Stakeholder Session, March 26, 2019: Fee-For-Service Claim Adjustments

March 11, 2019

The Centers for Medicare & Medicaid Services (CMS) published its final rule on covered outpatient drugs (CODs) on February 1, 2016. Under the final rule, each state Medicaid agency is required to adopt a methodology based on actual acquisition cost (AAC) for CODs. As has been published in previous Medi-Cal Updates, pursuant to California's State Plan Amendment 17-002, which was approved by CMS on August 25, 2017, the Department of Health Care Services (DHCS) implemented a new fee-for-service reimbursement methodology for CODs to comply with the final rule. Although the mandated policy was effective on April 1, 2017, it took time to update the state’s claims processing system to reimburse using the new methodology. The associated system changes went into effect on February 23, 2019.

DHCS will make retroactive adjustments for impacted claims with dates of service on April 1, 2017, through the implementation date of February 23, 2019. DHCS is conducting a stakeholder session on March 26, 2019, to present how claim adjustments will roll out.

Session Specifics
When: Tuesday, March 26, 2019, 1 – 2 p.m.

Teleconference Information: Dial toll-free number 1-888-324-8106, then enter passcode 1856294 when prompted.

For those who wish to follow along, a PDF version of the stakeholder presentation slides will be uploaded by 4 p.m. on Monday, March 25, 2019, to the Pharmacy Reimbursement Project page on the DHCS website, under the Latest News heading.