Florida
As previously announced in a provider alert dated June 28, 2022 Provider Alert, the Agency for Health Care Administration (Agency) has been implementing Referring, Ordering, Prescribing, and Attending (ROPA) requirements as directed by the 21st Century Cures Act (Cures Act) and by the Centers for Medicare and Medicaid Services (CMS). Previous provider alerts on National Provider Identifier (NPI) requirements for ROPA providers can be found on the Agency's website in the Provider Message Archive. Providers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b).
All Fee-For-Service claims submitted January 1, 2023, or after from a non-exempt provider type that does not have a ROPA provider listed on the claim will be denied. The exempted provider types that will not require a ROPA on the claim are listed below, all other provider type claims must have a ROPA provider identified by NPI on the claim for reimbursement by Florida Medicaid.
In a provider alert dated June 28, 2022, the Agency previously set the effective date as October 1, 2022. To allow providers more time to prepare, we have extended the effective date to January 1, 2023. In addition, the Agency has continued to evaluate the effected provider types and has added several types to the exempted list.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
Gov. Eric Holcomb (R) administration that the state has $6.1 billion in reserve following the closeout of its fiscal year, having collected $353 million more in revenue than the current budget needs. Because of the new law passed during the special session, the first one billion dollars in excess goes to paying down debt in the teacher pension fund. The remaining surplus will be disbursed to taxpayers as part of the Governor’s inflation relief plan.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Louisiana
The Board of Pharmacy Regulation Revisions Committee will be meeting on October 11 at their office in Baton Rouge to discuss these regulatory proposals.
Also in Louisiana, the Department of Insurance Office of the Commissioner promulgated Regulation 122 defining the roles and responsibilities solely within the purview of pharmacy benefit managers and pharmacy services administrative organizations.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Maine
The agenda has been posted for the October 6th Board of Pharmacy meeting.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Mississippi
New Medicaid Paper Claims Billing Manual available online. In preparation for the Mississippi Division of Medicaid's (DOM) transition to a new Fiscal Agent effective Oct. 3, a newly developed Paper Claims Billing Manual, produced by Gainwell Technologies, is available on the is available on the DOM website.
The Paper Claims Billing Manual is designed to offer guidance and assistance to providers submitting claims for reimbursement to DOM, including detailed information specific to the submission of paper claims.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Missouri
The Board of Pharmacy next Lunch with the Chief Inspector online seminar is taking reservations for the October 13th compliance update.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Nebraska
The Department of Health and Human Services announced the selection of three health plans to provide health care services in Heritage Health, the state’s Medicaid managed care program. Molina Healthcare of Nebraska, Nebraska Total Care and UnitedHealth Care of the Midlands were selected; contracts will be effective January 1, 2024.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Nevada
The state joined Washington and Oregon in offering the ArrayRx card, a state-backed discount card program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New Mexico
The Immunization Coalition and Department of Health Immunization Program have put together a brief survey to gauge how provider offices handle vaccines for their adult patients.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
New York
As referenced in the 1% Across the Board (ATB) Medicaid Rate Increase, the New York State Department of Health revised the Medicaid Fee-for-Service (FFS) pharmacy professional dispensing fee to comply with this change. Effective September 22, 2022, the professional dispensing fee will change from $10.08 to $10.18 for covered outpatient drugs, when applicable. This was based on the enacted budget and was effectuated by Centers for Medicare and Medicaid Services (CMS) state plan approval. This does include retroactive adjustments to the dispensing fee back to April 1, 2022. Those adjustments will be processed at a future date, details will be forthcoming.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.
North Carolina
Please find here a notice from North Carolina Medicaid to permanently transition to a specific dispensing fee for North Carolina Medicaid based on the Cost-of-Dispensing Study performed every five years. This fee is currently $10.24. Also, included in this notice is North Carolina Medicaid's decision to allow for more than one dispensing fee per month.
Also in North Carolina, see the Medicaid Special Pharmacy Newsletter providing Revised Procedures for Prior Authorization of palivizumab (Synagis®) for Respiratory Syncytial Virus Season 2022/2023 – Coverage starts Oct. 1, 2022.
