 2023, the Medicaid State Plan will be updated to allow South Carolina pharmacists to bill for hormonal contraception services in accordance with the Pharmacy Access Act and as described in this bulletin.

To be eligible for reimbursement for these services, pharmacists must complete a Healthy Connections Medicaid provider enrollment application. Pharmacists may apply on or after September 18, 2023. Interested pharmacists are encouraged to apply on the providers page of the Department of Health and Human Services’ (SCDHHS) website and enroll as an “individual pharmacist” under the provider type “other medical professional.” In addition to the standard enrollment information, pharmacists must provide information on the pharmacy or pharmacies where they will be providing this service. Training on completing this application and enrollment process is available on the SCDHHS website.

Once enrolled, pharmacies will be able to bill dates of service on or after October 1, 2023, for Medicaid members. This includes members enrolled in the full-benefit Medicaid program and those enrolled in the Family Planning limited benefit program. Pharmacies will be reimbursed for the procedure and diagnosis codes listed below under the Healthy Connections Medicaid member’s medical benefit utilizing the CMS form 1500. These services will be reimbursed in parity with nurse practitioners and physician assistants at 80% of physician rates. The reimbursement rates for these services are available in the Base Physician Fee Schedule available on SCDHHS website. Covered services and billing guidance will be added to the Physicians Services provider manual by October 1, 2023.

Also in South Carolina, the Joint Pharmacist Immunization Protocol has been updated to allow pharmacists to administer Respiratory Syncytial Virus (RSV) in certain populations without a patient-specific prescription.

Pharmacists who administer vaccines under this Protocol shall maintain a current copy of this Protocol at each location at which a pharmacist administers a vaccine and an appropriate area for administering vaccines with the supplies and equipment.

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

Michael Silber2023-09-22T14:27:46-04:00September 22, 2023|South Carolina|

Tennessee

Please see the webinar invitation for TennCare Pharmacies, during which OptumRx will unveil the findings from the Pharmacy TennCare Cost of Dispensing Survey. During this event, OptumRx will also disclose the updated professional fees applicable to all pharmacies within the TennCare Pharmacy Network. Please do not hesitate to reach out to your Provider Liaison Pharmacist with questions or concerns at TNRxEducation@optum.com.

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

Michael Silber2023-09-22T14:27:04-04:00September 22, 2023|Tennessee|

Utah

The Department of Health & Human Services released the results of its recent survey of the average cost of dispensing a Medicaid prescription in the state. The mean cost of dispensing, weighted by Medicaid prescription volume, was $11.57 per prescription for all pharmacies including specialty pharmacies. For non-specialty pharmacies only, the mean cost of dispensing, weighted by Medicaid prescription volume, was $11.24 per prescription.

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

Michael Silber2023-09-22T14:26:18-04:00September 22, 2023|Utah|

Vermont

The Vermont Board of Pharmacy posted the agenda for the September 27th meeting. The agenda includes drafts for state pharmacists prescribing protocols for emergency contraception and ACIP-recommended vaccines which are included in the agenda posting.

On September 18th, the Department of Vermont Health Access (DVHA) made changes to the Pharmacy Manual regarding automatic refills for Medicaid members. Vermont Medicaid does not pay for prescriptions that are not medically necessary or for individuals who are no longer eligible for Vermont Medicaid. Providers may not use automatic refill systems to deliver or provide prescriptions to members. Members and providers may not agree to waive the requirements of this section. Providers may contact members to initiate a refill, but members must choose to fill each prescription, and providers must determine that the member remains eligible for Vermont Medicaid before providers deliver or dispense the prescription. Providers may not assume that, because a member’s prescription authorizes refills, the member has implicitly requested that the provider refill the prescription. For questions, please contact the Change Healthcare Pharmacy Help Desk at 1-844-679-5362. Vermont providers can also send inquiries via email to PBA_VTHelpdesk@changehealthcare.com.

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

Michael Silber2023-09-22T14:25:49-04:00September 22, 2023|Vermont|

Alabama

The Medicaid Agency has published a PSA video to encourage Medicaid recipients to complete their eligibility renewal forms when their notices come in the mail. Medicaid providers and partners are encouraged to share this video in public locations and on websites. 

Medicaid has taken extraordinary efforts to notify recipients when it is time to renew. 
Renewal notices are sent through regular mail, and the Agency is contacting recipients by 
email, text message and phone when it is time to renew (if they have provided contact 
information to the Agency). Several outreach resources are available for Medicaid partners to 
make it simple to share the key messaging. 
 
Please share the following key messaging from Medicaid: 
 
* Public Service Announcement – August 29, 2023 
* How to Update Contact Information with the Agency (Medicaid Recipients) 
* Video: Keep Your Coverage 
* Video (Spanish): Keep Your Coverage 
 
Medicaid regularly updates information for recipients on the COVID-19 Information for Providers webpage. Medicaid recipients who have questions should call Medicaid’s Recipient Call Center at (800) 362-1504 or visit a Medicaid office in their area. Providers may contact the Provider Assistance Center at (800) 688-7989. 

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

Michael Silber2023-09-08T11:03:07-04:00September 8, 2023|Alabama|

Arizona

Last week, the Governor’s Regulatory Review Council (GRRC) held a Study Session that included pharmacy technician rules to permanently authorize pharmacy technician to administer vaccines under the delegation and supervision of a pharmacist. This week, at its September 6 meeting, the GRRC approved the rules. The rules take immediate effect.

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

Michael Silber2023-09-08T11:02:38-04:00September 8, 2023|Arizona|

Arkansas

Gov. Sarah Huckabee Sanders (R) may call a special session in September to address property tax relief. 

Also in Arkansas, the Governor appointed two new members to serve a six-year term on the Board of Pharmacy. Clint Boone from Little Rock replaces Rebecca Mitchell and Beth Ann Davenport from Bentonville will succeed Amy Fore. 

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

Michael Silber2023-09-08T11:02:13-04:00September 8, 2023|Arkansas|