02/05/2019

Medicaid

Recent Oncology Related Issues and News

PENDING MEDICAID ISSUES - 

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 Enrollees Must Have Access to High-quality Cancer Care, ASCO Writes in Comments to CMS. (ASCO in Action)

Jan 16, 2019 - In a comment letter to the Centers for Medicare & Medicaid Services (CMS), ASCO urged the agency to ensure that every Medicaid enrollee with cancer can access the high-quality care needed to treat their disease.

READ ARTICLE

Public Comment on MDHHS Medicaid Health Plan Common Formulary IS OPEN

Submit your comments by February 22nd!  To read more about the Medicaid Health Plan Common Formulary and what managed Medicaid plans are required to reimburse and how to submit comments, CLICK HERE

Most Recent Bulletins That May Affect Medical Oncology

January 15, 2019 - MSA 19-01 - Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) Code Updates

CLICK HERE  to review all MSA Bulletins

Most Recent Announcements That May Affect Medical Oncology

January 8, 2019: Outpatient Hospital Providers U6 modifier update

Update to BBA posted August 24, 2018

For dates of service January 1, 2018, and ongoing MDHHS was continuing to reject claims with adjustment reason code A8 when reporting drugs that are acquired through the 340B program with the accompanying required U6 modifier. The affected codes (J7606, J7608, J7611, J7612, J7613, J7620, J7644, J7676, and J7682) have assigned status indicators M on Medicare’s Addendum B. This was fixed in the system update on December 14, 2018 and MDHHS will resurrect all affected claims. Claims with dates of service prior to December 31, 2017 began to process correctly in the last software update on September 21, 2018.

To visit the Biller "B" Aware website CLICK HERE