Finally, effective with date of service Aug. 31, 2022, the NC Medicaid and NC Health Choice programs cover Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) – 12 years of age and older (N/A) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91312 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use.
Effective with date of service Aug. 31, 2022, the NC Medicaid and NC Health Choice programs cover Moderna COVID-19 Vaccine, Bivalent (Original and Omicron BA.4/BA.5) – Booster Dose (N/A) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code 91313 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use. More information.
Providers are encouraged to review this information. All bulletin articles, including those related to COVID-19, are available on DHB's Medicaid Bulletin webpage.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Oklahoma
Gov. Kevin Stitt (R) appointed pharmacists Randy Curry D.Ph., and Shonda Lassiter, D.Ph, to the Board of Pharmacy.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Oregon
The Board of Pharmacy posted the agenda and meeting materials for its October 12-14 meeting.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Rhode Island
Please find the October 2022 provider update here.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Texas
The Board of Pharmacy has moved to the George H. W. Bush State Office Building. Their new mailing address is Texas State Board of Pharmacy, 1801 Congress Avenue, Suite 13.100, Austin, TX 78701. All telephone numbers, emails and faxes remain the same.
In advance of the October 3 Texas House Select Committee on Health Care Reform, NACDS submitted a statement recommending allowing pharmacists to permanently order and administer CDC/ACIP -recommended vaccines for ages 3 and older; permitting certified pharmacy technicians to also administer vaccinations to the same age group; and initiate corresponding treatment pursuant to the result of CLIA-waived tests.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Washington
The Pharmacy Quality Assurance Commission (PQAC) is conducting an accessible labeling capability assessment survey to assess current pharmacy practices around providing accessible labeling options to patients, including whether such options are already made available, and what technological, financial, or resource-based obstacles prevent such options from being offered. PQAC filed a rulemaking inquiry (CR-101) to consider new and amended rules related to prescription label accessibility standards on issues pertaining to both visual/print disability access and the translation of prescription drug information for individuals for whom English is not a primary language.
Also in Washington, the Health Care Authority (HCA) is publishing quarterly updates to many of the Apple Health billing guides effective October 1, 2022.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Wyoming
The Joint Corporations, Elections and Political Subdivisions Committee will meet October 13-14 to finalize interim work and prepare for the 2023 General Session. The agenda includes PBMs at 3:30 p.m. on October 13.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Arkansas
On September 19, the Insurance Department (AID) issued Rule 118, a final rule regulating Pharmacy Benefit Managers.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
California
The Department of Health Care Services posted the following alerts and weekly notices on the Medi-Cal Rx Web Portal.
- Diabetic Supplies Updates: Changes to the Lists of Covered Diabetic Test Strips and Lancets and Covered Self-Monitoring Blood Glucose Systems (Glucometers), Control Solutions, and Lancing Devices, Effective November 20, 2022 (September 20)
- Medical Supplies and Enteral Nutrition Coverage Reminder (September 19)
- Now Active – Physician Administered Drug Policy Updates (September 16)
- Now Active – Reinstatement of Limited Prior Authorization Requirements for 11 Drug Classes (September 16)
- Medi-Cal Rx Weekly Wrap-Up for September 9-15 (September 16)
- Informational Claim Message: Prescriber Enrollment (September 15)
- Medi-Cal Enrollment for Ordering, Referring, Prescribing Providers (September 15)
Also in California, Medi-Cal posted the following:
- Billing Update for Bebtelovimab Use for COVID-19 Treatment (September 20)
- National Correct Coding Initiative Quarterly Update for October 2022 (September 16)
- Addition of Novavax COVID-19 Vaccine (September 16)
- Medi-Cal Update – Durable Medical Equipment and Medical Supplies – September 2022 – Bulletin 564 (September 16)
- Medi-Cal Update – Pharmacy – September 2022 – Bulletin 1023 (September 16)
- New Laboratory Test for Orthopoxvirus is a Medi-Cal Benefit (September 16)
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Delaware
The Office of Controlled Substances Controlled Substance Advisory Committee Meeting scheduled for September 28 is cancelled. The next meeting will be held on November 30 at 9:00 a.m.
For more information, contact NACDS’ Sandra Guckian at 703-774-4801.
