http://www.med-ehub.comRSS Feed for Med~eHUB120http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/869/Default.aspxEssential Benefit Guidance Released by HHSLisa BlantonMon, 19 Dec 2011 21:25:39 GMT63e25257-6672-4ddd-a687-010d86a00be2http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/864/Default.aspxTo comply with SL 2011 - 145, section 10.37.(a)(6) and N.C. GEN. STAT. Section 108A-70.21(b1), DMA will be submitted State Plan Amendments for the purpose of revising the rate methodology language to reflect rate changes for SFY 2011 – 2012. These changes are effective November 1, 2011 and reflect rates paid to North Carolina Medicaid and Health Choice services providers will be reduced by 2.67%. Nursing Homes will have their rate reductions effective July 1, 2011. Hospital providers will follow their normal rate update schedule of October 1, 2011 with the implementation of the DRG update. Fee schedules previously posted on the website with the effective date of October 1, 2011 have been removed and revised fee schedules are currently on DMA’s website under the heading of “What’s New” section at http://www.ncdhhs.gov/dma/provider/index.htm. For questions concerning the reductions, please call DMA Finance Management at 919-647-8111.Lisa BlantonTue, 15 Nov 2011 23:13:55 GMT015e6e2a-e573-45e6-9e60-b592a198479ehttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/863/Default.aspxReview of Drug Costs to Medicaid Pharmacies and Their Relation to Benchmark Prices (A-06-11-00002) States historically have based reimbursement for the costs to acquire Medicaid prescription drug ingredients on the average wholesale price (AWP). States generally use reimbursement methodologies based either solely on the AWP or the AWP in combination with another benchmark price, such as the wholesale acquisition cost (WAC). For multiple-source drugs that meet certain criteria, reimbursement is limited, in the aggregate, to Federal upper limit (FUL) amounts established by CMS. As part of the Medicaid drug rebate program, manufacturers report the average manufacturer price (AMP) of drug ingredients based on actual sales transactions. A primary publisher of AWPs announced that it would discontinue publishing them by September 26, 2011. We performed this review to provide information that States can use as they consider changes to their reimbursement methodologies. Our review found that the AWP, WAC, and AMP had consistent relationships with invoice prices for single-source drugs, but none of the benchmarks had consistent relationships with invoice prices for multiple-source drugs without FULs. Although it was based on actual sales transactions, the AMP was the least consistent benchmark. States may be able to better approximate the invoice prices of drugs by developing different reimbursement methodologies for single-source drugs, brand-name multiple-source drugs, and generic multiple-source drugs. We recommended that CMS share the results of this review with States to use when considering changes to their pharmacy reimbursement methodologies, including those for single-source drugs, brand-name multiple-source drugs, and generic multiple-source drugs. CMS officials said that they appreciated the information we provided. Download the complete report at www.Med-eHUB.com or email us at info@Med-eHUB.comLisa BlantonThu, 20 Oct 2011 17:05:28 GMTd4f4c383-6f74-4f76-9e52-f09a2e5582dahttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/862/Default.aspxEffective October 1, 2011, the Alabama Medicaid Agency will: Limit the number of brand name prescriptions. Email info@Med-eHUB.com for additional information. See Med-eHUB's "Reimbursement Details by State" report for additional information.Lisa BlantonFri, 30 Sep 2011 15:47:09 GMT621d1137-3ee0-4987-98ea-fb217ade0432http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/861/Default.aspxBeginning September 28, 2011, drugs dispensed by retail pharmacies to Idaho Medicaid recipients will be reimbursed at the lower of: Contact info@Med-eHUB.com for additional information.Lisa BlantonFri, 30 Sep 2011 15:35:37 GMTd62c1b0e-86f5-4766-aed2-773f6b62157ehttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/858/Default.aspxJuly 2011 - Centene has been selected for both Kentucky (Kentucky Spirit Health Plan) and Louisiana's (Louisiana Healthcare Connections) Medicaid Contracts. Plan implementation is currently in progress. Go to www.Med-eHUB.com or email us at info@Med-eHUB.com for additional information.Lisa BlantonTue, 23 Aug 2011 16:23:10 GMT8c69bfed-3124-44b3-a23c-e70cbfbbe993http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/857/Default.aspxKMAP Pharmaceutical Pricing Formula Formula Pricing Formula Effective September 2011 Single Source AWP - 13% WAC + 4.6% Multi-source AWP - 27% WAC - 8.6%Lisa BlantonTue, 23 Aug 2011 16:09:20 GMT8b823f71-3578-4f6f-ab12-0d596a1aed28http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/854/Default.aspxUnder the new state budget for the fiscal year beginning July 1, 2011, Connecticut will be closing the ConnPACE prescription drug assistance program for individuals who are enrolled in Medicare.Lisa BlantonTue, 09 Aug 2011 21:24:07 