07/24/2018

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - UPDATED 7/10/2018

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....

Update 7/10/18 - MSHO continues to work with traditional Medicaid to address issues with Managed Medicaid plans not offering the same benefits as traditional Medicaid.  There has been some success with approvals on a case by case basis for Meridian Medicaid.  Efforts continue.

Update 6/4/18 - MSHO has submitted the first case to traditional Medicaid who has agreed to follow up with the managed plan, Total Healh Care, within 30 days.  Stay tuned.

5/15/18 - MSHO conferenced with traditional Medicaid and established a plan to address the disparities and step edits in place with many of the Managed Medicaid plans.  This process will begin later this week addressing a couple of companies at a time.  We will continue to update as issues are resolved.

5/1/18 - MSHO and Medicaid have set a call to discuss the best approach to address the outstanding issues.  This call will occur next week.

Public Comment on MDHHS Medicaid Health Plan Common Formulary

The Michigan Department of Health and Human Services (MDHHS) is soliciting comments from the public on the Michigan Medicaid Health Plan Common Formulary.  The Common Formulary applies to pharmacy claims paid by Medicaid Managed Care Organizations – it will not apply to claims paid through Fee-for-Service.  The public may submit comments on the drugs included or not included on the Common Formulary, new drug products, prior authorization criteria, step therapy criteria and other topics related to drug coverage under the Common Formulary.  The comments will be reviewed by MDHHS and the Michigan Medicaid Health Plan Common Formulary Workgroup. The next drug classes to be reviewed by the Workgroup include Diabetes, GI and Endocrine & Metabolic. Changes may be made to the Common Formulary based on comments received.  Comments will be solicited once per calendar quarter. 

To view the Michigan Medicaid Health Plan Common Formulary CLICK HERE

Please send your comments by August 24, 2018 to:

Linda VanCamp, Formulary Analyst
Bureau of Medicaid Care Management & Quality Assurance
Medical Services Administration
P.O. Box 30479
Lansing, Michigan 48909-7979

Telephone Number: 517-373-9252
Fax Number: 517-763-0142
E-mail Address: MDHHSCommonFormulary@michigan.gov

Most Recent Bulletins That May Affect Medical Oncology

June 29, 2018 - MSA 18-14 - Hospital 340B Final Settlement Adjustment Process

June 27, 2018 - MSA 18-21 - Timely Hearing Requests

 CLICK HERE  to review all MSA Bulletins

July 18, 2018: Attention All Providers: This serves as a reminder of MDHHS timely filing policy effective January 1, 2017. All claims must be submitted within a year of the date of service. For institutional invoices this would be the header “To/Through” date of service; for professional invoices this would be the claim line “From” date of service. Any claims with dates of service greater than a year old are REQUIRED to have a claim note to be considered for reimbursement, claims that do not have a claim note will be suspended/denied with CARC 16 and RARC N307. Reporting of a claim note does not guarantee reimbursement; the claim will be manually reviewed to determine if it meets one of the exceptions to the timely filing policy.

• MSA 16-37 Timely Filing Billing Limitations
• MSA 17-44 Clarification to MSA 16-37
• Timely Filing Provider Tip

Providers with additional questions can contact provider support at 1-800-292-2550 or ProviderSupport@Michigan.gov.

To visit the Biller "B" Aware website CLICK HERE