The Texas Medicaid Standing Order for Mosquito Repellent has been revised and is available for use with the mosquito repellent benefit for people enrolled in Medicaid (both traditional and managed care) and CHIP. Pharmacy staff must obtain a copy of the revised standing order, effective May 1, because of the change in prescribing authority of the standing order. The previous standing order expires Apr. 30. Pharmacies may request a copy of the standing order by emailing vdp-formulary@hhsc.state.tx.us.
- • Pharmacies or pharmacists not operating under the standing order will require a prescription from a valid healthcare provider prior to dispensing mosquito repellent to people enrolled in Medicaid or CHIP.
- • People enrolled in in the Children with Special Health Care Needs Services Program will always require a prescription for mosquito repellent from a health care provider.
- • People enrolled in the Healthy Texas Women program do not require a prescription.
Neonatal Emergency Billing Address Requirements In accordance with House Bill (HB) 15 (83R) and HB 3433 (84R), HHSC established rules for inpatient hospital designations for neonatal services and maternal services. Hospitals without designation will not be reimbursed for inpatient neonatal or maternal services except emergency services required to be provided or reimbursed under state or federal law. The level of care designation for each hospital will be reviewed by HHSC every three years and updated as appropriate.
Action: Providers who submit claims for inpatient newborn care must use the billing address that matches the facility address of the neonatal designation where neonatal services are rendered. To be considered for reimbursement of neonatal claims, providers must have their neonatal billing address. Business edits will set on encounters where the provider is billing incorrectly.
January 1: Peer Specialist Background: This policy is a result of House Bill (H.B.) 1486, 85th Legislature, Regular Session, 2017, which requires HHSC to establish a Medicaid reimbursable peer service benefit and adopt rules establishing training and certification requirements for peer specialists to provide Medicaid-reimbursable peer specialist "services to persons with mental illness or services to persons
The attached Peer Specialist notification outlines the new benefit, requirements for eligibility and service delivery, as well as claims filing/reimbursement details effective Jan. 1, 2019.
January 1: Morphine Equivalent Dose Limitations for RightCare to Decrease in January RightCare from Scott and White Health Plan will decrease the daily morphine equivalent dose limit for people enrolled in Medicaid Managed Care on January 1, 2019. The new limit will be set at 90, and apply to all opioid prescriptions with exceptions for those people diagnosed with cancer or those receiving palliative or hospice care. Prescribing providers and pharmacies should contact the Navitus Provider Hotline 1-877-908-6023 for dosage limitation override assistance.
SUD Policy Background: The attached SUD Policy notification outlines the finalized Substance Use Disorder Services policy update to be effective Jan. 1, 2019.
This policy update includes:
- Updated statement of benefits section
- Addressed Mental Health Parity and Addiction Equity Act requirements by allowing limits to be exceeded for adults with prior authorization
- Made Medication Assisted Treatment payable on same day as withdrawal management and treatment services
- Made Vivitrol payable to Chemical Dependency Treatment Facilities
- Made buprenorphine payable to Physician Assistants and Nurse Practitioners as allowed under the Comprehensive Addiction and Recovery Act of 2016
- Updated Prior Authorization forms for Fee for Service Medicaid recipients: Qualified Credentialed Counselor signature now permissible consistently across all forms, and supporting documentation now required with all forms consistently.