GMT027f167b-68a2-41f8-80e5-e7c4395fa8dbhttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/853/Default.aspxEffective September 1, 2011, the dispensing fee for each Medicaid prescription will be reduced by 85 cents. Payment for a legend drug prescription will be determined by adding $6.50 (previously $7.35) to the estimated acquisition cost (EAC) of that drug and dividing the sum by 0.9804. An additional 15 cents will be added to that amount if the pharmacy has been certified as providing free delivery service to Medicaid clients. Another 50 cents will be added to that amount if the pharmacy dispenses a premium preferred generic. Lisa BlantonTue, 09 Aug 2011 19:12:31 GMT58e877b2-2c7b-4abb-84fe-4592f973a797http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/852/Default.aspxReimbursement Methodology Changes - NJ Medicaid See us at www.Med-eHUB.com for more info or email us at info@Med-eHUB.comLisa BlantonMon, 11 Jul 2011 22:51:20 GMTd710fa89-3398-480f-9dea-bb551c68ae99http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/851/Default.aspxNJFC/Medicaid Program Changes - 1July11 - NJ Medicaid Lisa BlantonMon, 11 Jul 2011 20:28:55 GMT225ea825-53c4-4a19-b4d7-d77f3b57fabehttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/848/Default.aspxRule 5101:3-9-05, "Reimbursement," sets forth the reimbursement methodology for the Medicaid pharmacy program. A change has been made to continue the dispensing fee for noncompounded drugs at $1.80 beyond June 30, 2011.Lisa BlantonTue, 05 Jul 2011 14:25:24 GMTac096038-7b45-4170-8574-6b21034b080bhttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/839/Default.aspxPUBLIC NOTICE SOUTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES Payment to Medicaid Providers Reduced and Beneficiary Co-payments Increased July 8, 2011Lisa BlantonTue, 07 Jun 2011 17:33:15 GMTadc99244-fa1d-48a7-a988-825f1c225b43http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/838/Default.aspxPharmacy Services REDUCTION - 8JULY2011 Reduce reimbursement from AWP minus 13% to AWP minus 16% (including waiver prescription medications) Reduce dispensing fee from $4.05 to $3.00 (including waiver prescription dispensing fees).Lisa BlantonTue, 07 Jun 2011 17:29:10 GMTe5d36095-f9b9-4973-9ea0-eb6bf8d3e2fehttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/832/Default.aspxStatewide Medicaid Managed Care Expansion Program - Florida Medicaid Email info@Med-eHUB.com for related documents, links and info.Lisa BlantonWed, 01 Jun 2011 19:44:25 GMT72c96c98-74a8-4871-8380-97a99ec6c42chttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/831/Default.aspxOne of the most controversial state health initiatives this year is a plan in Florida to cut Medicaid costs by dramatically expanding the use of managed care. Florida lawmakers voted to move all Medicaid enrollees in the state — more than 3 million people who are poor, elderly or disabled — to commercial managed care programs. Florida is not alone. At least a dozen other states are considering expanding managed care programs this year. That growth comes atop expansions in 20 states last year and 13 states the year before. Although most health care experts say managed care can improve care while lowering Medicaid costs, consumer advocates say states should proceed with caution. Article ReferenceLisa BlantonTue, 31 May 2011 19:01:28 GMT116f4d4a-1fb3-4ec6-9ea2-951b07e3b021http://www.med-ehub.com/FederalProgramDashboardWhatsInsideMedeHUB/tabid/438/itemId/827/Default.aspxA new bulletin, BT201111 - The IHCP to Require PA for Brand Medically Necessary Mental Health Drugs - dated May 17, 2011, has been posted to the IHCP Web site at http://www.indianamedicaid.com/ihcp/Publications/bulletin_results.asp Email info@Med-eHUB.com for additional information.Lisa BlantonWed, 18 May 2011 21:01:25 GMT9e37416b-ebe7-43ef-a3fc-bc0a116ab16fhttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/825/Default.aspxOn April 22, 2011, CMCS released a State Medicaid Director’s letter clarifying the nonapplicability of the appeals component of the five National Correct Coding Initiative (NCCI) methodologies. See the letter at www.Med-eHUB.com or email info@Med-eHUB.com for a copy.Lisa BlantonWed, 27 Apr 2011 00:30:18 GMT3e9edaf6-7d46-41b3-9cb1-c511bdd59ab9http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/822/Default.aspxTomorrow, April 26th the United States Supreme Court will hear oral arguments in Sorrell v. IMS HealthLisa BlantonMon, 25 Apr 2011 15:26:03 GMT476dc302-9c86-4fba-8d49-1e80f82e6a48http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/819/Default.aspxReimbursement for South Carolina Medicaid providers will be reduced by 3% effective for dates of service beginning on Friday, April 8, 2011. Email Med-eHUB: info@Med-eHUB.com for the announcement. Lisa BlantonMon, 11 Apr 2011 16:35:06 GMTe082b45f-e45d-4193-b5fb-fc5fc061b6c0http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/807/Default.aspxThe Centers for Medicare & Medicaid Services (CMS) issued a final rule in the Federal Register (75 FR 69591) that withdraws the determination of Average Manufacturer Price (AMP), and the Federal upper limits provisions, as well as the definition of "multiple source drug" from regulation. This final rule