Monday, November 14th, 2011
On November 7th, the Medicaid Electronic Health Record (EHR) Incentive Program launched in New York. This means that eligible professionals (EPs) and eligible hospitals in New York will be able to complete their incentive program registration. More information about the Medicaid EHR Incentive Program can be found on the Medicare and Medicaid EHR Incentive Program Basics page of the CMS EHR website.
If you are a resident of New York, and are eligible to participate in the Medicaid EHR Incentive Program, visit your State Medicaid Agency website for more information on your state’s participation in the Medicaid EHR Incentive Program. Click on a State below to access its website.
As of November 7th, 39 states have launched Medicaid EHR Incentive Programs and through October, 23 states have issued incentive payments to Medicaid EPs and eligible hospitals who have adopted, implemented, or upgraded certified EHR technology. CMS looks forward to announcing the launches of additional states’ programs in the coming months.
For a complete list of states that have already begun participation in the Medicaid EHR Incentive Program, see the Medicaid State Information page on the CMS EHR website.
Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.
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Wednesday, September 7th, 2011
Do you have questions regarding prescription drug coverage for your Medicaid patients when, starting October 1, their pharmacy coverage will be transitioned to Medicaid Managed Care?
At the request of the Medical Society of the State of New York (MSSNY), on Wednesday, September 14, Department of Health staff led by Janet Elkind, Director of the Bureau of Pharmacy & Policy Operations, will host a call specifically for physicians and their staff to ask questions regarding this important change in Medicaid prescription drug coverage.
The call will take place at 5:00 PM.
The call-in information is:
Call in #: 866-394-2346
Passcode: 590 814 6107
Please confirm your participation in this call by e-mailing firstname.lastname@example.org
As has been previously reported in the MSSNY e-news, all physicians that treat Medicaid beneficiaries should be aware that, effective October 1, their patients enrolled in Medicaid Managed Care (MMC) plans will begin receiving their prescription drug coverage through their plans, rather than through the state fee for service program. The change was one of a myriad of cost-saving measures that were proposed by the Governor’s Medicaid Redesign Team and enacted as part of the 2011-12 State Budget. Medicaid prescription drug coverage had been “carved out” of MMC since the late 1990s.
MMC plans will establish their own formularies and prior authorization procedures. However, health plans will be required to include on their formularies all categories of prescription drugs that are currently part of the New York State Medicaid fee for service prescription program. Consistent with New York’s managed care utilization review laws, plans will also be required to maintain internal appeals systems and assure access to an external appeal to address circumstances where patients are denied coverage for medications that are prescribed by their treating physicians.
MMC plans are required to develop and implement comprehensive implementation and communication plans to assure patient access to needed medications. These transition plans must be approved by the NYS Department of Health (DOH). DOH has indicated that it will permit a one-time, temporary fill of non-formulary drugs for up to a 30 day supply of medication. This would include drugs that are on a plan’s formulary but require prior authorization or step therapy under a plan’s utilization management rules.
Recognizing the confusion that implementation of this change may cause, MSSNY has urged DOH to take a number of steps to reduce transitional issues. These include asking DOH to maintain a link on its website where physicians will be able to easily check the formularies and prescription authorization procedures that will be established by each MMC plan; assuring MMC plans have sufficient staff to promptly respond to physician requests for non-formulary medications; and facilitating meetings and communications with physicians across the State of New York to get local physician feedback.
Tuesday, August 30th, 2011
The AMA continues to hear concerns expressed by physicians, states and specialty societies that a significant number of physicians will be subjected to the e-prescribing penalty in January 2012.
Consequently, the AMA’s Executive Vice President, James Madara, MD, called Centers for Medicare & Medicaid Services (CMS) Administrator Donald Berwick, MD, to urge the agency to provide more flexibility so that a 1 percent penalty in 2012 does not affect as many physicians. During the call, Dr. Madara thanked Dr. Berwick for issuing a recent proposed rule creating additional penalty exemptions, but went on to alert the administrator to the concerns being expressed. He urged Dr. Berwick to consider additional steps, such as establishing a new reporting period in 2012 and refraining from applying the penalty until 2013.
