12/18/2018

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - UPDATED 12/18/2018

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...

Providers must enroll in Michigan Medicaid program

MSMS - Health care providers that serve Medicaid beneficiaries are facing an upcoming enrollment deadline that is necessary for them to continue to receive payments from Medicaid. While the Michigan Department of Health and Human Services (MDHHS) has revised the timeline to give providers more time to enroll, the department is urging providers to complete the enrollment process as soon as possible.  READ MORE 

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 

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

December 13, 2018: Medicaid Managed Care Plan Provider Enrollment Deadline

December 13, 2018: Health care providers that serve Medicaid beneficiaries are facing an upcoming enrollment deadline that is necessary for them to continue to receive payments from Medicaid.

While the Michigan Department of Health and Human Services (MDHHS) has revised the timeline to give providers more time to enroll, the department is urging providers to complete the screening and enrollment process as soon as possible.

For dates of service on or after Jan. 1, 2019, MDHHS will prohibit contracted Medicaid Health Plans and Dental Health Plans from making payments to typical providers not actively enrolled in Community Health Automated Medicaid Processing System (CHAMPS) – the state’s online Medicaid enrollment and billing system.

Typical providers are health care professionals that provide health care services to beneficiaries. They must meet education and state licensing requirements and have assigned National Provider Identifiers (NPI). Examples include, but are not limited to, physicians, physician assistants, certified nurse practitioners, dentists and chiropractors.

At this time, contracted Integrated Care Organizations (ICOs), Prepaid Inpatient Health Plans (PIHPs) and MI Choice Waiver agencies are exempt from this requirement.

CHAMPS enrollment neither requires nor mandates providers in a managed care network to accept Fee-for-Service Medicaid beneficiaries. CHAMPS enrollment is used solely to screen providers participating in Medicaid.

Resources:

• MSA 18-47
• Medicaid Provider Enrollment webpage
• CHAMPS Provider Enrollment Step by Step Instructions:
  • Individual /Sole Provider Type
  • Rendering/Servicing Provider Type
• CHAMPS Provider Verification Tool  
• Providers who have questions about the enrollment process or require assistance may contact the MDHHS Provider Enrollment Help Desk at 1-800-292-2550.

To visit the Biller "B" Aware website CLICK HERE