State Issues

Most recent update at the top...scroll down for history...

Medicaid Update

August 10, 2010

The latest on Incontinence - to date the Department does not have a policy on these products though they remain on the fee schedule.  NCAMES is working with the Department to prevent sole-sourcing as we have offered a proposal to save the needed money in the budget.  NCAMES is waiting on word from the department.

February 25th, 2010

Incontinence Update:
The policy allowing durable medical equipment (DME) providers to seek reimbursement for medically necessary incontinence, ostomy, and urological supplies has been placed on temporary hold. The policy is under budgetary review.

Note: Any recipient needing these supplies should be referred to a home health agency in their area to obtain these items. A home care agency that is enrolled with Medicaid to provide Private Duty Nursing (PDN) services can also provide incontinence, osotomy and urological supplies to Medicaid recipients and there will no reimbursement to DME providers of the supplies effective 3/1/2010.

Prodigy Rebate Update
Per Prodigy the rebate checks are being sent out, NCAMES is verifying with Prodigy the exact date of mailing and hopes to share that with our membership tomorrow, but no later then Friday February 26, 2010
 

Save Homecare Petition  

Click here to be directed to the Homecare Petition 

Update on Urological, Diapers, Ostomy Supplies

Prior Approval Items Removed:

During the NCAMES winter meeting Mary Lou Fleming (NCAMES Medicaid Chair) updated the attendees on the last Medicaid committee meeting. One issue discussed was a change in some items in regard to prior approval requirements that we wanted to make sure you knew about.

*The following items no longer require prior approval:

1. E0982
2. E0990
3. E0992
4. E0202
5. E0935
6. E0966
7. E0967
8. E2602
9. K0046
10. K0047
11. K0052
12. K0056
13. A9284

*These apply to all dates of service.
  

Medicaid Diabetes Contract with Prodigy - Q&A

Update December 15, 2009

Question:
SUPPLIES: Prodigy is out of ½ cc syringes until Jan 1, 2010 and DMA is verifying availability on the quantity and at which wholesalers these syringes are still available? What is the phone and fax # at Prodigy where folks can send their MD prescription to when a Pediatric patient need a second meter?

Answer:
One (A second meter), this is what is posted under the updates link on our NC Provider page. For pediatric patients whose doctors require two meters for optimum patient care, please include a copy of the patient’s prescription with your rebate form and submit by mail or fax to 704-285-6495

Question:
I want to confirm that the ½ cc and 1/3 cc syringes will be in stock at Prodigy Jan 2nd 2010

Answer:
Yes, DMA in response to the temporary supply issue will temporarily lift the 1 time override on syringes (1/2cc and 1/3 cc), effective Friday December 18, 2009 until the supply issues has been resolved (Jan 2, 2010).

Question:
What is the present availability of ½ cc syringes through wholesalers?

Answer:
Cardinal and McKesson.

Question:
Please provide additional information on meters:

Answer:
CMN/PA is required on the voice meter and can only be provided through a DME provider or pharmacy/DME provider. The approved CMN/PA needs to be kept on file for the period of 5 years. With the completed CMN/PA for the voice meter on file, the provider can pursue reimbursement for the meter from Prodigy.  For a broken meter, contact Prodigy directly because all meters carry a lifetime replacement warranty. For a lost or stolen meter or a meter destroyed by fire, please contact DMA Clinical Policy DME section at 919-855-4310 for verification requirements and approval for a replacement meter.

Update December 11, 2009
DENIALS: DMA is looking into the denials and why certain claims deny. They hope to have more insight in the middle of next week.

 

Comments from DMA:
Pharmacies and DME providers should submit claims according to Medicaid policy. Medicaid recipients are eligible for a meter once every 2 years. If another meter is required, then prior approval may be requested under DME program outside of the limits established. If a Medicaid recipient receives a meter at another pharmacy or DME provider and the current pharmacy or DME provider is unaware of that request then current pharmacy or DME provider will be reimbursed for the meter. However, pharmacies and DME providers should bill for meters according to Medicaid policies and procedures within their individual locations.

