DOH Medicaid Update June 2006 Vol. 21, No. 6

Office of Medicaid Management
DOH Medicaid Update
June 2006 Vol. 21, No. 6

 

State of New York
George E. Pataki, Governor

Department of Health
Antonia C. Novello, M.D., M.P.H., Dr. P.H.
Commissioner

Medicaid Update
is a monthly publication of the
New York State Department of Health,
Office of Medicaid Management

Brian Wing, Deputy Commissioner

 


Medicare Part D
Update!

Changes to the Medicaid
"Wrap-Around" Program
For Full Benefit Duals Enrolled in Medicare Part D
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As you are aware, on January 1, 2006, Medicare Part D became the source of prescription coverage for those recipients with both Medicare and Medicaid. NYS Medicaid continues to cover certain drugs which are excluded from the Part D benefit, such as barbiturates, benzodiazepines, some prescription vitamins, and non-prescription (OTC) drugs.

NYS Medicaid also provides a "wrap-around" program, that covers medications, in some circumstances, which are included in the Part D benefit but which the recipient is unable to receive from their Part D plan.

There are two key changes to the Medicaid wrap-around program:

1. Limited Wrap-Around Benefit:

Effective July 1, 2006, drugs reimbursed by Medicaid under the wrap-around benefit will be limited to the following four categories of drugs:

  • Atypical antipsychotics
  • Antidepressants
  • Antiretrovirals used in the treatment of HIV/AIDS
  • Immunosuppressants used in the treatment of transplants

    All other categories of drugs included in the Medicare Part D benefit will be covered only through the Medicare Part D program for full benefit duals.

2. Changes to the MVS Requirements:

Providers were notified in December 2005 that they must seek a denial from Medicare Part D, and complete a Medicare Verification System (MVS) process, prior to payment by Medicaid under the wrap-around benefit. This requirement has been discontinued. Obtaining an MVS approval, and recording the MVS number on the prescription, is not required prior to payment of wrap-around claims by Medicaid. However it is still anticipated that prescribers will provide assistance to recipients to request coverage determinations or exceptions from the Medicare Part D plan, when drugs are not available. Pharmacists must continue to verify that they have attempted to bill the recipient's Part D plan for that drug prior to submitting the claim to Medicaid.

General Guidelines on Use of the Wrap-around Benefit:

Medicare Part D is the primary payor for dual eligibles, and should provide access to all medically appropriate medications through the coverage determination and appeal process. It is anticipated that the Medicaid wraparound benefit will be used for the four classes of drugs noted:

  • these drugs are not covered by the specific plan,
  • when the patient does not meet the plan's utilization management requirements; or
  • when there are quantity limits inconsistent with the prescribed amount.

The Medicaid wrap-around program cannot be used to obtain:

  • early refills,
  • refills for lost or stolen drugs,
  • extended or vacation supplies

Pharmacist Instructions for the Wrap-around Benefit:

When the recipient presents their prescription to the pharmacist, the pharmacist must first complete all the following necessary CMS procedures to assure Medicare Part D coverage is available. When these procedures are attempted, and coverage by Part D has failed, the pharmacist may dispense the medication to the recipient and submit a claim to Medicaid.

All Medicaid rules apply to wrap-around benefit claims, including any Medicaid prior authorization requirements and co-payment guidelines. If the drug requires prior authorization under Medicaid, the prescriber and pharmacist must complete the Medicaid PA process for duals by calling 1-877-309-9493. If the drug is also covered under Medicare Part B, and the recipient is eligible for coverage, the pharmacist is required to seek coverage under that payor prior to billing Medicaid.

Pharmacist Procedures for Billing Medicare Part D Plans:

Pharmacists are to use the following processes when experiencing difficulty with the recipient's Medicare plan enrollment, cost sharing, or coverage of medications:

  1. Check for enrollment in a Part D plan, by asking for a plan ID card or other documentation from a Part D plan, or, submit an E1 query. If the E1 response is only a telephone number, call that telephone number to obtain the billing information from the plan. Pharmacists can also get information on a beneficiary's enrollment, and on how to contact the plan, by calling Medicare's dedicated pharmacy assistance line (1-866-835-7595), which is available 24/7. This number is to be used only by pharmacists.
  2. If the individual is enrolled in a plan, but is not being charged the correct dual-eligible co-payment amounts, contact the drug plan (which has expedited access for pharmacy requests to adjust co-payments), or, if the situation is urgent and other steps have not worked, contact Medicare's pharmacy assistance line for urgent caseworker assistance for the beneficiary.
  3. If there is no evidence of a Part D plan enrollment but there is clear evidence of both Medicare and Medicaid eligibility (for example, a Medicare card and a Medicaid card or prior history of Medicaid prescription coverage at the pharmacy) bill the POS Contractor (WellPoint) for the claim. The pharmacist can also call the dedicated pharmacy assistance line to confirm that the beneficiary is in Medicare.

Procedure for Billing Medicaid:

After completing all necessary CMS procedures to assure Medicare Part D coverage, and failing to gain coverage, the pharmacist may submit the claim to Medicaid.

The claim MUST include the following additional information, which verifies that the pharmacist has attempted, and failed to bill Medicare, in order to receive payment approval:

  1. A value of "2" (Override) in the Eligibility Clarification Code - Field 309-C9
  2. A value of "03" (Other coverage, Claim not covered) in the Other Coverage Code - Field 308-C8
  3. A value of "07" (Medicare Approved) in the Other Payer Amount Paid Qualifier - Field 342-HC
  4. A value of "0.00" (dollar amount) in the Other Payer Amount Paid - Field 431-DV

Note:

If your billing system does not allow for the entry of the "07'" qualifier and the "0.00" dollar amount in fields 342-HC and 431-DV, it is acceptable to leave them blank.


Attention
Prescribers and
Pharmacists

Exclaim

ERECTILE DYSFUNCTION DRUGS NO LONGER COVERED
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Effective immediately, the Medicaid program is prohibited from covering drugs used for the treatment of sexual or erectile dysfunction, unless such drugs:

  • are used to treat other conditions, and
  • have received approval from the Food and Drug Administration (FDA) for that purpose.

Pharmacy Reimbursement Changes
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Pharmacy reimbursement for prescription drugs under the New York State Medicaid program is limited to:

  • the lower of the billing pharmacy's usual and customary price charged to the general public,
  • the federal upper limit (FUL) for specific multiple source drugs, or
  • the estimated acquisition costs (EAC) established by the NYS Department of Health.

Pharmacist

Recently enacted legislation has resulted in changes to the Medicaid pharmacy reimbursement rates. The following changes to estimated acquisition cost definitions will apply to payments that are issued for services that are provided on and after July 1, 2006:

  • Sole or Multi-source Brand Drugs

    The average wholesale price (AWP) of the prescription product minus fifteen percent (15%).
    State and federal requirements for the dispensing of brand-name drugs must be met.

