Increasing physician visit limits first in series of 2019 enhancements

Effective Jan. 1, 2019, the Mississippi Division of Medicaid (DOM) is increasing the number of physician visits it covers for Medicaid beneficiaries, the first of a series of changes the agency plans to roll out in the coming year.

The move is part of the new Medicaid EASE Initiative – Enhancing Access to Services and Engagement – a bundle of programmatic changes aimed at bolstering Medicaid beneficiaries’ access to needed services in the most appropriate setting.

With the first phase of the EASE Initiative, DOM will increase the physician visit limit for beneficiaries from 12 to 16 visits per year. This increase supplements limit flexibilities already in place for different populations of Medicaid beneficiaries.

Beneficiaries in nursing homes, for instance, can receive up to 36 physician visits annually. Individuals who participate in the MississippiCAN program will continue to be eligible for enhanced services offered by the managed care company with which they are enrolled, which include unlimited physician visits. DOM will also continue to offer unlimited medically necessary physician visits for children up to age 21.

DOM plans to announce additional EASE Initiative reforms in the coming months. These projects are still in development and include increases to the monthly prescription drug limit and home health visit limit, behavioral health and substance use disorder reforms, and an effort to reduce potentially preventable hospital readmissions. DOM will share more information about these projects as they are developed.

Even prior to the development of the EASE Initiative, DOM began taking steps toward improving beneficiary access to care. For example, DOM is seeking approval from the Centers for Medicare and Medicaid Services to allow certain physician-administered drugs to be billed and reimbursed as either a medical claim or a pharmacy point-of-sale (POS) claim to improve access to those drugs.

Drew Snyder, Executive Director

Previously, many physician-administered drugs could only be billed as a medical claim. These include expensive therapies physicians previously may have been reluctant to keep in stock, such as 17P, or Makena (hydroprogesterone caproate) injection. If approved, drugs that are billable through pharmacy POS will be known as Clinician Administered Drugs and Implantable Drug System Devices (CADD).

The proposed CADD list can be found on our Pharmacy Resources page or on our Fee Schedules and Rates page. CADDs will not count toward the monthly prescription drug limit.

“With the Medicaid EASE Initiative, we are looking to build on the momentum that began during the 2018 legislative session and the recommendations of important stakeholder groups such as the Mississippi Medical Care Advisory Committee,” said Drew Snyder, executive director. “I look forward to sharing more information about the EASE Initiative as well as other developments in the coming months.”

Published Dec. 4, 2018