PA-22-0036
Proposes to increase the maximum monthly court-ordered guardian fee deduction for the purposes of determining a long-term care recipient’s monthly cost of care.
OH-22-0033
This SPA approves language specifying that the Single Pharmacy Benefit Manager (SPBM) will follow Ohio’s Unified Preferred Drug List.
UT-22-0010
This SPA proposes to amend the reimbursement methodology for provider-administered drugs from the Average Sale Price (ASP) Drug Pricing File to the same methodology as other covered outpatient drugs, with the exception that no professional dispensing fee will be paid. This SPA also replaced the term Utah Estimated Acquisition Cost (UEAC) with Wholesale Acquisition Cost (WAC).
ME-22-0029
This plan amendment updates the reimbursement methodology for physician services,
family planning and supplies, nurse-midwife services, and nurse practitioner services to the lower
of provider charges or 72.4% of the current corresponding Medicare rate, updates the fee schedule
for those services not covered by Medicare, and removes outdated provisions related to the
Primary Care Case Management (PCCM) program.
family planning and supplies, nurse-midwife services, and nurse practitioner services to the lower
of provider charges or 72.4% of the current corresponding Medicare rate, updates the fee schedule
for those services not covered by Medicare, and removes outdated provisions related to the
Primary Care Case Management (PCCM) program.
CA-22-0002
This amendment is to add doula services under the preventive services benefit and as a professional service under the freestanding birth center benefit.
ME-22-0034
This plan amendment authorizes a 4.9% rate increase for Family Planning and Supplies
services that do not have a Medicare rate.
services that do not have a Medicare rate.
MT-22-0017
This SPA proposes to increase the
professional dispensing fee to $15.73 for pharmacies with an annual prescription volume between 0 and 39,999 prescriptions; $13.62 for pharmacies with an annual prescription volume between 40,000 and 69,999; or $11.52 for pharmacies with an annual prescription volume greater than or equal to 70,000.
AR-22-0022
This SPA proposes to update language and the reimbursement methodology for 340B Antihemophilic
Factor products and Physician Administered Drugs.