  • Multi-source Generic Drugs

    The lower of the average wholesale price (AWP) minus thirty percent (30%), or the FUL.
    If an FUL has not been assigned by the Centers for Medicare and Medicaid Services (CMS), the State based maximum acquisition cost (MAC), when established by the NYS Commissioner of Health, will be applied.

In addition, the pharmacy reimbursement for specialized HIV pharmacies which meet specific programmatic and operational criteria will be defined as follows:

  • Sole or Multi-source Brand Drugs

  • The average wholesale price (AWP) minus fourteen percent (14%).

    State and federal requirements for the dispensing of brand-name drugs must be met.

  • Multi-source Generic Drugs

    The lower of the average wholesale price (AWP) minus twenty-two percent (22%),or the FUL.

    If an FUL has not been assigned by CMS, the State based maximum acquisition cost (MAC), when established by the NYS Commissioner of Health, will be applied.

Questions can be directed to the Medicaid Pharmacy Policy and Operations staff at 518-486-3209.


Implementation of the Medicaid Preferred Drug Program
Effective June 28, 2006
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Effective June 28, 2006, the Department of Health, in conjunction with First Health Services Corporation, will begin implementing prior authorization requirements for drugs identified as "non-preferred" within the Medicaid pharmacy Preferred Drug Plan (PDP) benefit.

Background:

Pills

In 2005, legislation was passed which requires that the Medicaid program implement a Preferred Drug Plan (PDP). This new program promotes the prescribing of less expensive, effective prescription drugs when medically appropriate. The legislation provides a number of protections for consumers and prescribers to assure that all medically necessary drugs are available.

How It Will Work:

For selected categories of drugs, where there are multiple drugs with similar efficacy, preferred and non-preferred drugs are identified. Prescribers will need to complete a prior authorization process in order for their patients to receive non-preferred drugs. The prior authorization process will require either a phone call, or a fax, by the prescriber providing information about the patient's medical need for the non-preferred drug. The process will be straightforward, easy to use and serve to confirm the appropriateness of the medication based on the patient's needs.

How to Obtain a Prior Authorization:

Similar to current procedures, prescribers will initiate the prior authorization process and pharmacists will validate the prior authorization number. Detailed instructions are included; additional information and updates will be available on the Department's website:

Prescribers: To get a prior authorization number for non-preferred drugs, prescribers must contact the First Health Services clinical call center, which is accessible, 24 hours per day, 7 days per week:

Call 1-877-309-9493

The clinical call center is staffed with pharmacy technicians and pharmacists who will work with your office to assure that Medicaid recipients receive their medications. There are also provisions for a 72- hour emergency supply of necessary medications. Additional instructions follow.

Pharmacists:

Prescriptions for non-preferred drugs will carry a prior authorization number ending with a "W." The "W" alerts pharmacy providers to select the non-preferred drug option when calling the prior authorization phone line to validate the prior authorization number. The "W" should not be included in the prior authorization field when submitting a claim. The prior authorization number for non- preferred drugs is an 11-digit number. Detailed instructions and the pharmacy worksheet on validating a prior authorization number for a non-preferred follow.

What about Existing Prescriptions for Non-preferred Drugs?

Prior authorization is only needed for new prescriptions written after June 28, 2006. Patients who already have a prescription for a non-preferred drug may continue to obtain the medication without prior authorization for any remaining refills. Prior authorization must be approved before any subsequent prescriptions are written. Each prior authorization is good for the life of the prescription (up to six months).

Implementation:

Implementation of prior authorization requirements for non-preferred drugs will occur in phases, starting with an initial group of drug classes. Phase I categories of drugs will be implemented effective June 28, 2006. The initial therapeutic classes are:

  • Angiotensin II Receptor Blocking Agents (ARBs)
  • Angiotensin Converting Enzyme (ACE) inhibitors
  • Beta Blockers
  • Dihydropyridine Calcium Channel Blockers (CCBs)
  • CCB/ACE inhibitor Combinations
  • Bisphosphonates

Listed below is a "Quick List" for Phase I, which is an easy-to-use summary of the preferred drugs in each category effective 6/28/06.

Also included in this article is the full listing of preferred and non-preferred drugs for each of these drug classes.

It is anticipated that Phase II of the program will be implemented at the end of September, 2006. As these additional drug classes are added, your office will be notified of the new Preferred Drug List. This information will also be widely distributed, and available on the Department's web site, prior to implementation:

http://www.health.state.ny.us and http://newyork.fhsc.com

Medicaid Preferred Drug Quick List - Phase I

The following is a listing of preferred drugs in each of the initial classes of drugs.

Effective 6/28/06, drugs not listed below will require prior authorization.

Prescribers are encouraged to use preferred drugs when appropriate.

ACE InhibitorsBeta Blockers
PREFERRED DRUGSPREFERRED AGENTS
Altace® acebutolol
benazepril HClatenolol
benazepril HCl/HCTZbetaxolol
captoprilbisoprolol fumerate
captopril/HCTZlabetalol
enalapril maleatemetoprolol tartrate
enalapril maleate/HCTZnadolol
lisinoprilpindolol
lisinopril/HCTZpropranolol
Mavik®timolol maleate
moexipril HCl 
Uniretic®Bisphosphonates - Oral
 PREFERRED AGENTS
Angiotensin Receptor BlockersFosamax® Solution
PREFERRED AGENTSFosamax® Tablet
Benicar HCT®Fosamax® Plus D
Benicar® 
Cozaar®Calcium Channel Blockers (DHP)
Diovan HCT®PREFERRED AGENTS
Diovan®Afeditab CR®
Hyzaar®Dynacirc®
Micardis HCT®Dynacirc CR®
Micardis®felodipine ER
 isradipine
ACEI + Calcium Channel Blocker Combinationnicardipine HCl
PREFERRED AGENTSNifediac CC®
Lotrel® Nifedical XL®
Tarka®nifedipine
 nifedipine ER
 nifedipine SA
 Norvasc®
 Sular®

If you have any questions about the new Medicaid Pharmacy PDP, please call: (877) 309-9493.


Instructions for Prescribers:
PREFERRED DRUG PROGRAM PRIOR AUTHORIZATION

Prior Authorization Call Line 1- 877- 309- 9493
Prior Authorization Fax Line 1- 800- 268-2990

REMEMBER: Drugs identified by NYS Medicaid as "Preferred" do not require Prior Authorization. If you prescribe the preferred drug, no additional action is necessary.

