PHARMACY PROVIDERS, PLEASE NOTE!!!

If you are unsure about the coverage of a drug product, please contact the PBM help desk at 1-800-648-0790.

Please file adjustments for claims that may have been incorrectly paid. Only those products of the manufacturers which participate in the Federal Rebate Program will be covered by the Medicaid program. Participation may be verified in Appendix C, available at http://www.lamedicaid.com. 

Should you have any questions regarding any of the following messages, please contact Molina Medicaid Solutions at (800) 473-2783 or (225) 924-5040.

ATTENTION HOME HEALTH PROVIDERS:
TRANSITION TO 15 (fifteen) MINUTE UNITS FOR HOME HEALTH AIDE SERVICES

In the past, Home Health providers have been instructed to bill home health aide services with 1 unit for a visit. National guidelines require these services to be billed in 15 (fifteen) minute units.

Effective with date of service August 1, 2016, claims processing logic will be updated to reflect the intent of Medicaid policy and National guidelines related to Home Health Aide.

Beginning with date of service August 1, 2016, providers will be required to bill home health aide visits in 15 (fifteen) minute units. Providers are encouraged to make changes to internal processes and systems to accommodate the change and avoid claims payment issues.

Provider documentation of the visit must reflect the arrival time and departure time of the aide for the visit to substantiate the provider’s claim for the number of 15 (fifteen) minute units billed. This documentation must be retained and made available for review upon request according to Medicaid standards for provider participation. If you have questions about the content of this message, you may contact Molina Provider Relations at 1-800-473-2783.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective July 1, 2016 FFS Medicaid Pharmacy Program will cover mosquito repellent to decrease the risk of exposure to the Zika virus. Please refer to http://www.lamedicaid.com/provweb1/Pharmacy/pharmacyindex.htm for more information.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Pursuant to Act 339 of the 2016 Regular Session of the Louisiana Legislature changes will be implemented to the Medicaid Fee-for-Service (FFS) Pharmacy Program regarding drugs and the Preferred Drug List/Prior Authorization (PDL/PA) process. Effective June 2, 2016, any new drug introduced into the market in one of the therapeutic classes reviewed by the Louisiana Department of Health (LDH) Pharmaceutical and Therapeutics (P&T) Committee may be prior authorized until the next P&T meeting. This applies only to new drugs added with a labeler’s mandatory drug rebate program effective date of June 2, 2016 or thereafter.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective July 1, 2016 OTC Aspirin 81mg, Folic acid 0.4 and 0.8mg, and Vitamin D 400IU will be covered for preventive purposes for specific recipients with no pharmacy copayment. Hospice recipients will be exempt from pharmacy copayments. Please refer to http://www.lamedicaid.com/provweb1/Pharmacy/pharmacyindex.htm for more information.

Attention Fee for Service (FFS) Louisiana Medicaid Providers:

Effective July 5, 2016, the Fee for Service (FFS) Louisiana Medicaid Pharmacy Program in collaboration with the Louisiana Medicaid Drug Utilization Review (DUR) Board has established clinical pre-authorization criteria for elbasvir/grazoprevir (Zepatier®), tedizolid phosphate (Sivextro®), and the Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors and combination products. Please refer to http://www.lamedicaid.com/provweb1/Pharmacy/pharmacyindex.htm for more information.

ATTENTION LOUISIANA MEDICAID PROVIDERS:
MONTHLY PROVIDER UPDATE

In the past, the Louisiana Department of Health provided a bi-monthly provider update, which is a publication comprised of news articles related to Louisiana Medicaid. The articles consisted of Medicaid program initiatives, clarification of common provider problems, or reminders of upcoming program changes.

It has been determined that the provider update will resume as a monthly electronic publication and will be posted on lamedicaid beginning August 1, 2016.

ATTENTION FEDERALLY QUALIFIED HEALTH CENTERS:
The Process for Annual PPS Rate Adjustment Notification is Changing

In the past, each Federally Qualified Health Center (FQHC) has received an annual letter indicating the updated prospective payment system (PPS) rate for the facility. Beginning with updates for State Fiscal Year (SFY) 2017, FQHCs will no longer receive a letter notifying them of their annual PPS rate adjustment.

The Medicare Economic Index (MEI) is the determining factor for the yearly change in the PPS rate. For SFY 2017, which begins July 1, 2016, each FQHC’s current rate will increase by 1.1 percent. Updated PPS rates will be communicated to the FQHCs and others via the Medicaid published fee schedule, available on the Medicaid website (www.lamedicaid.com) under the Fee Schedules link.

If you have questions about the content of this message, you may contact Molina Provider Relations at 1-800-473-2783.