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Update for Pharmacy Reimbursement SPA 17-0002

The Mississippi Division of Medicaid (DOM) submitted State Plan Amendment (SPA) 17-0002 Pharmacy Reimbursement to the Centers for Medicare and Medicaid Services (CMS) on March 15, 2017. On June 1, 2017, DOM received a request for additional information (RAI) letter from CMS for SPA 17-0002. DOM provided a formal response to the RAI letter on June 27, 2017, and is awaiting CMS approval of the SPA.

Once SPA approval is received from CMS, DOM will utilize a phased weekly approach to reprocess/adjust impacted pharmacy claims.

Example Adjustment Schedule

Adjust claims using new reimbursement methodology for Dates of Service = Adjustment reflected on Remittance Advice dated:
April 1-8 (Saturday – Saturday) First Monday in month of implementation
April 9-15 (Sunday – Saturday) Second Monday in month of implementation
April 16-22 (Sunday – Saturday) Third Monday in month of implementation
Same pattern until completed Same pattern until completed

 

In an effort to support providers during this adjustment period, DOM will be making an estimated financial impact available to pharmacy providers. The estimated impact is based upon claims reprocessing for claims filled in April 2017. The reports will be produced by August 2017. Providers will be notified of the process to obtain their estimated financial impact reports once the data is available.

If you have questions, please contact us at 601-359-5253, section option #4.

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