PROGRAM INFORMATION

  • Effective June 28, 2006, drugs identified by NYS Medicaid as non-preferred require prior authorization. A list of preferred and non-preferred drugs is available at http://www.nyhealth.gov and at http://newyork.fhsc.com
  • The prescriber, or an agent of the prescriber, must call the prior authorization call line to initiate a prior authorization.
  • Fax requests are permitted. A completed copy of the preferred drug program prior authorization fax request form, found on the reverse side of this page, should be sent to 1-800-268-2990. Fax requests may take up to 24 hours to process.
  • If calling for prior authorization of a non-preferred drug, the prescriber is not required to maintain any forms; however, the prescriber or their agent should be prepared to answer the questions below and document the drug name, the reason the non-preferred drug is being requested and the prior authorization number in the patient's medical record. (Note-prescribers are still required to maintain a copy of prior authorization worksheets for currently existing prior authorization programs (i.e., Zyvox, Serostim, mandatory generic) in the patient's medical record).
  • Prior authorization is required for each new prescription and is effective for the life of the prescription (up to five refills in six months).

PRESCRIBER PROCEDURE

  • To initiate the prior authorization process, the prescriber must call the prior authorization phone line at 1-877-309-9493 and select Option "1" for Prescriber.
  • To obtain a prior authorization for a non-preferred drug, select Option "1" again. Please be prepared to provide the following information when calling:
    • Prescriber's Medicaid ID number or license number
    • Client's Medicaid ID number
    • Non-preferred drug name
  • The questions you will be asked will include the following:
    • Has the patient experienced a treatment failure with the preferred drug?
    • Has the patient experienced an adverse drug reaction with a preferred drug?
    • Is there a documented history of successful therapeutic control with a non-preferred drug and transition to a preferred drug is medically contraindicated?
  • If uncertain which selection to make or if assistance with the prior authorization process is required, select Option "3" for support.
  • Once authorization is given and a prior authorization number is obtained, the number must be written on the face of the prescription. Please be sure to include the "W" when writing prior authorization numbers for non-preferred drugs on the patient's prescription.

For billing questions, contact 1-800-343-9000. For clinical concerns or preferred drug program questions, contact 1-877-309-9493. For Medicaid pharmacy policy and operations questions, call (518) 486-3209.


NEW YORK STATE MEDICAID PROGRAM PREFERRED DRUG PROGRAM
PRESCRIBER PRIOR AUTHORIZATION REQUEST FAX FORM

Prior Authorization Fax Line 1- 800- 268- 2990

All drugs that have been identified as non-preferred drugs must be prior authorized effective June 28, 2006. To request prior authorization via fax, please submit this form. Fax requests may take up to 24 hours.

PATIENT INFORMATIONPRESCRIBER INFORMATION
Client Name:Prescriber Name:
Client Medicaid ID # (2 letters, 5 numbers, 1 letter):Provider ID Number (MMIS)__ __ __ __ __ __ __ __

OR license

NYS Physician /PA/Resident: 0 0 __ __ __ __ __ __

NYS Optometrist: U __ __ __ __ __ __ or V __ __ __ __ __ __

NYS Nurse Practitioner/Midwife: F __ __ __ __ __

NYS Dentist: 0 0 0 __ __ __ __ __

NYS Podiatrist: 0 0 0 0 __ __ __ __

OR

Out-of-State License: __ __ __ __ __ __ __ __

(Use your state abbreviation in the first two spaces.)
Client Address:Prescriber Address:
City:                       State:City:                 State:
Home Phone:             Zip: Office Phone #:            Office Fax #:         Zip:
Gender (circle): M     F   DOB:Contact Person:
DIAGNOSIS AND MEDICAL INFORMATION
Non-Preferred Drug Name:Strength and Route of Administration:Frequency:
[  ] New Prescription OR
Date Therapy Initiated:
Expected Length of Therapy:Qty:
Height/Weight:

Drug Allergies:

Diagnosis:
Prescriber's Signature:Date:
RATIONALE FOR REQUEST OF PRIOR AUTHORIZATION
FORM CANNOT BE PROCESSED WITHOUT REQUIRED EXPLANATION
[ ]  Patient has experienced a treatment failure with a preferred drug.

[ ]  Patient has experienced an adverse drug reaction with a preferred drug.

[ ]  There is documented history of successful therapeutic control with a non-preferred drug and transition to a preferred drug is medically contraindicated.

[ ]  Other (please specify-if necessary, fax additional pages):

For billing questions, contact 1-800-343-9000.

For clinical concerns or preferred drug program questions, contact 1-877-309-9493.

For Medicaid pharmacy policy and operations questions, call (518) 486-3209


Instructions for Pharmacists:
PREFERRED DRUG PRIOR AUTHORIZATION VALIDATION

Prior Authorization Call Line 1-877-309-9493

The prescriber must initiate the prior authorization process.*

PHARMACY RESPONSIBILITY

  • Call 1-877-309-9493 prior to dispensing to validate the prior authorization number. Select Option "2" for Pharmacy.
    • If the prior authorization number on the prescription ends with the letter "W," select Option "1" for prior authorization of non-preferred drugs. You will be asked to respond to the questions on the prior authorization worksheet. Please note: the "W" is used only to identify non-preferred drugs and is not a part of the prior authorization number. Do not enter the "W" when entering the prior authorization number.
    • If you are uncertain which selection to make or require assistance with the prior authorization process, select Option "3" for support.
  • You will be provided confirmation that you have authorization to dispense the drug.
  • Pharmacists may validate multiple prior authorizations during one telephone call.
  • Use the same prior authorization number for refills - you do not need to call the prior authorization line again for refills of this prescription.

SUBMITTING A CLAIM

  • After the prior authorization is complete, there will be a slight delay while the information is transmitted to our fiscal agent. Until that transfer occurs, the prescription cannot be adjudicated on-line. We recommend you wait approximately two minutes before you begin your electronic claim submission.
  • When billing a prescription electronically, the prior authorization number must be entered into the prior authorization code field.
  • No more than two claims requiring prior authorization numbers can be submitted for payment in one transaction. Refer to the ProDUR/ECC Provider Manual for complete instructions.
  • For technical questions regarding electronic on-line claims adjudication call 1-800-343-9000.
  • Prior authorization does not guarantee payment. Payment is subject to eligibility and other Medicaid guidelines.

*For information on acceptable conditions for an emergency supply and for prior authorization to dispense an emergency supply of a non-preferred drug, call 1-877-309-9493 and press Option "3" for technical support.

