Preferred Agents for Drug Classes Reviewed at May 19, 2006 Pharmacy and Therapeutics Committee Meeting
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ELIGIBILITY AND BENEFIT PLAN COVERAGE UNDER MEDICAID MODERNIZATION
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EPSDT RATE INCREASES AND EXPANDED COVERAGE FOR ADULT PREVENTIVE MEDICINE SERVICES EFFECTIVE JULY 1, 2006
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NOTICE OF MATCH PAYMENT INSTRUCTIONS
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EXCLUSIONS AND LIMITATIONS OF MEDICAID BASIC PLAN BENEFITS
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NEW PCS PAYMENT RATES EFFECTIVE JULY 1, 2006
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ADULT DAY CARE PROVIDER BILLING
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NOTICE OF 2006 MEDICAID RATES FOR SWING-BED DAYS AND ADMINISTRATIVELY NECESSARY DAYS
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INFORMATION REQUEST RELATED TO PCS WAGE DETERMINATION
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IDAHO MEDICAID DISPROPORTIONATE SHARE HOSPITAL
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Replacing information in IR 2005-11 for this drug class only: NEW PRIOR AUTHORIZATION CRITERIA FOR PROTON PUMP INHIBITOR DRUG CLASS
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PRIOR AUTHORIZATION CRITERIA FOR ALZHEIMER’S DRUG CLASS
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Replacing information in IR 2004-46 for this drug class only: NEW PREFERRED AGENTS FOR URINARY INCONTINENCE DRUG CLASS
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PRIOR AUTHORIZATION CRITERIA FOR LEUKOTRIENE DRUG CLASS
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PRIOR AUTHORIZATION CRITERIA FOR INHALED CORTICOSTEROID DRUG CLASS
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PRIOR AUTHORIZATION CRITERIA FOR INHALED BETA-2 AGONIST DRUG CLASS
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CHANGE IN MEDICAID COVERAGE FOR MALE CIRCUMCISION
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Home Health Cost Settlement Process
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CLARIFICATION OF DD and EPSDT SERVICE COORDINATOR AND PARAPROFESSIONAL RESPONSIBILITIES
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CHANGES IN REIMBURSEMENT METHODOLOGY FOR HOSPITAL-BASED AMBULANCE SERVICES
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ADDITION OF LIMITED INPATIENT MENTAL HEALTH SERVICES FOR CHIP-B PARTICIPANTS
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Change in Medical Transportation Prior Authorization Requirements
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CLARIFICATION OF TIMELY FILING REQUIREMENTS
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Expansion of the UM/CM Neonate Program to All Hospitals
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Bariatric Surgery, Panniculectomy/Abdominoplasty
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1. RESIDENTIAL HABILITATION SUPPORTED LIVING BILLING INSTRUCTIONS FOR DD AND ISSH WAIVER PARTICIPANTS ATTENDING PUBLIC SCHOOL
2. BILLING AND ADDENDUM PROCESS CLARIFICATIONS FOR MEDICAID INFORMATION RELEASE MA04-50
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CLARIFICATION OF MEDICAID REIMBURSEMENT POLICY FOR BILLING THE COMPONENTS OF THE GLOBAL SURGICAL PROCEDURE CODES: PRE-OPERATIVE, INTRA-OPERATIVE AND POST-OPERATIVE
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Idaho Medicaid is pleased to announce that we are now able to accept Type of Bill 721, 722, 723, and 724 for dialysis claims. This will facilitate the crossover billing from Medicare.
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EXPEDITED MEDICAID ELIGIBILITY FOR CERTAIN NEWBORNS
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DISENROLLMENT OF HEALTHY CONNECTIONS ENROLLEES FROM YOUR PRACTICE
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Effective for dates of service on or after 10/01/04, Medicaid has revised its hospice rates.
