HRSA-PROVIDERS List

ALL: 6-19-13 Bree Collaborative seeks input on draft warranty payment model for total knee, hip replacement surgery

DSHS HRSA PROVIDERS — 2013-06-19T20:57:06+00:00

NOTE: Some providers may receive this notice more than once. Our apologies if so. We are trying to reach as many interested parties as possible.

ATTN: Medicaid providers

Dear Health Care Partners and Interested Parties:

The Dr. Robert Bree Collaborative invites all stakeholders - providers, hospitals, purchasers/employers, health plans, and patients - to provide input on a draft warranty payment model for Total Knee and Total Hip Replacements surgery. This warranty model is an attempt to align purchasing and payment with best practices that lead to safer care, better outcomes, and lower costs. [...]

SFTP: ATTN SFTP USERS -- Addition of README directory within ProviderOne SFTP Accounts

DSHS HRSA PROVIDERS — 2013-06-18T00:31:02+00:00

SFTP USERS: Addition of README directory within ProviderOne SFTP Accounts

ProviderOne has added an additional directory that will be used to pass important information to SFTP users. The new directory is titled "README" and will include a single folder where messages will be delivered to SFTP account holders. Messages can include password update requirements, outage information and general SFTP messages. SFTP users are instructed to monitor the new directory for important information on a regular basis. [...]

Pharmacy,Medsupplies,Clinicians; Effective for dates of service on and after August 1, 2013

DSHS HRSA PROVIDERS — 2013-06-14T20:16:44+00:00

ATTN: Pharmacy, Medsupplies and Clinicians

Dear Provider:
Effective for dates of service on and after August 1, 2013, the Medicaid Program of the Health Care Authority (agency) will no longer reimburse for prescriptions written by prescribers who are not enrolled with the agency.

For prescriptions written by prescribers who are not enrolled with the Agency, the DME provider or pharmacy may accept cash payment from the client if they complete the Agreement to Pay for Healthcare Services form 13-879 and mark the box indicating order, prescribed, or referred by non-enrolled licensed health care professional. [...]

Pharmacy,Mngedcare: PN 13-37 Smoking cessation for pregnant clients

DSHS HRSA PROVIDERS — 2013-06-11T20:12:47+00:00

[hca_medicaid]
Provider Notice 13-37

Dear Provider:

Effective for dates of service on and after July 1, 2013, the Medicaid Program of the Health Care Authority (agency) will pay for prescription and over-the-counter smoking cessation products through pharmacies for pregnant clients receiving tobacco cessation counseling from the prescribing provider. The prescription must indicate that the client is pregnant, the estimated due date, and that the client is receiving smoking cessation counseling from the prescribing provider. [...]

Mngedcare: ABA and Centers of Excellence -- Important Information for Plans -- 6-7-13

DSHS HRSA PROVIDERS — 2013-06-08T01:10:45+00:00

ATTN: Health Plans

SUBJECT: ABA and Centers of Excellence - Important Information

The Health Care Authority reminds all contracted managed care organizations (MCOs) to actively work toward contracting with Centers of Excellence (COE) to provide autism spectrum disorder-related services. Child evaluation and screening services, as well as Applied Behavior Analysis (ABA) services must be provided by a COE, such as the University of Washington Autism Clinic. Evaluation and screening are used to evaluate the appropriateness of ABA services. ABA services remain separate from, or "carved out," of the managed care contract. [...]

Mngedcare: SUBJECT: APA Hemophiliac Stop Loss 6-7-13

DSHS HRSA PROVIDERS — 2013-06-08T01:06:30+00:00

ALL PLAN ADVISORY apa #13-001

DATE: May 30, 2013

to: Managed care organizations

FROM: Barbara Lantz [Barbara Lantz initials]

Quality and Care Management Section Manager

subject: Hemophilia stop loss

For the contract periods of January 1, 2012 - June 30, 2012 and July 1, 2012 - December 31, 2013 submissions for hemophilia stop loss must comply with the following: [...]

ALL: HCA-DSHS release - Procurement results in the Strategy II Duals Project

DSHS HRSA PROVIDERS — 2013-06-06T22:37:38+00:00

ATTN: Medicaid providers

The following news release was distributed to the media earlier today.

JUNE 6, 2013 NR 013-015

FOR MORE INFORMATION:
Dorothy F. Teeter, Director, Health Care Authority, 360-725-1040
Jane Beyer, Asst. Secretary, Behavioral Health and Service Integration, DSHS, 360-725-2260

MaryAnne Lindeblad, Director, Medicaid program, Health Care Authority 360-725-1040

Health Care Authority, DSHS announce
apparently successful bidders for HealthPathWashington [...]

