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admin 03.10.2013

Privately owned vehicle (pov) mileage reimbursement rates, Gsa has adjusted all pov mileage reimbursement rates effective january 1, 2015. Medicaid reimbursement rates increase under affordable, Thanks to the affordable care act, medicaid reimbursement rates will increase to at least 100% of medicare rates in the 2013 and 2014 calendar years.. Wisconsin medicaid for the elderly, blind or disabled, Important information for medicaid and badgercare plus members regarding anthem data breach.
Medicaid fee-for-service reimbursement rates, Medicaid fee-for-service reimbursement rates. In an effort to distribute the Medicaid Update newsletter in a more timely manner, reduce costs, and be more environmentally minded, beginning in January 2009, the Office of Health Insurance Programs will no longer produce a printed version of the newsletter. The newsletter will be delivered monthly to your designated e-mail address in a Portable Document Format (PDF).
Providers who are unsure about receiving an electronic-only version of the newsletter should bear in mind that the PDF newsletter can always by printed and read in hard copy. You will receive your final printed newsletter by mail in December 2008 as we transition from print newsletters to electronic distribution. The Office of Health Insurance Programs anticipates that most providers will take advantage of this new delivery system, however, for those few who cannot, arrangements are being considered for hard copy delivery. Effective October 1, 2008, the pharmacy benefit for Family Health Plus managed care enrollees will be "carved-out" of the managed care plan benefit package. On October 1, 2008 EPIC will require the substitution of brand name multi-source drugs with a generic equivalent.
A new Medicaid waiver program for individuals 18 years of age and older with a physical disability and for seniors who choose to live in the community rather than in an institutional setting.
The Department of Health has created a new Web site to help providers prepare for Medicaid's new outpatient reimbursement method, Ambulatory Patient Groups (APGs). The cost of ambulance transportation of neonatal infants from community hospitals to facilities designated as Regional Perinatal Centers (RPC) is the financial responsibility of the RPC. Reporting of Present on Admission (POA) indicators for each diagnosis submitted on all INPATIENT Medicaid claims are mandatory for all inpatient facilities. Effective October 1, 2008, the pharmacy benefit for Family Health Plus managed care enrollees will be "carved-out" of the managed care plan benefit package and will be administered by the Medicaid fee-for-service program. If enrollees are already using a Medicaid Benefit Identification Card to obtain other benefits, they can use the same Benefit Identification Card to access their pharmacy benefits on or after October 1, 2008. Prescriptions for Family Health Plus enrollees will be subject to all Medicaid program requirements.
With the exception of controlled substances, prescriptions must be filled within 60 days and are valid for six months from original prescription date with up to five refills. Drugs administered in the physician's office (J-Code drugs) remain in the managed care benefit package and should continue to be billed to the enrollee's Family Health Plus managed care plan.


To obtain prior authorization for non-preferred drugs, call the pharmacy clinical call center at (877) 309-9493 and follow the appropriate prompts. Do you suspect that a Medicaid provider or an enrollee has engaged in fraudulent activities? Effective October 1, 2008, EPIC will require a prior authorization to cover brand name drugs when there is an A-rated generic available.
EPIC helps seniors pay for their Part D deductibles, co-payments, and prescriptions during the coverage gap - as well as the monthly Part D premiums. If Medicare Part D denies the claim, EPIC should be billed with an OCC of 3, along with the Other Payer Reject Code(s) (field 472-6E). If Medicare Part D approves the claim, EPIC should be billed for the Part D deductible or co-payment (Patient Pay Amount (field 505-F5)) with an OCC of 8. The New York State Department of Health (DOH) announces the "Nursing Home Transition and Diversion Waiver" (NHTD), a new Medicaid waiver program for individuals 18 years of age and older with a physical disability and for seniors who choose to live in the community rather than in an institutional setting. Considered part of an aggregate group that can be cared for at lower cost in the community than a similar group of Medicaid recipients in a nursing home.
DOH will administer this waiver program through nine Regional Resource Development Centers (RRDC) and three Quality Management Specialists (QMS) located throughout New York State.
The Department of Health will be contacting physicians to further explain their responsibility for providing orders for the services specified above.
The Department of Health has created a new Web site to help providers prepare for Medicaid's new outpatient reimbursement method, Ambulatory Patient Groups (APG's).
The cost of ambulance transportation of neonatal infants from community hospitals to facilities designated as regional Perinatal Centers (RPC) is the financial responsibility of the RPC. Upon discharge of the infant, transportation from the RPC back to the community hospital is paid by Medicaid fee-for-service. The purpose of the POA indicator is to differentiate between conditions present at admission and conditions that develop during an inpatient admission. As of July 17, 2008 reporting of Present on Admission (POA) indicators for each diagnosis submitted on all INPATIENT Medicaid claims are mandatory for all inpatient facilities. In order to minimize the administrative burden of this requirement, Medicaid is using the POA definitions as outlined by the Centers for Medicare & Medicaid Services (CMS) for Medicare. This requirement applies to all INPATIENT bills - including inpatient MH, substance abuse treatment, critical access hospitals, etc. Please Note: Facilities should continue to report POA indicators on Statewide Planning and Research Cooperative System (SPARCS) submissions. Questions about an Article?Each article contains a contact number for further information, questions or comments. Medicaid Update is a monthly publication of the New York State Department of Health containing information regarding the care of those enrolled in the Medicaid Program.


The electronic newsletter is the ideal way to have important policy information at your fingertips. Family Health Plus enrollees will be issued a Medicaid Benefit Identification Card to obtain their pharmacy benefit. Prescriptions may also be subject to prior authorization under Medicaid's Preferred Drug Program, Clinical Drug Review Program, and the Mandatory Generic Drug Program. Some exemptions will apply, consistent with those under the Medicaid Mandatory Generic Program.
Effective October 1, 2008, pharmacies will need to certify that the prescriber was consulted, or was unable to be reached, before EPIC is billed as the primary payer.
Please inform them or their caregivers about EPIC, and suggest they call the EPIC Helpline at (800) 332-3742.
It is anticipated that a total of 5,000 participants will be served by this waiver between now and August 2010. Prior authorization of transportation from community hospitals to an RPC will not be granted. Prior authorization from the appropriate county department of social services may be required.
This includes hospitalizations for substance abuse treatment, mental health admissions (including those from OMH licensed Article 31 and OASAS licensed Article 32 facilities), and all medical inpatient services. However, the Medicaid POA requirement applies to a broader range of inpatient providers, as described above. Please be advised that the Department of Health will reject records and inform facilities if there are problems with missing or incorrect indicators. This new delivery system will allow our providers to receive policy sensitive bulletins faster.
Providers will be able to read, print, and share the newsletter with other interested colleagues at their convenience. Mandatory generic requirements will apply only when EPIC is the primary payer, and no other drug coverage is available. We will include retrospective case reviews to determine the accuracy and validity of POA indicators submitted.
Please keep this new requirement in mind when prescribing or dispensing prescriptions to seniors enrolled in EPIC.



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