11/06/2018

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - UPDATED 11/6/2018

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 11/6/18:  MSHO has a meeting with Medicaid next week to discuss a new process for addressing claims issues with Managed Medicaid plans.

Additional Medicaid News:

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 Analgesics, CNS, Dermatological and Anti-Neoplastic.  Changes may be made to the Common Formulary based on comments received. Comments will be solicited once per calendar quarter. 

The Michigan Medicaid Health Plan Common Formulary can be found above.

Please send your comments by November 23, 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 

Michigan Second State To Pursue Outcomes-Based Contracts For Medicaid Rx Pricing

Michigan has asked CMS for permission to enter into outcomes-based contracts with drug manufacturers under its Medicaid program, Michigan Department of Health and Human Services spokesman Bob Wheaton confirmed Monday (Oct. 15).

Read the full article on Inside Health Policy here. 

Proposed Medicaid Policy Effective January 1, 2019 
Claims for Medicaid Beneficiaries Eligible for Medicare

To View Policy, CLICK HERE

NOTE from Vernell Hester, COC, CHONC, Billing Specialist, Beaumont Health Hematology Oncology:  

Good News - If this goes through and starts in January, it will be a great help for all of those patients who neglect to enroll in Medicare because they think they are fully covered by Medicaid and don’t want that extra expense of Part B premiums!  As of now, we have to bill the patient for 100% of the charges, since Medicaid will not pay anything without Medicare being active and paying first, and hope the patient is able to get retro coverage.  Then we have to jump through hoops to get the patient to enroll themselves or get Medicaid Buy-In.  Sometimes patients have even stopped treatment when they learned they were not covered!

Most Recent Bulletins That May Affect Medical Oncology

November 1, 2018 - MSA 18-42 - Rescinding the MI Marketplace Option

 CLICK HERE  to review all MSA Bulletins

Most Recent Announcements That May Affect Medical Oncology

October 4, 2018: Attention All Outpatient Hospital Providers: MDHHS is aware of a system issue that caused claim lines with drugs purchased through the 340B program to be incorrectly underpaid. This may have also affected a small volume of claims that have claim lines with submitted charges that are less than the payment rate. The issue was resolved with the July 2018 quarterly updates that went into the system on September 21, 2018. All affected claims have been identified and adjusted for correct payment. If claims were missed during the resurrection process, providers should adjust them with the claim note “340B underpayment defect”. Any claims billed ongoing will be reimbursed accurately.

To visit the Biller "B" Aware website CLICK HERE