addresses comments received in response to the proposed rule published in the Federal Register on September 3, 2010 (75 FR 54073).Lisa BlantonWed, 26 Jan 2011 17:06:18 GMT1f9d20d3-221a-4a49-86cf-6b3f89dc12e5http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/806/Default.aspxEffective December 15, 2010, CMS will not apply the FULs to B-rated drugs.Lisa BlantonWed, 26 Jan 2011 17:02:55 GMT87b9b3d3-8986-4ff7-8281-d158803c51a3http://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/805/Default.aspxPPACA NCCI Requirements Become Mandatory for Medicaid Med-eHUB is developing a State Status Table to show state compliance of these requirements. This is important to you due to the increased risk of delayed and denied claims in state MMIS systems that have implemented this requirement. Check back for the updated table by emailing us at info@Med-eHUB.com Lisa BlantonMon, 17 Jan 2011 21:56:36 GMTc26ac739-87b7-4822-b31e-6c9780cb702ehttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/723/Default.aspxFor dates of service on or after May 1, 2010, the reimbursement rate methodology is changing for physician-administered procedure-coded drugs. Currently, the reimbursement rate for most physician-administered drugs is the lowest Average Wholesale Price for a National Drug Code (NDC) corresponding to the procedure code. For dates of service on or after May 1, 2010, the new pricing methodology for physician-administered drugs that require an NDC will be 105 percent of the lowest Wholesale Acquisition Cost (WAC) for an NDC corresponding to the procedure code, as reported by First DataBank. In rare cases where no WAC pricing exists, the IHCP will use Medicare’s pricing, which is currently the Average Sales Price (ASP) plus 6 percent (ASP+6 percent). If both WAC pricing and Medicare pricing are unavailable, other pricing metrics may be used as determined by the Office of Medicaid Policy and Planning. Claim details for physician-administered procedure-coded drugs requiring an NDC and priced using the WAC or Medicare methodology will not be subject to the 5 percent reduction currently in effect for hospital outpatient and outpatient crossover claims through June 30, 2011. Physician-administered drugs that are not priced using the WAC or Medicare methodology, such as blood factor and parenteral nutrition, will continue to be subject to the 5 percent reduction. See BT200943, dated November 24, 2009, for additional information regarding the outpatient hospital services reduction. Physicians who furnish blood factor products may refer to provider bulletin BT200833, dated July 31, 2008, for pricing...Lisa BlantonFri, 16 Apr 2010 17:15:52 GMT2e121afd-7315-46bc-9808-b3f46ce9216fhttp://www.med-ehub.com/WhatsNewatStateMedicaid/tabid/202/itemId/722/Default.aspx This letter is one of a series intended to provide guidance on the implementation of the health insurance reform legislation, the Patient Protection and Affordable Care Act (PPACA); P. L. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010; P. L. 111- 152. Specifically, this letter provides initial guidance on Section 2001 of PPACA: Medicaid Coverage for the Lowest Income Populations, which establishes a new eligibility group and the option for States to begin providing medical assistance to individuals eligible under this new group as of April 1, 2010. Under the law, for the first time since the Medicaid program was established, States will receive Federal Medicaid payments to provide coverage for the lowest income adults in their States, without regard to disability, parental status or most other categorical limitations, under their State Medicaid plans.   The New Eligibility Group Section 2001(a)(1) of PPACA, as amended by section 10201 of PPACA, establishes a new eligibility group that all States participating in Medicaid must cover as of January 2014. As discussed below, section 2001(a)(4) adds a new subsection (k)(2) of section 1902 of the Social Security Act (the Act), which permits States to cover this group of individuals at State option, or to phase-in coverage of the group based on income, beginning April 1, 2010.   Specifically, section 2001(a)(1) establishes a new eligibility group (VIII) under section 1902(a)(10)(A)(i) of the Act. The new group fills in the gaps in existing Medicaid eligibility by making eligible very-low income individuals who are not otherwise eligible under mandatory eligibility categories. Thus, the law describes the individuals eligible under the new group as those who are not: Age 65 or older; Pregnant; Entitled to or enrolled in benefits under Medicare Part A; Enrolled under Medicare Part B; or Described in any of the other mandatory groups in the statute (subclauses (I) – (VII) of section 1902(a)(10)(A)(i) of the Act), such as certain parents, children, or people eligible based on their receipt of benefits under the Supplemental Security Income (SSI) program.   The Centers for Medicare & Medicaid Services (CMS) will be issuing additional guidance on other provisions contained in Section 2001 of PPACA at a later date. See the entire letter as an attachment on Med-eHUB page...Lisa BlantonTue, 13 Apr 2010 01:24:07 GMTc6c217db-bbdf-46e1-89b8-16feec9fa905