For billing questions, contact: 1-800-343-9000

For clinical concerns or preferred drug program questions, contact: 1-877-309-9493

For Medicaid Pharmacy policy and operations questions, call: (518) 486-3209


NEW YORK STATE MEDICAID PROGRAM
PREFERRED DRUG PRIOR AUTHORIZATION VALIDATION
PHARMACY WORKSHEET

Prior Authorization Call Line 1-877-309-9493

Drugs that have been identified as non-preferred drugs must be prior authorized effective June 28, 2006.

The prescriber will obtain the prior authorization number and write it on the new prescription. Remember, prescriptions for non-preferred drugs will carry a prior authorization number ending with a "W." The "W" is used to alert pharmacy providers to select the non-preferred drug option when calling the prior authorization phone line. The "W" should not be included in the prior authorization field when submitting a claim. The prior authorization number for non-preferred drugs is an 11-digit number.

Be prepared to respond to these questions when you call.

PRIOR AUTHORIZATION NUMBER (11- digit)


__ __ __ __ __ __ __ __ __ __ __
CLIENT IDENTIFICATION NUMBER - (2 letters, 5 numbers, 1 letter)


__ __ __ __ __ __ __ __
PHARMACY MMIS NUMBER


__ __ __ __ __ __ __ __
PHARMACY CATEGORY OF SERVICE (COS) - (0161, 0441, 0288)
Free-standing pharmacies usually have a COS of 0441



__ __ __ __
PHARMACY TELEPHONE NUMBER


(__ __ __)- __ __ __ - __ __ __ __
Area Code
NDC (11-digit)


__ __ __ __ __ __ __ __ __ __ __
QUANTITY (per fill)


__ __ __ __
NUMBER OF REFILLS


____

For billing questions, contact 1-800-343-9000

For clinical concerns or preferred drug program questions, contact 1-877-309-9493

For Medicaid pharmacy policy and operations questions, call (518) 486-3209


Medicaid Preferred Drug List Phase I
Effective 6/28/06
Return to Table of Contents

The following is a complete list of all preferred and non-preferred drugs in each of the initial classes of drugs subject to the Preferred Drug Program.

Drugs identified as Non-Preferred will required prior authorization.

ACE InhibitorsACE Inhibitors
PREFERRED AGENTSNON-PREFERRED AGENTS - PA Required
Effective 6/28/06
Altace®
benazepril HCl
captopril
enalapril maleate
lisinopril
Mavik®
moexipril HCl
Accupril®
Aceon®
Capoten®
fosinopril sodium
Lotensin®
Monopril®
Prinivil®
quinapril HCl
Univasc®
Vasotec®
Zestril®
ACEI + Diuretic CombinationACEI + Diuretic Combination
PREFERRED AGENTSNON-PREFERRED AGENTS - PA Required Effective 6/28/06
benazepril HCl/HCTZ
captopril/HCTZ
enalapril maleate/HCTZ
lisinopril/HCTZ
Uniretic®
Accuretic®
Capozide®
fosinopril HCT
Lotensin HCT®
Monopril HCT®
Prinzide®
Quinaretic®
Vaseretic®
Zestoretic®
Angiotensin Receptor Blockers Angiotensin Receptor Blockers
PREFERRED AGENTSNON-PREFERRED AGENTS - PA Required Effective 6/28/06
Benicar®
Cozaar®
Diovan®
Micardis®
Atacand®
Avapro®
Teveten®
Angiotensin Receptor Blockers + Diuretic Angiotensin Receptor Blockers + Diuretic
PREFERRED AGENTSNON-PREFERRED AGENTS - PA Required Effective 6/28/06
Benicar HCT®
Diovan HCT®
Hyzaar®
Micardis
HCT®
Atacand HCT®
Avalide®
Teveten HCT®
ACEI + Calcium Channel Blocker CombinationACEI + Calcium Channel Blocker Combination
PREFERRED AGENTSNON-PREFERRED AGENTS - PA Required Effective 6/28/06
Lotrel®
Tarka®
Lexxel®
Beta Blockers Beta Blockers CC
PREFERRED AGENTSNON-PREFERRED AGENTS - PA Required Effective 6/28/06
acebutolol
atenolol
betaxolol
bisoprolol fumerate
labetalol
metoprolol tartrate
nadolol
pindolol
propranolol
timolol maleate
Blocadren®
Cartrol®
Coreg®CC
Corgard®
Inderal LA®
Inderal®
InnoPran XL®
Kerlone®
Lopressor®
Levatol®
Sectral®
Tenormin®
Toprol XL®CC
Trandate®
Zebeta®
Bisphosphonates - OralOral Bisphosphonates
PREFERRED AGENTSNON-PREFERRED AGENTS - PA Required Effective 6/28/06
Fosamax®Solution
Fosamax®Tablet
Fosamax®Plus D
Actonel®
Actonel®with Calcium
Boniva®
Calcium Channel Blockers (DHP)Calcium Channel Blockers (DHP)
PREFERRED AGENTSNON-PREFERRED AGENTS - PA Required Effective 6/28/06
Afeditab CR®
Dynacirc®
Dynacirc CR®
felodipine ER
isradipine
nicardipine HCl
Nifediac CC®
Nifedical XL®
nifedipine
nifedipine ER
nifedipine SA
Norvasc®
Sular®
Adalat®
Adalat CC®
Cardene®
Cardene SR®
Plendil®
Procardia®
Procardia XL®

New Payment for Power Mobility
Device Evaluation Services
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Wheelchair

Effective for dates of service on or after July 1, 2006, Medicaid will reimburse power mobility device (PMD) evaluation services to qualified practitioners (privately practicing physicians and nurse practitioners) in addition to an office or inpatient visit. This is to recognize the additional physician work and resources required for submitting pertinent parts of the medical record. It also ensures that each patient receives the type of power wheelchair or power operated vehicle most suited to his or her medical needs.

The following criteria must be met for payment:

Face-to-face examination: As a condition for payment for PMDs, Medicaid requires that the equipment be ordered by a qualified practitioner who has conducted a face-to-face examination of the patient. A patient who has had a face-to-face examination during an inpatient hospital stay will not need a separate face-to-face examination, as long as the qualified practitioner who performed the face-to-face examination during the hospital stay prescribes the PMD within 45 days after the date of discharge. The face-to-face examination requirement does not apply when only accessories for PMDs are being ordered.

Written fiscal order: The qualified practitioner must submit a written order for the PMD to the Durable Medical Equipment (DME) provider. This order must be received by the DME provider within 45 days after the face-to-face examination, or in the case of a recently hospitalized beneficiary, within 45 days after the date of discharge from the hospital. The written order must include the patient's name, the date of the face-to-face examination, the diagnoses and conditions that support the claim for the PMD, a description of the specific type of PMD required, and the expected length of time the patient will need the equipment. The order must be signed and dated by the qualified practitioner.