Pharmacy,Mngedcare : PN 13-38 Nonbilling individual providers

DSHS HRSA PROVIDERS — 2013-06-06T17:11:00+00:00

[medicaid_logo.wmf]
Provider Notice 13-38

Dear Provider:

Effective for dates of service on and after August 1, 2013, the Medicaid Program of the Health Care Authority (agency) will no longer reimburse pharmacies for prescriptions written by prescribers who are not enrolled with the agency.

Prescribers must enroll in the ProviderOne System as one of the following: [...]

ALL: June EHR (Electronic Health Records Incentive program)

DSHS HRSA PROVIDERS — 2013-05-31T18:05:34+00:00

Attached is the 2013 June EHR (Electronic Health Records) Newsletter.

LISTSERV SUBSCRIBERS NOTE: Please do not reply directly to this message. Either use one of the email addresses above or direct your query to http://www.hca.wa.gov/medicaid/Pages/contact.aspx
GOE/JK
NOTICE: This message (including any attachments) may contain information that is privileged, confidential, proprietary and/or otherwise protected from disclosure to anyone other than its intended recipient(s). Any dissemination, copying, retention or use of this message or its contents (including any attachments) by persons other than the intended recipient(s) is strictly prohibited. If you have received this message in error, please immediately notify the sender [...]

Tribal : PN 13-35 IHS Encounter Rate Increase

DSHS HRSA PROVIDERS — 2013-05-30T20:56:50+00:00

[hca_medicaid]

Provider Notice 13-35

Dear Indian Health Services (IHS) and Tribal 638 Health Clinic providers,

* The IHS encounter rate for 2013 increased to $330.00 per encounter.
(See Federal Register/Vol. 78, No. 74/Wednesday, April 4, 2013.)

* Retroactive to dates of service on and after January 1, 2013, the Health Care Authority (agency) will pay the new IHS encounter rate. [...]

Pharmacy, Mngedcare: PN 13-36 Prescription Drug: Maximum Allowable Cost Update

DSHS HRSA PROVIDERS — 2013-05-29T17:31:59+00:00

[medicaid_logo.wmf]

Provider Notice 13-36

Dear Provider,

The Medicaid Program of the Health Care Authority (agency) will implement the following changes to maximum allowable costs in the Prescription Drug Program:

MAC Additions

Generic Name

Strength

Form

MAC Effective 07/01/13

CLINDAMYCIN PALMITATE HCL

75MG/5ML

POWD SOLR

$0.49710

LAMOTRIGINE

50MG

TAB SR 24HR

$9.69260

LAMOTRIGINE

100MG

TAB SR 24HR

$10.30890

LAMOTRIGINE

200MG

TAB SR 24HR

$10.99310

LAMOTRIGINE

250MG

TAB SR 24HR

$15.86410

LAMOTRIGINE

300MG

TAB SR 24HR

$16.64730

MORPHINE SULFATE

60MG

TABLET CR

$0.47130

VANCOMYCIN HCL

125MG

CAPSULE

$22.38020

VANCOMYCIN HCL

250MG

CAPSULE

$37.33690

MAC Adjustments

Generic Name

Strength

Form

MAC Effective 07/01/13 [...]

ALL: Health Information Technology Survey for WHIIEC

DSHS HRSA PROVIDERS — 2013-05-28T16:52:20+00:00

Re: Health Information Technology 5/28/2013
Solicitation of Information for
Washington Health Information industry Education Council (WHIIEC)

Dear Health Care Provider:

I am contacting you on behalf of the Health Care Authority which participates in the Washington Health Information Industry-Education Council (WHIIEC), seeking your guidance as an industry professional in Health Information Technology (HIT). WHIIEC is an independent forum convened by the Health Care Authority as a collaborative venue between Washington state HIT employers and HIT educators. Its purpose is to best prepare and place learners to meet the evolving needs for professional and technical HIT staff. As the competition for [...]

Hospitals,Mngedcare: PN 13-34 Outpatient Hospital Services Medicaid Provider Guide

DSHS HRSA PROVIDERS — 2013-05-20T18:45:54+00:00

[medicaid_logo.wmf]
Provider Notice 13-34

Dear Provider,

Retroactive to dates of service on and after April 1, 2013, unless otherwise stated, the Medicaid Program of the Health Care Authority (the agency) will make the changes noted in this provider notice.

Fee schedule changes

The agency will update the Outpatient Prospective Payment System (OPPS) and Outpatient Hospital Fee Schedule with the following codes: [...]

Mh-Rsns: Creating Connections delays deadline for Mental Health Survey 5-17-2013

DSHS HRSA PROVIDERS — 2013-05-17T20:51:45+00:00

ATTN: Mental Health professionals and providers

Creating Connections survey deadline extended to May 24

We are extending the deadline for the Creating Connections survey until the close of business Friday, May 24.

