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.

The Department of Health, Pharmacy Quality Assurance Commission adopted regulations allowing retired pharmacists to apply for a retired active pharmacist license status and practice pharmacy under certain conditions.

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

The State Pharmacy Association’s (WSPA) bill, HB 1445  by Rep. My Lihn Thai (D), clarifies that the reconstitution and mixing of nonsterile products according to FDA labeling and according to a prescription, often referred to as simple compounding, is not compounding. The bill was signed by Gov. Jay Inslee and will go into effect on July 25, 2021.

Also in Washington,  Gov. Jay Inslee (D) signed into law the Second Substitute to HB 1161  which modified the requirements for the manufacturer’s drug take-back programs under the Department of Health.

Also in Washington, Apple Health (Medicaid), administered by the Health Care Authority will implement changes to the State Maximum Allowable Costs (SMAC) list for the fee-for-service (FFS) Prescription Drug Program. on June 1, 2021. 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, HB 1127  by Rep. Vandana Slatter establishes privacy and security standards for COVID-19 health data passed both houses and was sent to Gov. Jay Inslee (D) to sign into law.

Also in Washington, the Health Care Authority (HCA) sent a Provider Alert informing providers about updates to the COVID-19 vaccine clinical policy regarding the roster billing for COVID-19 vaccine administration. When billing for vaccines for fee-for-service clients, there are three options:

1. Bill each individual claim.
2. Use batch 837.
3. Template billing.

HCA is no longer requests that you bill the vaccine with the vaccine administration code. If you do submit a claim with both codes, HCA will not pay for the vaccine but will pay for the administration of the COVID-19 vaccine. These policies apply to both fee-for-service (FFS) providers and HCA-contracted managed care organizations (MCOs). For more information go to Apple Health (Medicaid) COVID-19 vaccine clinical policy under Reimbursement information and billing guidance.

Lastly in Washington, the Office of the Insurance Commissioner extended two Emergency Orders until May 16, 2021:

• Notice requires health insurers to waive copays and deductibles for coronavirus testing. It also requires insurers to allow a one-time early refill for prescription drugs; to suspend any prior authorization requirement for treatment or testing of Covid-19, and to allow 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.
• Notice concerning insurance coverage for coronavirus diagnostic testing, prohibiting all health carriers from balance billing for Covid-19 diagnostic testing processed by out-of-network laboratories, when determined to be medically necessary. It also requests that insurers notify the agency if out-of-network laboratories submit claims but have not published a cash price or fail to accept such a price.

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

The Health Care Authority issued a final rule effective May 1, 2021, requiring providers to agree that all claims for Apple Health clients in fee-for-service and managed care are subject to 340B standards as part of participation in the 340B drug pricing program.

Also in Washington, the Office of the Insurance Commissioner extended two emergency orders until May 16, 2021, that are of interest to pharmacies.

• Notice extending the Emergency Order 20-01 requiring health insurers to waive copays and deductibles for coronavirus (Covid-19) testing. The order also requires insurers to allow a one-time early refill for prescription drugs; suspend 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.
• Notice extending Emergency Order 20-06 concerning insurance coverage for COVID-19 diagnostic testing prohibits all health carriers from balance billing for COVID-19 diagnostic testing processed by out-of-network laboratories, when determined to be medically necessary. The order also requests that insurers notify the agency if out-of-network laboratories submit claims but have not published a cash price or fail to accept such a price.

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

The Pharmacy Quality Assurance Commission issued an emergency rule effective until July 3^rd increasing the amount of time to 15 days that a practitioner has to deliver a signed prescription when authorizing an emergency prescription of a Schedule II substance to the pharmacy. The rule also defines “signed prescription” and allows practitioners to fulfill signature requirements through paper, electronic transmission, facsimile, photograph, or scanned copy. The rule extends August 5, 2020, emergency rule is issued in response to the COVID pandemic.

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

The Health Care Authority submitted a Medicaid state plan amendment (SPA 21-0012) providing the state flexibility to automatically enroll COVID-19 vaccine administration providers that have already completed Medicare application processes for participation. It also allows the Medicaid program the flexibility to not require NPIs for the administration of vaccines to Medicaid recipients during the public health emergency.

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