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MS SPA 21-0018 Covered Outpatient Drugs disapproved by CMS

State Plan Amendment (SPA) 21-0018 was submitted to allow the Division of Medicaid (DOM) to 1) set the fees for covered outpatient drugs the same as those in effect on July 1, 2020, and 2) remove the five percent (5%) reimbursement reduction for physician administered drugs effective July 1, 2021. Additionally, this SPA allowed for setting a ceiling for the blood factor professional dispensing fee of $260.00. These changes were being made to be in compliance with Miss. Code § 43-13-117, amended by MS Senate Bill 2799, effective July 1, 2021. Additional authority: Miss. Code § 43-13-121.

The Centers for Medicare and Medicaid Services (CMS) has disapproved MS SPA 21-0018. The Division of Medicaid will return to the previously approved payment methodology for Covered Outpatient drugs and reprocess fee-for-service claims for prescription drugs for dates of service July 1, 2021 through June 30, 2022, with the exception of the five percent (5%) reduction for physician administered drugs. No action is required on the part of the pharmacy provider.

For more information read the submitted SPA pages.