Hurry and help Creating Connections by completing a brief (10-20 minutes) online survey.

Respondents will be entered in a drawing for a $50 gift card! Winners of the gift cards will be notified on or before June 14. [...]

Mngedcare,Sftp: ProviderOne SFTP Password Resets 5-16-13

DSHS HRSA PROVIDERS — 2013-05-17T00:49:44+00:00

ATTN: SFTP, Managed Care, Health Plans and Prepaid Health Plans

ProviderOne SFTP server will be unavailable tonight

Tonight, May 16, the ProviderOne SFTP server will be unavailable from 6 to 10 p.m. During this timeframe, both submission to and retrieval from the ProviderOne SFTP server will be unavailable.

As a routine security precaution, we are resetting all Provider's SFTP accounts. To get your new password, you will need to contact our HCA Security Help Desk by sending an e-mail to: hcaitsecurity@hca.wa.gov Please use the following subject line in your e-mail: 'FTP Password Reset' In the body of your e-mail, include [...]

SFTP: SSH File Transfer Protocol

DSHS HRSA PROVIDERS — 2013-05-16T23:52:41+00:00

ATTN: SFTP Providers

SFTP server will be unavailable Sunday afternoon

On Sunday May 12, the ProviderOne SFTP server will be unavailable from 1 p.m. - 6 p.m. PDT for a software update. (SFTP stands for "SSH File Transfer Protocol" or "Secure File Transfer Protocol," a computer process that allows secure file transfers.)
During the update, both submission to and retrieval from the ProviderOne SFTP server will be unavailable. Normal SFTP activities will resume upon completion of the update at 6 p.m. PDT. [...]

Hospitals,Hospice-Homehlth,Nursinghomes,Mngedcare: PN #13-30 Revised Nursing Facilities Medicaid Provider Guide with coverage updates

DSHS HRSA PROVIDERS — 2013-05-15T22:36:38+00:00

[medicaid_logo.wmf]

Provider Notice 13-30

Dear Provider,

Effective for dates of service on and after May 15, 2013, the Medicaid Program of the Health Care Authority (the agency) is publishing a revised Nursing Facilities Medicaid Provider Guide with coverage changes and housekeeping revisions.

Specific changes to the guide include:

* Replace the acronym ADSA with Aging and Long-Term Support Administration (ALTSA).
* Add information about client eligibility verification.
* Add information about submitting certain claims for Healthy Options clients. [...]

ALL: Health Information Technology Survey for WHIIEC 5-15-2013

DSHS HRSA PROVIDERS — 2013-05-16T00:37:18+00:00

Re: Health Information Technology 5/15/2013

Solicitation of Information for

Washington Health Information industry Education Council (WHIIEC)

Dear Health Care Provider:

I am contacting you on behalf of the Health Care Authority which participates in the Washington Health Information Industry-Education Council (WHIIEC), seeking your guidance as an industry professional in Health Information Technology (HIT). WHIIEC is an independent forum convened by the Health Care Authority as a collaborative venue between Washington state HIT employers and HIT educators. Its purpose is to best prepare and place learners to meet the evolving needs for professional and technical HIT staff. As the competition for [...]

Fqhcs-Rhcs: New email address for questions about FQHCs and RHCs 5-15-2013

DSHS HRSA PROVIDERS — 2013-05-15T20:31:19+00:00

ATTN: FQHCs and RHCs

Change in address for reimbursement-related inquiries

Due to staffing changes, the Health Care Authority is requesting that all FQHC/RHC reimbursement-related emails be directed to the following address: FQHCRHC@hca.wa.gov

Please send inquiries to this mailbox only; do not send them to specific staff.

Thank you! Please let us know if you have any questions. [...]

Clinicians,Hospitals,Pharmacy,Mngedcare: 13-33 HCA no longer covers the anemia drug peginesatice (Omontys®)

DSHS HRSA PROVIDERS — 2013-05-14T21:33:16+00:00

[hca_medicaid.gif]
Provider Notice 13-33

Correction: Effective for dates of service retroactive to February 23, 2013, the Health Care Authority no longer covers the anemia drug peginesatice (Omontys®), 0.1 mg, injectable (HCPCS code J0890).

Dear Provider,

The Medicaid Program of the Health Care Authority(agency) previously issued provider notices 13-16 and 13-24 incorrectly informing providers that effective April 1, 2013, the anemia drug peginesatice (Omontys®), 0.1 mg, injectable (HCPCS code J0890) would no longer be covered. [...]