Supporting documentation: The qualified practitioner who performed the face-to-face examination must submit to the DME provider the written order accompanied by supporting documentation of the patient's need for the PMD in the home and community. The supporting documentation will include pertinent parts of the medical record that clearly support the medical necessity for the PM Din the patient's home and community, which may include the history, physical examination, diagnostic tests, summary of findings, diagnoses, and treatment plans. It may also include information from other examinations, as well as relevant reports from other healthcare providers. This supporting documentation must be received by the DME provider within 45 days after the face-to-face examination, or in the case of a recently hospitalized patient, within 45 days after the date of discharge from the hospital.

Billing and payment: The physician or nurse practitioner can bill Medicaid through the appropriate evaluation and management (E&M) code for the face-to-face examination. In addition, the following code is reimbursable for dates of service on and after July 1, 2006 for the work and resources involved in compiling and submitting the required documentation from the medical record.

G0372    Physician service required to establish and document the need for a power mobility device (use in addition to primary Evaluation and management code)     $21.60

Reimbursement for G0372 is limited to privately practicing physicians and nurse practitioners for evaluations and documentation collection performed in a private office or inpatient setting only.

Facility Payment for PMD Evaluation Services (e.g., clinic, hospital, skilled nursing facility)

Payment for PMD evaluation services and documentation collection and submission performed by salaried facility employees is included in the facility's rate. Facilities are required to follow the same face- to-face, fiscal order and documentation criteria listed above for privately practicing physicians and nurse practitioners.

Questions may be referred to the Division of Medical Review and Provider Enrollment at (518) 474-8161.


Attention
DME Providers

FEE SCHEDULE CHANGES
FOR DURABLE MEDICAL EQUIPMENT
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Please make the following changes, noted in BOLD, in your Durable Medical Equipment (DME) Fee Schedule (Rev. 4/1/06):

  • A7520 F9 Tracheostomy/laryngectomy tube, non-cuffed polyvinylchloride (PVC), silicone or equal, each. Effective for dates of service (DOS) on or after January 1, 2005, frequency is once per month (p. 44).
  • A7034F3 #Nasal Interface (mask or cannula type) used with positive airway pressure device, with or without head strap. Effective for DOS on or after July 1, 2006, frequency will be once every five years (p. 30).
  • E0911F3 #Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, attached to bed, with grab bar. Effective for DOS on or after April 1, 2006, price is $432.00 (p. 32)
  • E0912F3 #Trapeze bar, heavy duty, for patient weight capacity greater than 250 pounds, free standing, complete with grab bar. Effective for DOS on or after April 1, 2006, price is $742.07 (p. 32)

Questions may be referred to the Division of Medical Review and Provider Enrollment at (518) 474-8161.


Attention
Pharmacies,
Pharmacists and
Prescribers

PROBLEMS IDENTIFIED DURING CREDENTIAL VERIFICATION
REVIEWS
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In addition to audits and investigations, the Office of the Medicaid Inspector General's (OMIG) Bureau of Investigations & Enforcement (BIE) has been conducting onsite visits known as Credential Verification Reviews (CVRs), of providers' places of business.

These field visits are performed to ensure overall compliance with Medicaid regulations.

The initial problems identified are included as a reminder of your responsibilities as an enrolled Medicaid provider, and of the impact the failure to comply with regulations and policy may have upon you.

Recent CVRs, audits and investigations have resulted in monetary penalties and/or sanctions being imposed due to noncompliance in the following circumstances:

Pharmacy/Pharmacist

  • Supervising pharmacist must be enrolled and currently identified in the Medicaid enrollment file.

    Recent CVRs have revealed that pharmacies have not been complying with Medicaid regulation 18 NYCRR Section 504.1. Pharmacies must have an active, enrolled Supervising Pharmacist. Pharmacies are reminded that they must review the OMIG Sanction Provider list to determine if a pharmacist can be enrolled as a Supervising Pharmacist. The Sanction Provider list should also be reviewed to see if it contains the names of any other pharmacist employed by the pharmacy.

Pharmacy/Pharmacists

RX

  • A facility Medicaid provider identification number may be used to process Medicaid pharmacy claims only as a last resort.

    If the prescriber's license number or New York State Medicaid provider identification number has not been provided, pharmacists must attempt to contact the prescriber to obtain their license number or Medicaid provider identification number and to verify the prescriber's identity. License information is also available on the State Education Department's website at:

    http://www.op.nysed.gov/opsearches.htm

    If a pharmacist is certain that the prescription is from a legitimate prescriber and their license number or Medicaid provider identification number is readily available in the records of the pharmacy, it is not necessary to record this number on the prescription.

    Pharmacies must assure the accuracy of prescription information contained on Medicaid claims. Erroneous reporting of prescriber information constitutes an unacceptable practice and can result in administrative action.

Prescribers

  • Prescription Writing Requirements (see Medicaid Updates September 2005 and March 2004 ).
    Prescribers must provide their State license number or Medicaid provider identification number on all prescriptions written for Medicaid recipients. This will ensure proper processing of your patient's prescription. When a prescription is written by an unlicensed intern or resident, the supervising physician's Medicaid provider identification number or State license number must be provided. Please refer to the December 2003 Medicaid Update for further information on prescription requirements.

    Please note: recent CVRs, audits and investigations have resulted in monetary penalties and/or sanctions being imposed due to noncompliance in the preceding circumstances.

Questions may be referred to the Bureau of Investigations & Enforcement at (518) 408-5002.


Attention
NYC Ordering
Providers

Ordering Ambulette Service in New York City
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For Medicaid recipients enrolled in a managed care plan, the managed care plan arranges and pays for need transportation. Contact the managed care plan for these recipients.

Map

For Medicaid recipients not enrolled in a managed care plan, the following questions and answers are designed to facilitate the ordering of appropriate ambulette services.

What is the responsibility of the ordering practitioner?

As an ordering practitioner, you are responsible for ordering only necessary Medicaid transportation within the recipient's Common Medical Marketing Area (CMMA), the geographic area from which a community customarily obtains its medical care and services.

In New York City, the CMMA is five (5) miles from one's residence.

Recipients who have reasonable access to a mode of transportation used for normal activities of daily living, such as shopping and recreational events, should also use this mode to travel to and from medical appointments when that mode is available to them.

  • Medicaid may not pay for transportation expenses outside of the CMMA, or reimburse for a mode of transportation which the recipient does not use for normal activities of daily living, unless the recipient can demonstrate circumstances justifying such payment.

Medicaid may restrict payment for the transportation if it is determined that:

  • the recipient chose to go to a medical provider outside of the CMMA when services were available within the CMMA, or
  • the recipient could have taken a less expensive form of transportation and opted to take the more costly transportation.

