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’ Ben Pearlman at 617-515-2603.

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’ Ben Pearlman at 617-515-2603.

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’ Ben Pearlman at 617-515-2603.

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’ Ben Pearlman at 617-515-2603.

Yesterday Governor Kathy Hochul (D) released her executive budget for SFY 2022-23 which contains several provisions impacting pharmacies. Several provisions deal with the scope of pharmacy practices including: 

• NYSDOH (New York State Department of Health) Oversight of Certain Professions: Transfers the oversight of Health/Mental Hygiene professions including pharmacists from NYSED to NYSDOH. 
• Pharmacist CLIA-Testing: Allows licensed pharmacists to perform non-invasive CLIA-waived tests like other qualified healthcare professionals and authorizes licensed pharmacists to serve as direct limited-service laboratory, directors ordering and administering such tests 
• CDTM: Makes current CDTM law which expired this year permanent 
• Medication Administration: Changes scope of practice laws to allow certified medication aides to administer routine medications under certain conditions, allows physicians and NPs to issue non patient specific standing orders to COVID-19, flu, and upper respiratory illness testing, and allows any individual to collect specimens from patients for COVID-19 or flu testing per training and under supervision of a registered nurse, NP, or physician 

Opioids/Addiction 

• Naloxone/MAT: Requires pharmacies to maintain a stock of a 30-day supply of at least one version of opioid antagonists/naloxone and MAT/Buprenorphine, as permitted within DEA rules and wholesaler thresholds. Last week with the help of members, we educated OASAS about these restrictions and are glad to see they included language recognizing the limitations on pharmacies ability to stock these medications. See language in proposal attached, comments welcomed. 
• Expanding Alcohol Awareness: Expands alcohol awareness programs to include other forms of addiction and recreational cannabis 

Also in New York, The New York Board of Pharmacy has just released its updated NYS Drug Price List dated December 2021, including the required sign that must be posted offering the list to the public upon request. 

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

The New York State Department of Health has proposed to amend regulations to limit the Medicaid fee for service prescriptions to a maximum of 11 refills within a 12-month issuance.  Comments are due by March 6, 2022.

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

On New Year’s Eve NYS Governor Kathy Hochul (D) signed into law two pieces of legislation supported by NACDS. The first S3556 strengthens state anti-mandatory mail order (ammo) law. Legislators, concerned that the AMMO law was not operating as intended, passed S3566 to ensure that patients can get their prescriptions at their local pharmacy rather than be directed to mail order by their PBM. In addition, Governor Hochul signed into law S.3762 which provides for licensure and registration of pharmacy benefit managers. The bill also sets forth duties and obligations that PBMs must follow when performing services and allows the department of financial services to enforce the law and receive complaints from consumers, pharmacies, and healthcare providers. Unfortunately, Governor Hochul did veto S6603 which would have provided Medicaid pharmacy payment parity citing the fiscal note as her reasoning.  

Also in New York: The State Education Department published its Notice of Adoption of their regulation related to Licensure Examination, Licensure by Endorsement, and Continuing Education Requirements in the Profession of Pharmacy The regulation is effective January 1, 2022 and eliminates the Part III exam requirement. Also commencing with registration periods beginning on or after January 1, 2023, a new requirement for a licensee to complete as part of the 45 hours of formal continuing education at least three hours of formal continuing education acceptable to the department in compounding, among other changes. 

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

The Board of Pharmacy met this week. The Executive Secretary Dina Jazrawi reported that the Board is continuing to accept applications to fill the two openings for registered pharmacy technicians to serve on the Board. Individuals must be registered and working in an Article 28 facility. In addition, there is still a pharmacist opening for a Downstate Office of Professional Discipline.

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

Governor Kathy Hochul (D) signed into law legislation SB 4807A authorizing pharmacists to administer additional vaccines recommended by the CDC to patients 18 years of age and older. This could not have been achieved without the support and drive of the Community Pharmacy Association of New York State and over 100 patient advocacy groups.

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