Sftp: SFTP server will be unavailable Sunday afternoon

DSHS HRSA PROVIDERS — 2013-05-10T19:39:56+00:00

Pharmacy,Mngedcare: PN 13-32 Update Patient Review and Coordination (PRC) program criteria

DSHS HRSA PROVIDERS — 2013-05-09T17:37:34+00:00

[medicaid_logo.wmf]
Provider Notice 13-32

Dear Provider:

Effective for dates of service on and after June 1, 2013, the Medicaid Program of the Health Care Authority (agency) will publish a revised Prescription Drug Program Medicaid Provider Guide with updates to the Patient Review and Coordination (PRC) program criteria to agree with an update of WAC 182-501-0135. [...]

Pharmacy,Mngedcare: PN 13-31 Update emergency fills information

DSHS HRSA PROVIDERS — 2013-05-09T17:34:46+00:00

[medicaid_logo.wmf]
Provider Notice 13-31

Dear Provider:

Effective for dates of service on and after June 1, 2013, the Medicaid Program of the Health Care Authority (agency) will publish a revised Prescription Drug Program Medicaid Provider Guide to update the "Emergency Fills" section of the guide.

For more details, see "What has changed" in the Prescription Drug Program Medicaid Provider Guide. [...]

Sftp: SFTP server will be unavailable Sunday afternoon

DSHS HRSA PROVIDERS — 2013-05-08T17:55:12+00:00

SFTP: SSH File Transfer Protocol

DSHS HRSA PROVIDERS — 2013-05-07T18:08:29+00:00

Pharmacy: PN 13-27 Prescription Drug MPG

DSHS HRSA PROVIDERS — 2013-05-07T15:26:45+00:00

[medicaid_logo.wmf]
Provider Notice 13-27

Dear Provider:

Effective for dates of service on and after June 1, 2013, based on recommendations by the Pediatric Mental Health Workgroup, the Medicaid Program of the Health Care Authority (agency) will require authorization for alpha-agonists that exceed the agency's dose for eligible clients 17 years of age and younger. [...]

Pharmacy: PN 13-28 Prescription Drug: Maximum Allowable Cost Update

DSHS HRSA PROVIDERS — 2013-05-06T15:59:52+00:00

[medicaid_logo.wmf]

Provider Notice 13-28

Dear Provider,

The Medicaid Program of the Health Care Authority (Agency) will implement the following changes to maximum allowable costs in the Prescription Drug Program:

MAC Additions

Generic Name

Strength

Form

MAC Effective 06/01/13

BUPRENORPHINE HCL-NALOXONE HCL

8-2MG

TABLET SUBL

$6.50160

DESMOPRESSIN ACETATE

0.01%

NASAL SOLN

$37.34010

LEVALBUTEROL HCL

0.63MG/3ML

NEBU SOLN

$1.34790

LEVALBUTEROL HCL

1.25MG/3ML

NEBU SOLN

$1.34790

LEVONORGESTREL

0.75MG

TABLET

$14.39550

LEVONORGESTREL

1.5MG

TABLET

$30.69150

MECLIZINE HCL

25MG

TABLET

$0.28090

METHYLPREDNISOLONE (DOSE PACK)

4MG

TABLET

$0.99423

POTASSIUM CHLORIDE MACROENCAPSULATED CRYSTAL

10MEQ

TABLET CR

$0.36640

RIZATRIPTAN BENZOATE

5MG

TABLET

$1.73600

RIZATRIPTAN BENZOATE

10MG

TABLET

$1.73600

[...]

ALL: 5-2-13 EHR Incentive Program Newsletter

DSHS HRSA PROVIDERS — 2013-05-02T18:30:41+00:00

[EHR logo]
Medicaid Electronic Health Records Newsletter
May 2013
*HELPFUL TIPS AND LINKS*

Tips:

* Please help us assist you with the timely processing of your EHR incentive applications. You MUST upload verification of AIU (Adopt, Implement, Upgrade) certified EHR technology for your group in the application.

* Please remember that if you do not attest within eMIPP (Washington State EHR Incentive registration application portal) within 90 days of registering at CMS, we are required to deny your application. If this occurs, you will need to return to CMS, re-register and re-submit your registration to begin the process again.
* [...]

Dental: PN 13-26 Update coverage and prior authorization requirements for selected procedure codes

DSHS HRSA PROVIDERS — 2013-05-01T21:19:43+00:00

[medicaid_logo.wmf]

Provider Notice 13-26

Dear Provider,

Effective for dates of service on and after May 1, 2013, unless otherwise specified, the Medicaid Program of the Health Care Authority (the agency) is republishing the Dental-Related Services Medicaid Provider Guide with Coverage Table changes and housekeeping changes:

Coverage Table changes include:

CDT Code

Nomenclature

Change

Effective Date

Guide

N/A

N/A

Updated hyperlinks throughout the document. [...]