Pharmacy Provider Self-Attestation Process Changes in 2021

December 1, 2020

Effective April 1, 2021, Medi-Cal pharmacy benefits will be transitioned to and thereafter administered through the fee-for-service delivery system for all Medi-Cal beneficiaries (generally referred to as “Medi-Cal Rx”). The Department of Health Care Services (DHCS) has partnered with Magellan Medicaid Administration, Inc. (Magellan) to provide a wide variety of administrative services and support for Medi-Cal Rx.

Magellan has contracted with Mercer Government Human Services Consulting (Mercer), part of Mercer Health and Benefits, LLC, to administer the annual pharmacy provider self-attestation survey for professional dispensing fee reimbursement. The objective of the next self-attestation survey is to assign professional dispensing fee rates for Medi-Cal enrolled pharmacies beginning July 1, 2021 and ending June 30, 2022.

DHCS, through Mercer, will be initiating the provider self-attestation process in April 2021 for the 2020 calendar year reporting period for those pharmacy providers seeking the higher of two professional dispensing fee rates determined by annual prescription volume. Key changes to the self-attestation process include:

  • The provider self-attestation process for the calendar year 2020 reporting period will begin in April 2021 (in previous years, the survey period was January 15 through the end of February).

  • Mercer, on behalf of Magellan and DHCS, will administer the provider self-attestation survey with options for online submission or an email submission of a Microsoft Excel® formatted template.

  • In addition to the standard online submission, pharmacies will have an additional survey submission option that will allow a bulk submission for multiple locations. The new template will allow a corporate office for chain-affiliated stores under common ownership to submit multiple stores in one self-attestation survey file.

As was done previously, newly approved fee-for-service pharmacy providers that are notified of their enrollment approval after the attestation period closes will receive the higher dispensing fee. However, those same providers will have to attest for subsequent reporting periods in order to continue to be eligible for the higher dispensing fee in subsequent fiscal years.

A virtual stakeholder information session will be held in February 2021 to review the new self-attestation survey process and project timeline.

DHCS reminds the Medi-Cal pharmacy fee-for-service provider community to closely monitor upcoming Medi-Cal pharmacy bulletins for additional information regarding future updates, by signing up via the Medi-Cal Rx Subscription Service.

For updates on Medi-Cal Rx, please visit the Department’s dedicated websites at Medi-Cal Rx and the DHCS Medi-Cal Rx Transition website. In addition, DHCS encourages stakeholders to review the Medi-Cal Rx Frequently Asked Questions (FAQ) document, which continues to be updated as the project advances.