02/19/2019

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 is brining together traditional Medicaid, Some managed Medicaid plans and the Medicaid Contract Managers at the Spring Reimbursement Meeting to help explain and address the disparities.  Be sure to attend this Spring Reimbursement Meeting on April 17th!

Issue in Bridges System in December Giving Resident Aliens Full Medicaid in Error

There was a system error in November and December 2018 that approved Resident Aliens for full Medicaid FFS, even when they did not have a full 5 years of residence.  This was confirmed by an Eligibility Specialist at MSA.  The issue was fixed late in December and as of January all the affected clients, not having the required 5 years of continued residence, have been converted to Medicaid ESO which, as we know, doesn’t cover anything in the outpatient setting.  This means there will be retroactive take-backs for services in November and December and non-coverage of treatments some patients may already have been given.  Offices might want to be very diligent in verifying Medicaid to identify those that now have ESO only and will be responsible for all services done as an Outpatient.

**Thanks to Vernell Hester, COC, CHONC, for this update!!

Michigan Medicaid Drug Carve-out Update

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