The Health and Human Services Commission that oversees Medicaid is reminding pharmacies that it is the responsibility of the billing provider to ensure that submitted claims contain the National Provider Identifier (NPI) number of the physician or other professional who ordered, referred or prescribed the items or services. Additionally, all ordering, referring or prescribing providers must be enrolled as participating providers in Texas Medicaid as required. Be advised that claims will be denied if the NPI is missing or invalid and if the provider is not appropriately enrolled. These requirements impact not only the Medicaid program, but also Healthy Texas Women and Children with Special Health Care Needs Services programs only. These requirements do not apply to out-of-network providers that order, refer or prescribe only for managed care members.

Also in Texas…On Monday, April 2, the Health and Human Services Commission will enhance the restriction on the use of opioid cough and cold products for people enrolled in Medicaid fee-for-service and the Children with Special Health Care Needs Services Program to deny coverage of these products for people less than 18 years of age. A list of currently impacted drugs which is subject to change daily is available on the Vendor Drug Program website.

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

The Health and Human Services announced that beginning February 12, they began coverage of mosquito repellents for the prevention of the Zika virus. The benefit will run continuously year-round.

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

Beginning January 9, the Health and Human Services Commission limited the daily morphine equivalent dose (MED) that people enrolled in Medicaid fee-for-service may receive to 300 MED, and will be applied to all opioid prescriptions for all clients, with exceptions for people diagnosed with cancer or those receiving palliative or hospice care.

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