As the medical practitioner requesting livery, ambulette, or ambulance services, you are also responsible for ordering the appropriate mode of transportation for the Medicaid recipient. A basic consideration for this should be the recipient's current level of mobility and functional independence.

  • The transportation provided should be the least specialized mode required based on the recipient's current medical condition. For example, if you feel the recipient does not require personal assistance but cannot walk to public transportation, you should authorize livery service, not ambulette service.

Due to the extensive network of mass transportation in New York City, recipients should use mass transportation to travel to and from medical appointments unless a specific condition contraindicates such use.

The following procedure codes are available for ambulette orders:

Procedure CodeDescription
NY100Transport Within the Common Medical Marketing Area
NY102Transport Outside the Common Medical Marketing Area
  • If the recipient will travel less than five miles, then use procedure code NY100 when ordering the transport.
  • If the recipient will travel more than five miles, then use procedure code NY102 when ordering the transport.

There is no separate reimbursement for an escort of a recipient.

  • Necessary escorts are to be transported by the ambulette service at no additional charge.

There is no enhanced reimbursement for a person traveling in a wheelchair, or a person needing to be carried down steps.

What are the specific guidelines for ordering ambulette transportation?

Ambulette transportation may be ordered if any one of the following conditions exist:

  • The recipient needs to be transported in a recumbent position and the ambulette service ordered has stretcher-carrying capacity; or
  • The recipient is wheelchair bound and is unable to use a livery service or bus; or
  • The recipient has a disabling physical condition which requires the use of a walker or crutches and is unable to use a livery service, bus or subway; or
  • The recipient has a disabling physical condition other than one described above or a disabling mental condition, either of which requires the personal assistance provided by an ambulette service, and the ordering practitioner certifies that the recipient cannot be transported by a livery service, bus or subway and requires transportation by ambulette service; or
  • An otherwise ambulatory recipient requires radiation therapy, chemotherapy, or dialysis treatment which results in a disabling physical condition after treatment and renders the recipient unable to access transportation without the personal assistance provided by an ambulette service.

What does the Department of Health consider an ambulette service?

As defined in Department regulations, an:

  • Ambulette service means an individual, partnership, association, corporation, or any other legal entity, which transports the invalid, infirm or disabled by ambulette to or from facilities which provide medical care. An ambulette service provides the invalid, infirm or disabled with personal assistance as defined in this subdivision.

Regulations define personal assistance as:

  • ...the provision of physical assistance by a provider of ambulette services or the provider's employee to a [Medicaid] recipient for the purpose of assuring safe access to and from the recipient's place of residence, ambulette vehicle and MA covered health service provider's place of business.

  • Personal assistance is the rendering of physical assistance to the recipient in walking, climbing or descending stairs, ramps, curbs or other obstacles; opening or closing doors; accessing an ambulette vehicle; and the moving of wheelchairs or other items of medical equipment and the removal of obstacles as necessary to assure the safe movement of the recipient.

  • In providing personal assistance, the provider or the provider's employee will physically assist the recipient which shall include touching, or, if the recipient prefers not to be touched, guiding the recipient in such close proximity that the provider of services will be able to prevent any potential injury due to a sudden loss of steadiness or balance.

  • A recipient who can walk to and from a vehicle, his or her home, and a place of medical services without such assistance is deemed not to require personal assistance.

If personal assistance is not necessary, what should I order?

If personal assistance is unnecessary, you should order livery service.

  • Most ambulette providers will transport livery-eligible recipients on the same vehicle as ambulette-eligible recipients.

In this case, you should order one of the two procedure codes below:

Procedure CodeDescription
NY200Transport Within the Common Medical Marketing Area
NY202Transport Outside the Common Medical Marketing Area

When do I order mileage?

New York City has established fixed payment amounts to reimburse trips that occur within the five boroughs that comprise the City. These amounts include all mileage incurred.

  • Mileage should not be ordered for any transports occurring within the five boroughs of New York City.

Mileage should only be ordered for long distance trips when the destination or origination is outside the five boroughs.

How do I document the need for a particular mode of transportation?

The Human Resources Administration form (MAP 2015) Livery, Ambulette and Non-Emergency Ambulance Services Medicaid Transportation Prior Approval should be used as a record of your order.

Prior approval should be obtained prior to rendering service.

Questions? Please contact the Bureau of Program Guidance, Provider Resource Unit at (518) 474-9219.


Attention
OMH Certified Clinics Only

Children's Clinic Rate Enhancements
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As the result of a recent legislative initiative, an enhanced fee will be paid to Office of Mental Health (OMH) certified only clinics (i.e., Article 31 clinics) for services provided to children after 6:00 PM Monday through Friday, or anytime on Saturday or Sunday.

The enhanced fee may be billed using rate code 4099, and may be billed retroactive to April 1, 2005.

  • This rate code must be billed in conjunction with a Fee-for-Service (FFS) regular visit (rate code 4301 or 4601), or with a fee-for-service collateral visit (rate code 4304 or 4604).

When submitting the claim for the add-on rate, the only field that needs to change is the rate code; the claim must have the same procedure and revenue codes, etc., that the regular OMH Clinic claim requires.

  • The two claims can be submitted in the same transaction, but they must be separate claims since their rate codes are different.

Rate Code 4099 is an add-on rate code for OMH Clinic Services Rendered to Children; therefore, Specialty Code 316 (Child) will be derived for these claims.

If a provider's file does not have Specialty Code 316, the claim will be denied.

Any OMH Clinic that requires Specialty Code 316 should call OMH at (518) 474-6911.

Other questions related to the billing process can be directed to CSC at (800) 343-9000.


New York State
Medicaid Coverage and Diabetes:
Fact Sheet for Clinicians
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Diabetes

The NYS Medicaid program reimburses for medically necessary care, services and supplies for the diagnosis and treatment of diabetes and continues to conduct quality improvement initiatives to increase the quality of life for New Yorkers with asthma and diabetes.

In concert with Island Peer Review Organization, the NYS Medicaid program is pleased to make available to health care practitioners; a new brochure entitled, "NYS Medicaid Coverage and Diabetes: Fact Sheet for Clinicians." The brochure offers information on Medicaid services, benefits and coverage for diabetes monitoring and treatment.

The Office of Medicaid Management anticipates that this diabetes brochure will help practitioners to better understand NYS Medicaid coverage and assist their patients in managing this chronic disease.

Diabetes

FREE copies of this new brochure may be obtained by using the attached "Disease Management Publication Request Form."

The NYS Medicaid program continues to offer patient-focused diabetes (as well as asthma) educational brochures and posters .These publications are available in both English and Spanish for health care practitioners and their patients.

