DOH Medicaid Update December 1999 Vol.14, No.12

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Leading clinicians, health plans, and the Department of Health have formed The New York Region Otitis Project. The project has developed a state of the art didactic and interactive conference on acute otitis media in children. This cooperative effort evolved from growing concerns among clinical and public health practitioners regarding the increasing prevalence of drug resistant bacteria, and from recent evidence that many children with acute otitis media can be successfully managed without initial antibiotics or with a shortened course of therapy when necessary.

The conference, "NEW STRATEGIES FOR JUDICIOUS USE OF ANTIBIOTICS IN ACUTE OTITIS MEDIA," will take place on Sunday, March 19, 2000, at The New York Academy of Medicine, 1216 Fifth Avenue, New York City, from 8:30 AM to 5:00 PM. This conference is co-sponsored by the Medical Society of the State of New York (MSSNY). It has been endorsed by District 2, New York State, American Academy of Pediatrics, and the New York State Academy of Family Practice.

Workshop topics and Speakers are:

CDC Campaign for Judicious Antibiotic Use - R.E. Besser, MD Atlanta
Dutch Experience with the Observation Option - EAM Sanders, MD, PhD, Netherlands
English Experience with the Observation Option - C.J. Cates, MA, MRCGP, United Kingdom
AHCPR Evidence Report: Natural History and Antibiotic Impact - W. Mason, MD, MPH, Los Angeles
Guidelines for Observation and Judicious Antibiotic Use - R.M. Rosenfeld, MD, MPH, Brooklyn
Panel Discussion - Overcoming Barriers to Judicious Antibiotic Use - R. Schiller, MD, Manhattan
Bacterial Resistance and Antibiotic Selection - R.E. Besser, MD, CDC.
Impact of Antibiotic Choice and Duration on Otitis Media Outcomes - W. Mason, MD, MPH.
Alternatives to Initial Antibiotics for Acute Otitis Media - R. Schiller, MD.

In addition, Harry Miller, MD of Albany Medical College and Robert Ruben, MD of Albert Einstein College of Medicine will facilitate an interactive session for all attendees. It will focus on the following four key clinical issues:

1. Critical criteria for the diagnosis of acute otitis media
2. Dealing with pressures to prescribe unneeded antibiotics
3. Implementing the observation option
4. Use of short course antibiotic therapy

The target audience includes pediatricians, family practitioners, emergency physicians, nurse practitioners, physician assistants, and otolaryngologists from the New York City metropolitan area, with limited seating available from outside that area. Continuing education credits will be awarded by MSSNY, and a registration fee will be charged. Invitations will be sent in late December 1999.

For further information, contact Dr. Richard Propp, Director's Office, 518-473-5876, or Denise Spor, RN, Bureau of Program Guidance, 518-473-6111.

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Medicaid payment regulations, 18 NYCRR 505.5(d)(2), state that reimbursement amounts for Durable Medical Equipment (DME) items with no price listed in the fee schedule must not exceed the lower of:

• the acquisition cost to the provider plus 50%; or
• the usual and customary price charged to the general public.

Acquisition cost to the provider means the line item cost from a manufacturer or wholesaler net of any rebates, discounts or other valuable considerations, mailing, shipping, handling, insurance costs or any sales tax. (See Rule 13 of the MMIS Provider Manual's General Information and Instructions.) Acquisition cost will be determined to be the lowest price offered to the provider. For instances where, for reasons beyond the provider's control, payment cannot be made in time to take advantage of the discount, a written explanation expressing the specific hardship must accompany the invoice when a prior approval is returned to the Prior Approval Unit for pricing.

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The Division of Provider Relations in conjunction with the Medical Society of the County of Albany, will present a program regarding common Medicaid billing problems physicians encounter, and how to avoid them. A goal of this program is to improve communications between physicians and the Office of Medicaid Management, particularly regarding eligibility and Medicaid billing procedures.

This session will take place on January 25, 2000 at the Desmond Hotel in Albany, New York. Membership in the Medical Society of the State of New York (MSSNY) is not required to attend this meeting. It is anticipated that this program will be the first of several such regional seminars. Any physician interested in improving their billing process is encouraged to attend. Contact the Medical Society at 518-456-8571 for reservations.

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The Department of Health is pleased to announce an increase in the rate for Home and Community Support Services, which is available under the HCBS/TBI Waiver. The rate for this service (Rate Code 9863), has been raised from $12.00 to $15.00 per hour. This increase is retroactive to April 1,1999; checks reflecting the retroactive payment will be sent to providers. For further information, please contact Bruce Rosen, Bureau of Medicaid Operations, Office of Continuing Care, at 518-408-1600.

