The Health Care Authority’s (HCA) Apple Health (Medicaid) announced that they are implementing changes to the State Maximum Allowable Costs (SMAC) list for the fee-for-service (FFS) Prescription Drug Program on November 1, 2021.
Also in Washington, HCA is publishing quarterly updates to billing guides starting on October 1, 2021.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Pharmacy & Therapeutics Committee and Drug Utilization Review Board are meeting virtually on October 20th at 9 AM to review drug classes for the Apple Health (Medicaid) PDL. To preregister and access the meeting materials, go to WA P&T Committee.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
To help combat phony vaccination cards, the Department of Health (WSDH) created a guide Verifying Vaccination Cards to help verify COVID-19 vaccination record cards. If a patient presents a vaccine card that is fake, report it to the U.S. Department of Health and Human Services (HHS) Office of Inspector General and the Washington State Office of the Attorney General (ATG).
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The State Secretary of Health Umair A. Shah, M.D., MPH, amended Order 20-03 issuing a statewide mask mandate requiring everyone over five years of age in public indoor settings regardless of vaccination status effective August 23, 2021. https://www.doh.wa.gov/Newsroom/Articles/ID/2901/Statewide-updated-mask-order-goes-into-effect-Monday-Aug-23.
Also in Washington, the State Health Care Authority (HCA) reminded health care providers that they are eligible for direct payments from the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program’s reimbursement at Medicare rates for COVID-19 testing, treatment and vaccinations of uninsured individuals.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Gov. Jay Inslee (D) announced that all health care workers must be fully vaccinated by October 18, 2021. https://www.doh.wa.gov/Portals/1/Documents/1600/coronavirus/505-160-VaccinationRequirementFAQs.pdf and https://coronavirus.wa.gov/covid-19-vaccines-toolkit-businesses-and-employers
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Executive Director of the Pharmacy Quality Assurance Commission (PQAC), Lauren Lyles-Stolz, submitted her resignation at the July board meeting. As a result, the state’s board, which is responsible for establishing policy for pharmacy practice, is looking for a new Executive Director to fill the position immediately. https://www.governmentjobs.com/jobs/3170061-0/executive-director-pharmacy-quality-assurance-commission-ems-doh5705
Also in Washington, the Health Care Authority (HCA) adopted regulations effective October 1, 2021, establishing standards for provider use of the qualified prescription drug monitoring program.
Finally in Washington, the Health Care Authority (HCA) is seeking provider input on their annual survey aimed at tracking progress toward our statewide goal of payments based on health outcomes rather than paying for each medical transaction. The survey is available until August 31st. More information is available at VBP website section.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
Gov. Jay Inslee (D) announced that the Washington State Health Care Authority, Apple Health (Medicaid) established provisions to make proactive vaccine counseling visits to their patients a reimbursable service to the provider effective June 28, 2021. To take advantage of this new billable service, go to – Apple Health COVID-19 vaccine billing policy
Also in Washington, due to the timing of the State Fiscal Year End and the Independence Day holiday, provider payments for the week of June 28, 2021, will be made on July 7, 2021. Claim submission deadlines were updated to ensure that providers can receive payment and RA documents on July 7, 2021. The deadline for claim submissions to ProviderOne to receive payment on July 7, 2021, will be 4 p.m. on July 1, 2021. The deadline for pharmacy claim submissions to the Point of Sale (POS) to receive payment on July 7, 2021, will be 6 p.m. on Wednesday, June 30, 2021. Report any issues to: mmishelp@hca.wa.gov
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The Health Care Authority issued a final rule changing the time frame in which manufacturers must report new drugs marketed in the state and incorporate the prescription drug pricing transparency program’s nondisclosure agreement.
Also in Washington, effective July 1, 2021, Apple Health (Medicaid) which is administered by the Health Care Authority (agency) will implement changes to the State Maximum Allowable Costs (SMAC) list for the fee-for-service (FFS) Prescription Drug Program. Please view the MAC memo for more details. Additionally, the full SMAC list can be found on the agency’s Provider billing guides and fee schedules website under the Prescription Drug Program and applies to claims billed FFS.
Also in Washington, effective for claims with dates of service on and after July 1, 2021, Apple Health (Medicaid) updated the pharmacy Expedited Authorization (EA) List. On the Provider Billing Guides and Fee Schedules Page, scroll to Prescription Drug Program Billing Guides to access.
Also in Washington, the Office of the Insurance Commissioner issued a notice extending the Emergency Order 20-01 requiring health insurers to waive copays and deductibles for COVID-19 testing. The order also requires insurers to allow a one-time early refill for prescription drugs, suspends any prior authorization requirement for treatment or testing of COVID-19, and allows enrollees to be treated by out-of-network providers within a reasonable distance at no additional cost when the insurer does not have enough in-network medical providers.
Lastly in Washington, the Department of Health issued a final rule effective June 18, clarifying dispensers must submit information to the prescription monitoring program as soon as possible, but no later than one business day. The rule also removes the requirement that a facility or entity be a trading partner with the state’s health information exchange to have access to the prescription monitoring program.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
The telemedicine rules workshop scheduled for June 4 was canceled. For more information about when it will be rescheduled, contact Amelia Boyd, Program Manager, at amelia.boyd@wmc.wa.gov.
Also in Washington, the Health Care Authority (HCA) issued a primary care stakeholder survey aimed at gathering provider and other stakeholder input on proposed provider accountabilities under the WA Multi-payer Primary Care Transformation Model. Feedback from this survey will be combined with payer input to build out an overall framework of accountabilities for both providers and payers under the Model.
For more information, contact NACDS’ Mary Staples at 817-442-1155.