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RESIDENTIAL HABILITATION SUPPORTED LIVING REIMBURSEMENT/SERVICE LEVEL CLARIFICATION
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Informational Letter 2004-49 issued by the Reimbursement Unit
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This information release was not issued.
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Informational Letter 2004-47 issued by Care Management
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NEW PRIOR AUTHORIZATION CRITERIA FOR ESTROGEN, ORAL HYPOGLYCEMIC, AND URINARY INCONTINENCE DRUG CLASSES
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NEW PRIOR AUTHORIZATION CRITERIA FOR LONG ACTING OPIOID DRUG CLASS
Drug/Drug Class: LONG ACTING OPIOID
Implementation Date:
Effective for dates of service on or after October 1, 2004
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Informational Letter #2004-44 issued by Care Management.
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This Information Release will summarize the negotiation process used to update rules, highlight key changes, and provide clarification regarding requirements in Medicaid mental health service benefits.
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This information release was not issued.
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This information release describes billing and service requirements for providing limited Medicaid mental health services through telemedicine technology.
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This release was not issued.
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NEW PRIOR AUTHORIZATION CRITERIA FOR ACE INHIBITORS and CALCIUM CHANNEL BLOCKERS DRUG CLASS
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NOTICE OF 2004 MEDICAID RATES FOR SWING-BED DAYS AND ADMINISTRATIVELY NECESSARY DAYS (AND)
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NEW PRIOR AUTHORIZATION CRITERIA FOR PROTON PUMP INHIBITORS
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REPLACEMENT OF INFORMATION RELEASE 2003-76
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NEW SERVICES AND BILLING CODES FOR ADULTS WITH DEVELOPMENTAL DISABILITIES
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Effective August 1, 2003, the new code to use for Language and Deaf Interpretation which encompasses all sign language or oral interpretive services is state-only code 8296A (Interpretive Services).
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EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) Codes
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In an effort to be consistent with Medicare policy and to avoid overpayments Medicaid is instructing providers to bill in the following manner
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Effective March 17, 2003, Medicaid is requesting all providers prescribe the preferred agents within the following classes of medications
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CLARIFICATION OF GUIDELINES FOR SPECIAL RATES FOR NURSING FACILITIES
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IDAHO MEDICAID DISPROPORTIONATE SHARE HOSPITAL (DSH) SURVEY
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Effective for dates of service on or after March 1, 2003, Medicaid will change how we treat the payment for coinsurance and deductible for Medicare Part A nursing facility crossover claims.
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STREAMLINING OF THE INDIVIDUAL SUPPORT PLAN (ISP) AND ADDENDUM PROCESS FOR PERSONS WITH DEVELOPMENTAL DISABILITIES
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Effective January 1, 2003, Medicaid will no longer accept claims for which providers have not accepted assignment when the electronic transmittal is received from CIGNA/Medicare.
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Effective for dates of service on or after December 1, 2002, the following changes have been made to reimbursement for procedure code 0501P.
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You recently received Information Release MA02-39 regarding program changes resulting from the need to meet a balanced state budget.
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1. Change in the Prior Authorization and Reimbursement Process for Clients Residing in Supported Living Arrangement 2. Change in documentation requirements for ESC/TSC authorization for crisis assistance hours.
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REPLACEMENT OF INFORMATION RELEASES 2004-14 & 2004-22: New Preferred Agents for Proton Pump Inhibitor and Triptan Drug Classes
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Effective for dates of service on or after April 01, 2002, the Department now requires prior authorization for HCPCS code E0147, Heavy duty, multiple breaking system, variable wheel resistance walker. “Medicare covers “safety roller” walkers only in patients with severe neurological disorder or restricted use of one hand. In some cases, coverage will be extended to patients with a weight exceeding the limits of a standard wheeled walker.” (HCPCS Level II Expert 2002)
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C-PAP supplies are separately billable items that do not require prior authorization from the Department.