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The Department of Health (DOH) is taking this opportunity to remind both prescribers and pharmacists to be on alert for forged prescriptions. Forged prescriptions can be written on prescription pads that have been stolen from large, busy clinics or physicians' offices. To prevent forged prescriptions, please pay attention to the following points:

Prescribers:

• If using a clinic blank prescription pad, always include a phone number or extension where you may be contacted for prescription verification. Without this information, pharmacies cannot call to confirm suspicious prescriptions.
• Always keep prescription pads/blanks in a secure location.
• Limit access to prescription pads/blanks storage area to those with a legitimate need.
• Clinics should maintain easily retrievable records for prescription verification.
• If a prescriber becomes aware of any forgeries using his/her name or provider number, contact DOH immediately at (518) 486-4121.

Pharmacists:

• Know your prescribers; call for prescription verification when necessary.
• Be alert for large quantities of maintenance drugs written in an emergency room setting.
• Be alert for individuals attempting to fill prescriptions for expensive medications on behalf of others.
• If you are suspicious, ask for identification from people who say they are caregivers. If the person is legitimate, they should not mind this request.
• Glance at the fax header - verify if you have any questions. Remember that fax headers can be changed at the point of origin.
• Pharmacists suspecting forged prescriptions should contact DOH at (518) 486-4121 or (518) 474-6866.

If it is suspected that there is any provider cooperation in the issuance or filling of forged prescriptions, e.g., pharmacists filling prescriptions that are obvious forgeries, contact DOH at one of the following numbers:

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The following drugs have been added to the list of drugs which are not included within the cost components of Article 28 Nursing Facility Rates:

Effective Date	Drug	Dosage	NDC#
July 28, 1999	Clozapine	Tab 25mg	00378-0825-01
July 28, 1999	Clozapine	Tab 100mg	00378-0860-01

Claims for these drugs that are submitted more than 90 days from the dispensing date must be submitted with a copy of this article. Computer Sciences Corporation (CSC) must receive these claims no later than 12:00 noon on March 1, 2000. Questions regarding submission of pharmacy claims may be addressed to CSC at 1-800-522-5535.

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Are you unsure which Computer Sciences Corporation (CSC) inquiry unit to call when you have questions about your remittance statement, preparing and submitting claims, obtaining paper claim forms* or other billing issues? Please refer to the following lists to determine the appropriate inquiry unit phone number for your category of service.

*OBTAINING PAPER CLAIM FORMS - Claim forms are usually sent to providers automatically. If you require additional claim forms outside of the automatic claim shipment, please place your request via phone to the appropriate number above, rather than in writing. Please be prepared to indicate the number of claim forms you have remaining, the number of claim forms submitted in the last three weeks, whether your claims are backlogged and if so, the number of claims that are backlogged. This information is necessary to facilitate the manual order of claim forms.

Providers making inquiries or requesting billing training by Regional Representatives should contact CSC by calling the appropriate number for your category of service listed above. Please be prepared to supply your Medicaid Provider ID number.

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The Department of Health recognizes that success in smoking cessation treatment may require several types of supports to help your patients. In an October 1999 Medicaid Update article it was announced that Medicaid will cover prescription smoking cessation products. In addition, the Department has compiled a list of cost-free programs, including toll-free numbers, which you may wish to share with your patients. These resources can be valuable to you and to your patients who are ready to quit smoking. Your continued assistance in this smoking cessation initiative and in the health of Medicaid recipients is greatly appreciated.

ADDITIONAL SUPPORTS FROM MANUFACTURERS

Glaxo Wellcome: Zyban

• Support package includes: a Patient's Program Guide, Plan to Succeed Workbook, Enrollment Questionnaire and envelope
• Toll-free enrollment number: 1-800-UCAN-QUIT (1-800-822-6784)

McNeil Consumer: Nicotrol Nasal Spray, Nicotrol Inhaler

• Support Package includes: Pathways to Change Booklet and a Personal Quit Guide
• Toll-free number 1-888-NICOTROL (1-888-642-6876)

OTHER RESOURCES

Local cessation support program information can be obtained from:

American Cancer Society

• Toll-free number: 1-800-ACS-2345 (1-800- 227-2345)

American Lung Association

• Toll-free number: 1-800-586-4872

BROCHURES AND OTHER INFORMATION

Centers for Disease Control and Prevention

• Toll-free number: 1-800-CDC-1311 (1-800-232-1311)

National Cancer Institute

• Toll-free number: 1-800-4-CANCER (1-800-422-6237)

U.S. Food and Drug Administration

• Toll-free number: 1-888-FDA-4KIDS (1-888-332-4543)

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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.state.ny.us/health_care/medicaid/program/main.htm