04/03/2018

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - UPDATED 4/4/2018

We Need Your Help To Address Michigan Managed Medicaid Plan Medical Benefit Drug Restrictions

MSHO continues to address the disparity in drug approvals between traditional Medicaid and the managed Medicaid plans. The managed plans are required to approve therapies that are a medical benefit with traditional Medicaid.  Thank you to those that sent in examples.  Those examples are in the hands of Medicaid and we are awaiting the next steps.  Stay tuned....

Issue:  CPT 96377 not being reimbursed by traditional and some managed Medicaid plans

Update 3/12/18 - Medicaid is aware.  They do not have 96377 loaded into their system.  In the interim MSHO has been advised to utilize the 96372 just as we did for Medicare & Medicaid in 2017.  They expect to have the 96377 loaded beginning 2nd quarter, April 1, 2018.

Most Recent Bulletins That May Affect Medical Oncology

January 30, 2018 - MSA 18-02 - Update to the Coverage of Physician-Administered Drugs and Biological Products

January 30, 2018 - MSA 18-01 - Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

 CLICK HERE  to review all MSA Bulletins

March 28, 2018: Attention ALL Providers: The Michigan Department of Health and Human Services (MDHHS) has made an update to the CHAMPS system to allow certain limited licensed professionals to enroll. These enrollment types will enroll as managed care only providers and will not be eligible to bill Medicaid Fee for Service (FFS). 

Effective immediately, individuals with the following license types may enroll in CHAMPS:

• Limited License Professional Counselor
• Limited License Psychologist
• Limited License Social Worker (Master’s Level)
• Limited License Marriage & Family Therapist

Providers needing to enroll in CHAMPS are encouraged to review the Provider Enrollment webpage for further resources. 

To visit the Biller "B" Aware website CLICK HERE

CMS Issues New Guidance to Manufacturers regarding the updated National Drug Rebate Agreement

On March 23, 2018, the Centers for Medicare & Medicaid Services (CMS) published in the Federal Register the final notice for the Medicaid National Drug Rebate Agreement (NDRA) (83 FR 12770) that announced changes to the NDRA which were applicable as of the March 23, 2018 publication date. The Federal Notice is available at the following link:  https://www.federalregister.gov/documents/2018/03/23/2018-05947/medicaid-program-announcement-of-medicaid-drug-rebate-program-national-rebate-agreement.

On March 26, 2018, CMS released guidance to manufacturers through Manufacturer Release #108 which provides additional information to manufacturers as to the actions required for current manufacturers to remain active in the Medicaid Drug Rebate Program. The release is now available for download at the following link: https://www.medicaid.gov/medicaid/prescription-drugs/program-releases/index.html.

The updated Affordable Care Act Federal Upper Limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment are now available on the Medicaid.gov website at https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html. States will have up to 30 days from the April 1, 2018 effective date to implement these updated FULs.  

For further information on the FUL program, please see the Federal Upper Limits page at https://www.medicaid.gov/medicaid/prescription-drugs/federal-upper-limits/index.html.