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Texas Medicaid Updates
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Friday, September 22, 2017

1) 
HHSC To Allow MCOs And Texas Medicaid & Healthcare Partnership To Extend Prior Authorizations

Managed care organizations (MCOs) extend prior authorizations for those expiring August 25, 2017 through the termination of the emergency period for individuals with a permanent residence in a FEMA-declared disaster county for up to 90 days. Specific information will be published by HHSC for prior authorizations associated with services paid by the Texas Medicaid & Healthcare Partnership (TMHP). HHSC will allow MCOs and TMHP flexibility in documentation for new authorizations. MCOs will be allowed to waive currently required provider documentation, MCO and TMHP review criteria, required consultation requirements for authorization, review and documentation requirements of the state plan, contract or limitation of services if: (i) the individual has a permanent residence in a FEMA-declared disaster county, and (ii) it is determined that the required information is not readily available due to the related disaster. Specific information will be published by HHSC regarding flexibilities for new authorizations associated with services paid by TMHP. Click Here for the Hurricane Harvey FAQ page.


2). Health And Human Services Issues Changes To Prescription Refills Due To Hurricane Harvey

Due to Hurricane Harvey an emergency procedure has been implemented for pharmacists to follow if a prescription rejects with an error code “79”(“Refill to Soon”). This emergency procedure is only for individuals that the pharmacist identifies as affected by Hurricane Harvey. Pharmacy staff should use professional judgement when filling prescriptions to ensure adherence to state and federal law. The override procedure is available for both Fee-for-Service and MCO claims with service dates of August 24 through October31, 2017.

Click Here for further guidance on how to fill a prescription early.


3)  Vendor Drug Program Will Not Extend Available Drugs Beyond The Centers For Medicare & Medicaid (CMS) Approved List

Managed care organizations are only allowed to cover drugs included in the Federal Medicaid Drug Rebate Program and not yet on the Vendor Drug Program (VDP) formulary until approved drugs are available in pharmacies for members with a permanent residence in a FEMA-declared disaster county. To the extent a pharmacy is unable to stock drugs on the VDP formulary, this approval applies to drugs dispensed from Aug. 25, 2017, until the emergency declaration is rescinded. Once a pharmacy is able to stock approved drugs, this allowance should be lifted. HHS produces a quarterly file that identifies all drug labelers that participate in the Medicaid Drug Rebate Program. The most recent file can be accessed Here

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