RA Messages for November 30, 2010

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 www.lamedicaid.com. 

ATTENTION PROVIDERS

For Medicaid pharmacy services beginning December 1, 2010, the Department of Health and Hospitals, Bureau of Health Services Financing will establish a four-prescription limit per recipient per calendar month. Please refer to www.lamedicaid.com for detailed information.

ATTENTION ALL PROVIDERS OF EPSDT PERSONAL CARE SERVICES

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Personal Care Services (PCS) program has revised the EPSDT-PCS Form 90 to include the physician's order. Effective January 1, 2011, all EPSDT-PCS prior authorization requests must be submitted using the EPSDT-PCS Form 90 with revision date November 1, 2010. Molina's Prior Authorization Unit will continue to accept requests on the current form until December 31, 2010; however, all requests received on or after January 1, 2011 that do not include the revised EPSDT-PCS Form 90 will be denied. Therefore, providers should begin using the revised form immediately when developing requests.

Molina's Prior Authorization Unit will continue to accept the form 90-L along with a physician's order for Children's Choice waiver recipients in lieu of the EPSDT-PCS Form 90 as long as the form 90-L was completed by the recipient's doctor within 90 days of the current EPSDT-PCS request.

A copy of the revised EPSDT-PCS Form 90 is available on the website at www.lamedicaid.com, following the Forms/Files/User Guides link.

ATTENTION HOSPITAL PROVIDERS: UPDATE TO RETROSPECTIVE REVIEW PROCESS

The process for submitting a request for precertification of retrospective reviews for acute inpatient hospitals was revised on October 18, 2010. After further review and after considering feedback from providers, the process has been updated. The revised process and procedure for requesting retrospective precertification for acute inpatient hospitals can be located on the Louisiana Medicaid website. These updated changes are effective November 29, 2010.

Please visit www.lamedicaid.com for detailed provider notices concerning these changes.

NOTICE TO ALL ENROLLED DIRECT SERVICE PROVIDERS
WITH THE FOLLOWING PROVIDER TYPES:

Adult Day Health Care (ADHC), EDA Waiver Personal Assistance Services (PAS), Environmental (HOME) Modifications (Environmental Accessibility Adaptations), Personal Emergency Response System (PERS), and Long Term Personal Care Services (LTPCS)

It is the responsibility of your agency to ensure the accuracy of the Freedom of Choice Lists by updating and maintaining your agency information that is presented to users via the Provider Locator Tool (PLT). Providers who have not updated their additional contact information on the PLT by January 1, 2011, will be removed from the Freedom of Choice list until they do so. To view the Provider Locator Tool User Manual for instructions on updating the additional contact information screen, go to: http://www.lmmis.com/provweb1/forms/userguides/ProviderLocatorInformationUserManual.pdf. This option will only update the additional contactinformation on the PLT and will not alter the information on the Provider Enrollment File. If you want to update the Provider Enrollment File, go to: http://www.lmmis.com/provweb1/Provider_Enrollment/ProviderEnrollmentIndex.htm.

ATTENTION ALL PROVIDERS
IMPLEMENTATION OF DEC 1, 2010 RATE REDUCTIONS

Due to a funding deficit in Medicaid caused by unfunded increases in utilization, the Department of Health and Hospitals must implement a budget reduction effective December 1, 2010. A portion of this reduction will come from adjustments to current provider reimbursement rates ranging from 2-5.8%.

The state has published Emergency Rules which address these program reductions which can be found online at the Office of State Register's website at http://www.doa.louisiana.gov/OSR/osr.htm by clicking on the Emergency Rules tab on the left navigation bar of the homepage. Refer to the homepage of the LA Medicaid website, www.lamedicaid.com, for a summary of these rules and a link to the LA Register.

Providers will be notified when the new rates are loaded for each program. At that time, providers should reference the LA Medicaid website for the most current fees. Claims for dates of service after December 1, 2010 that are adjudicated prior to the system update will be systematically adjusted and no action is required by providers. Continue to monitor future RAs. Contact the Provider Relations unit at (800) 473-2783 or (225) 924-5040 with questions related to the implementation of the rate reductions and claim adjustments.