Before the New York State Legislature recently adjourned, both Houses passed legislation (A3040B-S4807B) which would authorize pharmacists to administer long-acting injectable medication for MH/SUD per a prescription or order. In addition, the legislature rejected efforts to delay or repeal the planned FFS (Fee for Service) transition of the pharmacy benefit set to take effect on April 1, 2023. 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the March 2022 Medicaid Update.  

You may also go straight to an article or topic that pertains to you by selecting it from the current issue's table of contents below.  

 Policy and Billing 

• Early and Periodic Screening, Diagnostic, and Treatment Program Childhood Vaccine Counseling Coverage Benefit (Cover) 
• New York State Medicaid Professional Pathology Policy 
• Attention: New York State Medicaid Fee-For-Service Providers Administering Drugs 
• Pharmacy and Medical Billing Guidance for SPRAVATO® (esketamine) 
• Discontinued Coverage for TerSera Therapeutics LLC Drugs 
• COVID-19 Testing, Therapeutics, Vaccine Administration, and Vaccine Counseling Policy Reminders 

All Providers 

• Medicaid Consumer Fact Sheets Now Available 
• Official Launch of eMedNY Provider Enrollment Portal 
• New York State Medicaid Launches Emergency Triage, Treat, and Transport Program 
• NY State of Health: Affordable Care Act 12th Anniversary; Congress Encouragement to Extend American Rescue Plan Tax Credits; Medicaid Resumes Eligibility Reviews, Disenrolled Members Should Be Directed to the Marketplace 
• New York State Department of Health Medicaid Accelerated eXchange (MAX) Workshop Series: Register for Round Two and Upcoming Informational Webinar 
• Medicaid Breast Cancer Surgery Centers 

Pharmacy 

• Update on Pharmacy Billing for Compound Prescriptions 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The State Education Department regulation expanding the pharmacist immunization authority which took effect on January 31, 2022, is set to expire on April 10. At the last Board of Regents meeting, the Board took emergency action effective April 11 to keep the regulation in effect until it can be permanently adopted at the Board May Meeting.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The New York State COVID-19 Vaccine Team has recently updated its Guidance for the NYS COVID-19 Vaccination Program for individuals 12 years of age and older. The updates reflect the recent CDC changes in COVID-19 vaccine clinical guidance. The updates include: 

• Options for extended intervals between doses of the mRNA primary series (pages 1 and 2)  
• Additional details on myocarditis (page 2)  
• J&J extended shelf life (page 11)  

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The New York State Department of Health (NYS DOH) announced the Centers for Medicare & Medicaid Services (CMS) approval of New York’s section 1115(a) demonstration waiver. This approval is effective from April 1, 2022 through March 31, 2027. In accordance with federal guidelines, the State has 30 days to accept the related Standard Terms and Conditions (STCs), which is an operating agreement between the State and CMS.

The NYSDOH 1115(a) waiver request included a white paper  which structured the waiver request proposal around four subsidiary goals:

1. Building a more resilient, flexible and integrated delivery system that reduces racial disparities, promotes health equity, and supports the delivery of social care;
2. Developing supportive housing and alternatives to institutions for the long-term care population.
3. Redesigning and strengthening health and behavioral health system capabilities to provide optimal response to future pandemics and natural disasters; and
4. Creating statewide digital health and telehealth infrastructure

The CMS approval letter can be found on the NYS DOH website here.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The Office of Health Insurance Programs of the New York State Department of Health has approved the release of the February 2022 Medicaid Update. You may also go straight to an article or topic that pertains to you by selecting from the current issue's table of contents below.  

Policy and Billing 

• Medicaid Members are Exempt from Copayments for COVID-19 Related Treatment and Services 
• Change to Dental Clinic Billing in Ambulatory Patient Group 
• Updated COVID-19 Vaccine Counseling Coverage 

All Providers 

• Office of Health Insurance Programs Announces Launch of 2022 Medicaid Accelerated eXchange (MAX) Workshop Series 
• Medicaid Consumer Fact Sheets Now Available 
• Update to Upcoming eMedNY Provider Enrollment Portal 
• Driver's License Requirements 
• Parking and Toll Reimbursement for All Non-Emergency Medical Transportation Providers 

Pharmacy 

• Updated Statewide Formulary for Opioid Dependence Agents and Opioid Antagonists 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The NYS Department of Health has updated COVID guidance documents including:   

• Guidance for the New York State COVID-19 Vaccination Program for Individuals 12 Years of Age and Older  
• Information for Health Care Professionals about the Screening Checklist for the COVID-19 Vaccine: Individuals 12 Years of Age and Older  
• Guidance for the New York State COVID-19 Vaccination Program: Vaccination of Children Ages 5-11  
• Information for Health Care Professionals about the Screening Checklist for Administration of the Pfizer-BioNTech COVID-19 Vaccine for Children Ages 5-11  
• Information for Health Care Professionals about the Screening Checklist for the COVID-19 Vaccine: Additional Dose for Moderately to Severely Immunocompromised People  
• COVID-19 Immunization Screening and Consent Form: Additional Dose for Moderately to Severely Immunocompromised People   

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The New York State Department of Health has updated NYS Medicaid Coverage Criteria for COVID-19 Vaccine Counseling. This guidance can be found on the COVID-19 Guidance for Medicaid Providers webpage, which is updated regularly.

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.

The State Education Department (SED) has released draft regulations to authorize pharmacists to administer other immunizations to patients 18 years old or older, as recommended by the ACIP (Advisory Committee on Immunization Practices) of the CDC (Centers for Disease Control) (Centers for Disease Control). 

Also in New York, The New York State Department of Health has approved the release of January 2022 Medicaid Update. Links to the individual articles are also available below.  

All Providers 

• New Provider Enrollment Portal Coming Soon to eMedNY (Cover) 
• NY State of Health Open Enrollment Period Extended as Federal Public Health Emergency Continues 

Policy and Billing 

• Update to Fee-for-Service Reimbursement for Federally Qualified Health Center Claims After Third-Party Payers and Managed Care Visit and Revenue Reporting Requirements
• Medicaid Fee-for-Service Guidance for Duchenne Muscular Dystrophy Drugs 
• Update to New York State Medicaid Coverage of Real-Time Continuous Glucose Monitors 

Pharmacy 

• Reminder: Pharmacy Dispensing Non-Patient Specific Orders 
• Reminder: Newborn Eligibility and Billing Including Pharmacy Claim Processing 
• Clarification: Prescriptions Issued Under Collaborative Drug Therapy Management Protocols 
• New York State Medicaid Fee-for-Service Program Pharmacists as Immunizers 

For more information, please contact NACDS’ Mike Sargent at 207-272-6435.