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Effective for dates of service on or after December 1, 2002, Idaho Medicaid is adopting specific sections of the 2002 coverage criteria that have been established by Cigna Medicare for the following PET scan codes (2002 Cigna Medicare Coverage Issues Manual).
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Clozapine is a psychotropic medication that requires coordination and close medical oversight. Currently Clozapine is the only medication for which Medicaid makes a separate payment for care coordination.
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Effective for dates of service on or after November 1, 2002, cesarean section deliveries will be allowed a four-day inpatient length of stay before a continued stay review is required with the Department’s Quality Improvement Organization, Qualis Health.
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Effective December 1, 2002, several changes in reimbursement and policy for Medicaid programs will be implemented.
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Effective for dates of service on or after 10/01/02, Medicaid has revised its hospice rates.
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Effective immediately Medicaid point of sale (POS) pharmacy claims will allow the electronic billing of a 72-hour emergency supply of medication that requires prior authorization.
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The Idaho Medicaid Provider Handbook has been updated to include the current Hospice service guidelines.
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Idaho Medicaid has recently identified significant opportunities for improving the prescribing of long-acting opioid analgesics for chronic pain. Long-acting opioid analgesics are frequently prescribed for Medicaid clients for use in non-malignant chronic pain such as chronic back pain, headaches, osteoarthritis, and neuropathic pain.
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Effective October 7, 2002, the State of Idaho will begin using the National HIPAA Adjustment Reason Codes.
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Revised Policy of the Idaho Medicaid Dental Program
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We would like to clarify our DME program guidelines regarding spacers, nutritional products, and diabetic test strips.
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Correction to July DME information release #MA02-20
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A recent court ruling that has interpreted an amendment to statute has changed the requirements for state-funded abortions. For abortions performed with dates of service on or after July 1, 2002, the following rules apply:
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In conjunction with the beginning of the 2002/2003 Respiratory Syncytial Virus (RSV) infection season, effective dates of service on or after September 1, 2002, Idaho Medicaid will no longer require prior authorization for Synagis to be reimbursed.
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Any review received on or after September 30, 2002, by Qualis Health (formerly PRO-West), Idaho Medicaid's Quality Improvement Organization, will be reviewed utilizing InterQual® clinical appropriateness criteria. This criteria will be used to review for prior authorization of procedures and diagnoses on Idaho Medicaid’s Select Pre-Authorization List and for the length of stay reviews.
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As published in the June 2002 issue of Medic/Aide, Medicaid Information Release MA-02-16 stated that clinic services are reimbursable only when provided in the actual clinic setting. This definition is clearly established in the Code of Federal Regulations at 42 CFR 440.90, which specifically defines Clinic Services as those services furnished to outpatients “at the clinic”.
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Effective for dates of service on or after August 1, 2002, any client living in an ICF/MR in need of a wheelchair may obtain one from a qualified Medicaid supplier and have the purchase billed to Medicaid.
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In order to be compliant with the Health Insurance Portability and Accountability Act (HIPAA) and Medicaid's effort to align reimbursement rates with Medicare, the billing procedure for anesthesia will change.
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Effective July 1, 2001 all Medicaid fees for the above providers will be increased by 3.2% per Idaho Code, Title 1, Chapter 56, Section 136.
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NEW PAYMENT RATES EFFECTIVE JULY 1, 2001
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SURGICAL CODES FOR PRIOR AUTHORIZATION REVIEW
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HOSPICE RATES--Effective for dates of service on or after 4/1/2001
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CODE CHANGES FOR PRIOR AUTHORIZATION
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HCPC CODE G0169 DISCONTINUED
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DENTAL PROCEDURE CODE ADDITIONS/DELETIONS/LIMITATIONS/FEE UPDATES
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NOTICE OF 2001 MEDICAID RATES FOR EACH SWING-BED DAY AND ADMINISTRATIVELY NECESSARY DAYS (AND)
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Published in the MedicAide, 3/01. See page 8
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