Georgia
Beginning this week, the Georgia Department of Human Services (DHS) will provide cash assistance of up to $350 for active enrollees in Medicaid, PeachCare for Kids, SNAP (Supplemental Nutrition Assistance Program), and/or TANF government benefit programs.
Georgians with email addresses registered with DHS will receive virtual payments by eGift card, this is separate from current benefit payment cards. Plastic cards will be mailed to eligible Georgians who do not have their email address listed in Gateway.
The virtual payment card is a Mastercard prepaid card that works exactly like a debit card – and will live in the recipient's digital wallet (Apple, Google, Samsung Wallets). The virtual payments can also be used via keyed entry anywhere that accepts Mastercard payments, not just online.
Also in Georgia, the Georgia Pharmacy Foundation is offing a free CPE (Continuing Pharmacy Education) online seminar, Pharmacy Well Being – Strategies to Mitigate Burnout, presented by PharmWell, on Thursday, November 17, 2022, 7:30 pm – 8:30 pm. CLICK HERE to register.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.
Indiana
The Family and Social Services Administration's (FFSA) Indiana Health Coverage Programs (IHCP) announced that they will continue reimbursing Health Indiana Plan (HIP) services at Medicare rates through the end of 2023. However, January 1, 2024, they will transition to a reimbursement model with consistent rates across all its programs. IHCP plans to equalize rates among the HIP, Hoosier Care Connect, Hoosier Healthwise and fee-for-service programs.
Also in Indiana, IHCP will host an online seminar on September 28 to discuss provider notices published this month.
Also in Indiana, IHCP announced the intent to implement Statewide Uniform Preferred Drug List (PDL) for all Medicaid pharmacy plans effective July 1, 2023.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Kentucky
As a result of the adoption of an Emergency Administrative Regulation, beginning October 1, 2022, MedImpact will pay pharmacies a dispensing fee of $10.64 for each prescription of Suboxone every 7 days, as written by the prescriber. Prior to the adoption of the new regulation, Medicaid would only pay the fee every 23 days. This will be practically implemented as one dispensing fee and up to three additional professional service fees per rolling 28-day period. To receive the professional service fees, the pharmacist is required to take additional steps, including checking KASPER and providing patient counseling. Additional information as well as adjudication details are included in this Bulletin.
Also in Kentucky, The Board of Pharmacy has issued the following proposed rules for public comment. Comments are due to the BOP on November 30 and contact details are on the last page of each rule.
- 201 KAR 030 – amends to the license transfer regulation to establish a non-resident pharmacist license for any pharmacist located outside of Kentucky serving Kentucky patients; requires the pharmacist to have a non-resident pharmacist license and participate in NABP's Verify program; exempts the non-resident pharmacist from continuing education requirements in the state
- 201 KAR 2 460 -establishes an out-of-state pharmacy permit
- 201 KAR 2 360 – amends the Naloxone regulation allowing pharmacists to dispense to emergency departments under a protocol
For more information, contact NACDS’ Jill McCormack at 717-592-8977.
Louisiana
The Department of Health’s (LDH) deadline for Medicaid providers to submit an enrollment application is September 20, 2022. Claims will be denied beginning December 31, 2022, for providers who have not completed the enrollment process by September 30. Providers should visit www.lamedicaid.com to enroll. Additional guidance is located at www.ldh.la.gov/medicaidproviderenrollment. Providers can also email questions to LouisianaProvEnroll@gainwelltechnologies.com or call 833-641-2140.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Michigan
On September 19th, the state authorized delegated pharmacists to have prescriptive authority to prescribe self-administered hormonal birth control— including oral contraceptives, the patch, and the ring. The action allows pharmacists to opt into this program but does not require participation. The change happened under an interpretive statement (see attached) issued by the state’s Licensing and Regulatory Affairs Department (LARA) under the direction of a previous executive directive 2022-05 Gov. Whitmer issued in May this year. Pharmacists must enter into a delegation agreement prior – a sample delegation agreement is available on LARA’s website and attached. The governor’s executive directive in May instructed state departments and agencies to identify and assess opportunities to increase protections for reproductive health care. Here is the link to the Governor’s press release.
For more information, please contact NACDS’ Ben Pearlman at 617-515-2603.