Click here for Medicaid Q&A

New Medicaid Diabetes Contract
November 15, 2009

Dear NCAMES Members:

Information will be coming soon from NC Medicaid (DMA) regarding a new program from Prodigy Diabetes Care who will become the state’s sole source for diabetes care products as of November 15th (Target date). NCAMES has a very strong working relationship with the NC Medicaid office and after fighting off the “single source DME” they were still faced with huge budget shortfalls and had to find a way to save more money other than some line items cuts that we negotiated. NC Medicaid wanted to sole source diabetic supplies but NCAMES continued to communicate our desire to move away from this plan. Once DMA initiated the focus on diabetes testing supply costs, NCAMES continued work with them to make sure the patient and the provider were protected, while at the same time, save money. To our state, the most important outcome is the nearly $4 Million they will save over the two-year contract. It was very important to us to keep your reimbursement virtually the same despite the product and reimbursement model changes (lower reimbursement matched by lower cost of goods). Another element is that the reimbursement and costs are the same for all providers in NC, leveling the playing field in the market. The state sees this program as a win-win-win: Win for the state by saving money, win for the provider to keeps costs/payments nearly the same, and a win for the patients as they receive quality products. Soon, you’ll receive an announcement from the Medicaid office through email/fax with some operational and roll-out details. The goal is to make this transition as seamless as possible for all providers and recipients. We met for the last two days with Medicaid and yesterday with Prodigy Diabetes Care who promotes themselves as a high-tech, high-quality cost effective company based in Charlotte. Since the state decided to go forward with this plan, NCAMES assured them that we will continue to work together to implement this change and support our valuable membership base at the same time. We KNOW you will have questions and I can assure you that Medicaid wants to make this program a success. NCAMES will continue to work with them to ensure a transition that works for all. A few more details: Products affected: Glucose monitor, strips, lancets, lancing device, control solution and syringes.
 

Roll out plan:
 

Start date is November 15.

• DMA will mail recipients letters the week of Oct 12-16. All Medicaid staff is prepared for influx of calls.
• DMA will be sending email blast to physicians and providers. Also you will find this information on DMA’s website.
• Prodigy will be sending a team out or calling to educate vendors on the product and where to purchase the product.
• Prodigy will be sending a team out to all endocrinologists, diabetic educators, PCP’s, clinics, and providers to educate and provide a demo meter.
• Prodigy’s inbound call center will help Medicaid recipients locate a supplier and help with FAQ’s hotline 24/7.
• Current existing Medicaid recipients requiring special glucose monitors should apply for Prior Approval immediately so there is no break in service.
• DMA and HP Enterprises are aware of possible increase in PA’s for medical necessity strips or other products. HP Enterprises is the new name for EDS.
• Prodigy is and has been prepared for the increase in product. They suggest to order TWO weeks prior to the “go live” date.
• Prodigy has a special packaging with NDC# on the NC Medicaid product that will need to be put on claims and DMA is working on a special SC modifier for the companies that file with HPCS codes.
• Prodigy has three glucose monitors and all are offered to NC Medicaid program: Autocode, Voice, and Pocket. All are blood plasma.
• DME providers and Pharmacists will buy Autocode and Pocket meters up front for conversion and Prodigy will rebate full amount for what amounts to a free meter.
• Prodigy will not provide any rebate on existing vision impaired recipients to get a Voice meter. Resolution: Prior Approval on existing and normal
• DMA procedures on new Medicaid recipients for Voice meter.
   

Key contacts:
Prodigy Diabetes Care (supply and product questions):
800-366-5901 (main)
www.prodigymeter.com

Recipient Questions:
“careLINK”:
800-662-7030
www.nccarelink.gov

If you have any questions or concerns, please contact NCAMES at info@ncames.org

Updated February 9, 2010

NCAMES Executive Director, Beth Bowen, heard from Frake Hunsel from DMA and there is still NO decision by DMA to clarify this issue for DME. Background:  These items are currently on the DME fee schedule however, there is no policy in place at this time. The delay seems to be due to budget concerns. Frake will continue to update NCAMES. Thank you for your patience on this matter and please direct any concerns to beth@ncames.org and I will forward them to DMA right away!