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DPW Bulletins and Tips
January 28, 2013

The Department of Public Welfare (DPW) has issued the following bulletins.

Medical Assistance Bulletins:
01-13-01, Prior Authorization of Antipsychotics – Pharmacy Services issued January 7 and effective January 15 and applicable to the Medical Assistance (MA) Fee-for-Service (FFS) program. Prescriptions for antipsychotics that meet any of the following conditions must be prior authorized:

  1. A prescription for a non-preferred antipsychotic, regardless of the quantity prescribed. See the Preferred Drug List (PDL) for the list of preferred antipsychotics.
  2. A prescription for a preferred antipsychotic with a prescribed quantity that exceeds the quantity limit. See Quantity Limits in the MA Handbook for the list of drugs with quantity limits.
  3. A prescription for either a preferred or non-preferred antipsychotic regardless of quantity limit when prescribed for a child less than 18 years of age.
  4. A prescription for an atypical antipsychotic when there is a record of a recent paid claim for another atypical antipsychotic in the DPW Point-of-Sale On-Line Claims Adjudication System.
  5. A prescription for a preferred or non-preferred oral atypical antipsychotic for an individual 18 years of age and older when prescribed in a low-dose range as identified in the bulletin.

There are exemptions to these requirements and a grandfathering provision. View the complete bulletin from the link above).

01-13-08, Prior Authorization of Smoking Cessation Products issued January 7 and effective January 15 and applicable to the MA FFS program. Chantix was changed from non-preferred to preferred status.DPW is removing the reference for automated prior authorization in the handbook pages as this provision applied primarily to Chantix when designated as non-preferred. Quantity limits were added.

01-13-11, Preferred Drug List Update January 15, 2013 – Pharmacy Services issued January 22 and effective January 15 and applicable to the FFS program.

99-13-02,HealthChoices Physical Health Managed Care New East Zone Expansion issued January 18 and effective March 1 notifies MA providers that DPW will expand the physical health HealthChoices managed care program to all 22 counties in which ACCESS Plus operates and that ACCESS Plus will cease operation in these counties on February 28. Contact information for the Physical Health Managed Care Organizations (PH-MCOs) that will operate in these counties is included for those seeking to become network providers. The affected counties are Bradford, Carbon, Centre, Clinton, Columbia, Juniata, Lackawanna, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Pike, Schuylkill, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, and Wyoming.

Provider Quick Tips #150, Provider Enrollment Application Requirement Effective January 21, 2013 informs providers that effective January 21 DPW will only accept the current version of provider enrollment applications available on the department’s Enrollment Information web page. Beginning January 21, if the department receives any outdated versions of the enrollment application, a phone call to the contact person and phone number listed on the application will be made to notify him that the application cannot be processed and will be shredded. The current version of all provider applications contains the most recent updates and requirements to be enrolled as a MA provider.

Office of Mental Health and Substance Abuse Services Bulletin
01-18-2013, Targeted Case Management (TCM) – Travel and Transportation Guidelines notifies providers, MCOs, and County Mental Health/Intellectual Disability Administrators that  case manager travel time and time spent transporting or escorting individuals should not be billed as a unit of service.

Contact Betty Simmonds with questions regarding the above bulletins and tips.

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