  • The asthma brochure entitled, "What is Asthma? Simple Facts to Help You Breathe Easier," includes signs and symptoms of asthma and their possible cause.
  • The diabetes brochure entitled, "What is Diabetes? Simple Facts to Help You Live Healthier," provides information on common types of diabetes, common symptoms and ways to prevent or delay Type II diabetes.

Additional Information

Asthma

For additional information on NYS programs for Diabetes and NYS Medicaid, please visit the following websites:

http://www.health.state.ny.us/diseases/conditions/diabetes/index.htm

http://www.health.state.ny.us/health_care/medicaid/program/update/medup-index.htm

http://www.providers.ipro.org/index/nysdoh_diabetes

Copies of these free materials may be obtained by using the following Publication Request Form.


New York State Department of Health
Office of Medicaid Management
Bureau of Program Guidance

Disease Management Publication Request Form

Please complete and submit this form to receive
the New York State Medicaid program's Asthma and/or Diabetes brochures and posters

Date:_____________________

Requestor Information:

Name:___________________________________________________________________________________________

Organization:_____________________________________________________________________________________

Address:_______________________________________________________________________(No Post Office Boxes)

_________________________________________________________________________________________________

Telephone Number: (           )_____________________________________Fax Number: (            )___________________________________

TitlePublication #Quantity (Circle)
Medicaid Asthma Brochures:

______"What is Asthma?" (English)

______"What is Asthma?" (Spanish)


4942

4943


15   25   50   100

15   25   50   100
Medicaid Asthma Posters:

______"Got Asthma?" (English)

______"Got Asthma?" (Spanish)


4940

4941


15   25   50   100

15   25   50   100
Medicaid Diabetes Brochures:

______"What is Diabetes?" (English)

______"What is Diabetes?" (Spanish)


0918

0919


15   25   50   100

15   25   50   100

______New York State Medicaid Coverage
and Diabetes: Fact Sheet for Clinicians" (English)



3385


15   25   50   100
Medicaid Diabetes Posters:

______"Got Diabetes?" (English)

______"Got Diabetes?" (Spanish)


0916

0917


15   25   50   100

15   25   50   100

Mail to:
New York State Department of Health
Distribution Center
21 Simmons Lane
Menands, NY 12204

Or Fax: 518-465-0432


FHP

Family Health Plus Enrollees in Plans That Do Not Cover Family
Planning and Reproductive Health Services Can Soon Access These Services from Any Qualified Medicaid Provider
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Effective July 1, 2006, Family Health Plus (FHPlus) members enrolled in health plans that do not cover Family Planning and Reproductive Health Services may obtain these services from qualified Medicaid providers and pharmacies.

Below are some important questions and answers about this change:

Which FHPlus plans does this change apply to?

This change applies only to FHPlus enrollees of CenterCare, a health plan that operates in New York City, and the NYS Catholic Health Plan (d/b/a Fidelis Care New York) which operates in counties throughout the State.

It is anticipated that Suffolk Health Plan will offer FHPlus in Suffolk County in the near future and will not cover Family Planning and Reproductive Health Services. This change will also apply to FHPlus enrollees of Suffolk Health Plan.

All other FHPlus enrollees will continue to receive Family Planning and Reproductive Health Services through only their health plan.

How can a provider identify FHPlus enrollees affected by this change?

A Medicaid Benefit card is not generated for Family Health Plus recipients. Ask the patient for their health plan identification card. The card will show the patient's Client Identification Number (CIN) which is needed to bill eMedNY. You may also use the patient's CIN to verify coverage and plan enrollment through eMedNY. Eligibility status for these enrollees will appear as follows:

  • Phone message: "Family Health Plus," "Insurance Coverage Code SP or 91"
  • Verifone message: "Other or Additional Payor" for Elig-Ben Info, "FAMILY HEALTH PLUS" for Plan, and "91" or "SP" for Plan Cd.
  • ePACES message: "Other or Additional Payer" for Eligibility Information, "FAMILY HEALTH PLUS" for Plan Name, and "91" or "SP" for Carrier Code

Note: "SP" is the plan code for NYS Catholic Health Plan, and "91" is the plan code for CenterCare.

For Medicaid providers not familiar with the FHPlus card provided by the health plan, the card cannot be swiped.

The client identification number (CIN) will have to be entered manually into the system.

How will the provider be reimbursed for these services?

The provider must participate in Medicaid and qualified to provide family planning and reproductive health services, or related laboratory services.

Providers will bill eMedNY directly by submitting either an electronic or paper claim indicating family planning or reproductive health services. Reimbursement will be made at the Medicaid rates and fees.

For details on the codes and fields identifying these services, please refer to the online provider manuals at:

http://www.emedny.org/ProviderManuals/index.html

and HIPAA 837 Companion Guides at:

http://www.emedny.org/hipaa/emedny_transactions/transactions.html

To register with Medicaid as a provider, go to:

http://www.emedny.org/info/ProviderEnrollment/index.html

Pharmacists can access the list of Medicaid reimbursable drugs at:

http://www.eMedNY.org/info/formfile.html.

For billing questions or problems submitting claims, contact CSC Provider Services at (800) 343-9000.


Restructuring Long Term Care In
New York State
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Building

In the March 2006 edition, we discussed the collaborative efforts between the New York State Department of Health (DOH) and Office for the Aging (NYSOFA) to realize recommended improvements in the State's long term health care system made by the Governor's Workgroup on Health Care Reform in its 2004 report. We plan to report periodically to keep you abreast of the Department's progress on the long term care restructuring initiative. Accordingly, the following summary will provide an update.

A Comprehensive Long Term Care Medicaid Waiver

Significant progress has been made in planning for the rebalancing of the State's long term care system. An estimated 1,000 individuals attended the seven regional collaboration sessions held across the State with consumers, advocates and government officials. The meetings proved to be successful opportunities to discuss the design and development of a restructured long term care system. As previously mentioned in the March 2006 Medicaid Update, a Request for Information will also elicit valuable written input about community resources, service coordination and management, long term care service programs, system oversight, infrastructure, and cost neutrality in preparation for a new Medicaid 1115 waiver.

In regard to administrative activities, a fourteen member Advisory Council was named and is comprised of members of organizations representing consumers, providers, professional organizations, and government. The function of the Council is to review restructuring proposals, suggest new approaches/models, provide research and data, and serve as a liaison to its membership.

Subcommittees to the Council will be formed to address other long term care issues, such as workforce development, housing, technology, etc. Funding, recommended by the Governor, is included in the 2006-07 Enacted Budget to support the LTC restructuring effort, and will enable the Department to form an additional NYC based restructuring team this summer.

