12/04/2018

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - UPDATED 12/4/2018

Michigan Managed Medicaid Plan Medical Drug Benefit 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, keep them coming.  Examples are in the hands of Medicaid, we have had some progress.  Stay tuned....

Update:  MSHO has scheduled a meeting with Medicaid to discuss a new process for addressing claims issues with Managed Medicaid plans.  Watch for additional information soon...

Medicaid OKs Michigan waiver to negotiate drug prices based on outcomes

Modern Healthcare - Michigan has secured federal approval to negotiate Medicaid drug prices based on how well the medications work for patients, CMS Administrator Seema Verma announced on Wednesday. This is the agency's second approval of a value-based drug-purchasing proposal by a state Medicaid program. Oklahoma had the first-of-its-kind approval in late June, although the state isn't forecasting that the waiver will save money yet. The Michigan amendment will give the state authority to leverage additional rebate agreements for "outcomes-based" contracts with manufacturers.  READ MORE 

The State of Medicaid Expansion Post-Midterms

By most accounts, the biggest winner of the U.S. midterm elections was Medicaid Expansion. On November 6, 2018, three states passed ballot measures to expand Medicaid, while the residents of two other non-expansion states voted in Democratic governors in favor of expanding Medicaid. This recent overt display of support for expansion comes on the heels of a number of additional states that have reconsidered, and expanded, Medicaid. (READ MORE...) 

Most Recent Bulletins That May Affect Medical Oncology

November 30, 2018 - MSA 18-50 - Claims for Medicaid Beneficiaries Eligible for Medicare

November 30, 2018 - MSA 18-45 - Updates to the Medicaid Provider Manual

November 30, 2018 - MSA 18-44 - Standard Consent Form

November 30, 2018 - MSA 18-41 - Clarification of Medicaid Outreach Policy

 CLICK HERE  to review all MSA Bulletins

Most Recent Announcements That May Affect Medical Oncology

November 13, 2018: Negative Payment Takebacks
Attention Institutional Providers: It was found that the Michigan Department of Health and Human Services (MDHHS) has incorrectly been reimbursing claims secondary to Medicare when a negative dollar amount is reported as payment. MDHHS has taken back claims with dates of service from 2014 to current, these claims can be identified with the claim note “OICU Recovery due to incorrect reporting of Medicare (negative OI payment are not allowed)” on the credited TCN.

Any newly submitted claims with a negative payment amount reported from Medicare will be denied per the Medicaid policy below:

Medicaid Provider Manual >>> Billing and Reimbursement for Institutional Providers >>> Section 6.2.G

For Medicaid reimbursement, the amount billed for services does not equal the sum of the coinsurance and deductible items. It must be calculated as the gross hospital charges minus all Medicare payments, minus other insurance payments, and minus any patient-pay and/or copayment amount. If a claim is submitted with the amount billed equal to zero, other payment greater than or equal to Medicaid’s payment, or a negative amount, Medicaid does not make a payment. If there is a balance to be billed to Medicaid, the hospital may bill Medicaid for covered services only.

To visit the Biller "B" Aware website CLICK HERE