The AMA strongly believes that the agency plans to apply the penalty a year earlier than called for by Congress. Dr. Madara’s call follows a July 25 sign-on comment letter to CMS, where the AMA was joined by 92 states and specialty societies in calling for greater program flexibility. The AMA will continue to follow-up with CMS to secure additional changes to the program.
Thursday, June 23rd, 2011
The New York Medicaid e-prescribing incentive program applies only to non-facsimile electronic transmissions when compliant with Medicare Part D data standards.
E-Prescribing Incentive checks are being returned by prescribers who claim they do not e-prescribe.
PLEASE NOTE THE FOLLOWING:
Electronic Prescription Definition
New York State Pharmacy Regulations (http://www.op.nysed.gov/part63.htm) recognize two distinct types of electronically-transmitted prescriptions:
· a prescription transmitted electronically by facsimile;
The New York Medicaid Program accepts both types of electronically-transmitted prescriptions for standard claim reimbursement. However, pharmacies must verify a prescription is compliant with Medicare Part D data standards and requirements and NYS Pharmacy Regulations before submitting for the e-prescribing incentive.
Claims for prescriptions transmitted electronically by means other than facsimile and not Medicare Part D compliant are recognized by New York Medicaid for claim reimbursement purposes, but do not qualify for the e-prescribing incentive reimbursement.
The e-prescription must originate from the prescriber’s computer system (an electronic health record, electronic medical record, or stand-alone e-prescribing software) and must be transmitted to the retail pharmacy’s computer system.
For more information go to: http://www.health.ny.gov/health_care/medicaid/program/update/2009/2009-11spec.htm
Friday, March 4th, 2011
HISTORIC PROGRESS MADE IN REFORMING MEDICAID IN NEW YORK STATE
New York spends more on Medicaid per capita than any other state in the nation, but we rank only 21st in program quality for patients. In most counties, Medicaid costs alone account for more than half of the entire county tax levy.
To reform the system, Governor Cuomo created a Medicaid Redesign Team. The Team — comprised of health care professionals, stakeholders, and legislators — was charged with reducing costs and improving patient care. The Team held open meetings throughout the state and reviewed more than 4,000 ideas from team members, outside health care professionals, and citizens.
Last week, the Team accomplished their goal, submitting an unprecedented consensus plan that meets the Governor’s budget target and saves over $2.3 billion. What’s more, under the plan, one million New Yorkers will now have access to an innovative “patient-centered” medical program, making New York the national leader in providing this type of personal care. Today, the legislation to enact the plan was submitted to the Legislature to be included as part of the Executive Budget.
If you would like more information on this historic plan, click here to read about the Medicaid report. Thank you.
March 3, 2011
Friday, July 23rd, 2010
Attached is the most recent updated Preferred Drug List. Please feel free to share this with your members or post a link to your website. If your organization would like to schedule a presentation or if you have any questions or concerns regarding this program, please contact 518-951-2051 .
Please be aware of changes to the preferred and non-preferred status of some drugs on the preferred drug list, effective July 28, 2010.
Please visit: https://newyork.fhsc.com/
The preferred drug list can be found at:
A ‘quicklist’ of preferred drugs only can be found at:
All changes to the NYS Medicaid Preferred Drug List will be communicated to providers via the monthly Medicaid Update publications. Notifications will no longer be mailed to providers.
We appreciate your support of the New York State Medicaid Program.
Wednesday, June 16th, 2010
The following link will take you to the most recent updated Preferred Drug List. Please feel free to share this with your members or post a link to your website. If your organization would like to schedule a presentation or if you have any questions or concerns regarding this program, please contact 518-951-2051.
Please be aware of changes to the preferred and non-preferred status of some drugs on the preferred drug list, effective June 17, 2010.
In addition to these changes, the New York State Medicaid Clinical Drug Review Program (CDRP) is expanding to require prior authorization for the following:
Please visit https://newyork.fhsc.com/
The preferred drug list can be found at:
A ‘quicklist’ of preferred drugs only can be found at:
Prior Authorization Forms and Worksheets can be found at:
EFFECTIVE IMMEDIATELY all changes to the NYS Medicaid Preferred Drug List will be communicated to providers via the monthly Medicaid Update publications. Notifications will no longer be mailed to providers.
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