Nursing Home Transition and Diversion Medicaid Waiver

The federal Centers for Medicare and Medicaid Services (CMS) has submitted questions to the Department in response to the State's application for the new Nursing Home Transition and Diversion Medicaid Waiver (NHTD) waiver. The Department is preparing responses to those questions, with responses due to CMS by June 12, 2006.

Proposals were received in response to the Request for Applications, released in February 2006, for the Regional Resource Development Centers and Quality Management Specialists to administer the NHTD waiver. The selection process is underway.

Statewide Point of Entry

The Department of Health (DOH) and New York State Office for the Aging (NYSOFA) are also working together to establish a Point of Entry (POE) system to provide information, initial screening and assistance to all those interested in exploring the available options for long term care in New York or who are already receiving medical or other supportive services through NYSOFA programs, Medicaid or private pay providers. You should know that:

  • On May 16, 2006, DOH and NYSOFA representatives met with the local leaders of local departments of social services (LDSS) and area agencies for the aging (AAA) in the NYS capital region to share information and cooperatively plan to meet the challenges and complexities of restructuring a system to ensure access to services in the most appropriate setting.
  • This summer, a Request for Applications will be issued by NYSOFA to start up/operate the POE in each county across the State. Funding, recommended by the Governor, to support these contracts is included in the 2006-07 Enacted Budget.

How You Can Follow the Process

You can find copies of all published reports documenting our progress and keep up-to-date on upcoming meetings, requests for information, and opportunities for related State contracts on the DOH and NYSOFA websites at: http://www.nyhealth.gov (click Long Term Care and Health Care Reform Working Group Tabs), and http://www.aging.state.ny.us/explore


New Federal Grant Targeting Veterans with
Traumatic Brain Injury
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New York State has been awarded $300,000 for a three year period to improve community-based Traumatic Brain Injury services for war veterans. These services are urgently needed due to the nature of the engagements in Iraq and Afghanistan that can result in head injuries. The new funds will support collaborative efforts between the Department of Health and the federal Defense and Veterans Brain Injury Center for the care of military personnel. The intent is to expand the availability of referral services and training activities to enhance the skills and knowledge of State agency staff and service professionals to assure that military personnel receive appropriate services when they return home.

For additional information please contact the Department's Traumatic Brain Injury staff at (518) 474-6580.


Reporting of Pesticide Poisoning Is Simplified

Cleanup

PESTICIDE POISONING REGISTRY
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Pesticide poisonings were added to the list of reportable medical conditions in New York State in late 1990 as part of the effort to reduce the risk of pesticide poisoning in New York. Under these regulations, physicians and health facilities are required to report suspected or confirmed cases of pesticide poisoning. Clinical laboratories are also required to report depressed blood cholinesterase levels or abnormally high levels of pesticides in human tissue samples.

Reporting suspect pesticide poisonings is simple:

  • Physicians or their staff should call the New York State Department of Health (Department) Pesticide Poisoning Registry at (800) 322-6850 within 48 hours of seeing the patient.

A definitive diagnosis is not needed prior to calling and there is no paperwork for physicians to complete. Department staff investigate the reported case to collect information to monitor the health effects of pesticides. They may intervene in situations where a continued risk of pesticide poisoning exists. The work of the Pesticide Poisoning Registry complements the work of the regional poison control center. These centers supply information on immediate treatment and other emergency responses.

Poisonings may result from structural applications, yard applications, manufacturing or formulation settings, farm settings, or any other location where pesticides are used or stored. Because of their toxicity and easy availability, accidental or intentional ingestion of pesticides is also an ever-present threat.

An important public health issue in New York State is West Nile Virus (WNV). Some counties may apply pesticides to control mosquito populations. The Department will be conducting surveillance of reported health effects possibly resulting from exposure to the application of WNV-related pesticides. Any physician who suspects or confirms that their patient is experiencing health effects, due to exposure to WNV-related pesticides, should report that case to the Pesticide Poisoning Registry at (800) 322-6850.

The Pesticide Poisoning Registry strives to increase awareness in the medical community of the possibility of pesticide-related health effect and to develop interventions to reduce the risk of pesticide poisoning.

Additional information on the Pesticide Poisoning Registry, industrial hygiene assistance, and cholinesterase testing may be obtained by calling (800) 322-6850.


Info   

PROVIDER SERVICES
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Missing Issues?
The Medicaid Update, now indexed by subject area, can be accessed online at the New York State Department of Health website: http://www.nyhealth.gov/medicaid/program/update/medup-index.htm
Hard copies can be obtained upon request by emailing: MedicaidUpdate@health.state.ny.us or by calling (518) 474-9219.

Do You Suspect Fraud?
If you suspect that a recipient or a provider has engaged in fraudulent activities, please call the fraud hotline at: 1-877-87FRAUD. Your call will remain confidential.

As a Pharmacist, Where Can I Access the List of Medicaid Reimbursable Drugs?
The list of Medicaid reimbursable drugs is available at: http://www.eMedNY.org/info/formfile.html

Questions About an Article?
For your convenience each article contains a contact number for further information, questions or comments.

Do You Want Information On Patient Educational Tools and Medicaid's Disease Management Initiatives?
Contact Department staff at (518) 474-9219.

Questions About HIPAA?
Please contact CSC Provider Services at (800) 343-9000.

Address Change?
Questions should be directed to CSC at (800) 343-900, option 5.

Patient Eligibility
Call the Touchtone Telephone Verification System (800) 997-1111, (800) 225-3040 or (800) 343-9000.

Fee-for-service Provider Enrollment
A change of address form is available at:
http://www.emedny.org/info/ProviderEnrollment/Provider%20Maintenance%20Forms/6101-Address%20Change%20Form.pdf.

Rate-based/Institutional Provider Enrollment
A change of address form is available at:
http://www.emedny.org/info/ProviderEnrollment/Provider%20Maintenance%20Forms/6106-Rate%20Based%20Change%20of%20Address%20Form.pdf

Billing Question? Call Computer Sciences Corporation:
Provider Services (800) 343-9000.

Comments and Suggestions Regarding This Publication?
Please contact the editor, Timothy Perry-Coon at MedicaidUpdate@health.state.ny.us or via telephone at (518) 474-9219 with your concerns.


The Medicaid Update: Your Window Into The Medicaid Program

The State Department of Health welcomes your comments or suggestions regarding the Medicaid Update.

Please send suggestions to the editor, Timothy Perry-Coon:

NYS Department of Health
Office of Medicaid Management
Bureau of Program Guidance
99 Washington Ave., Suite 720
Albany, NY 12210
(e-mail MedicaidUpdate@health.state.ny.us)

The Medicaid Update, along with past issues of the Medicaid Update, can be accessed online at the New York State Department of Health web site:http://www.health_care/medicaid/program/update/main.htm

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