340B. The Contractor shall comply with 42 USC 256B and the requirements therein. Additionally, the Contractor shall comply with all policies and procedures set forth in IHCP Provider Bulletin BT201413, dated April 1, 2014, and any updates thereto. The Contractor must have procedures in place to exclude utilization data for drugs subject to discounts under the 340B Drug Pricing Program from the utilization reports submitted to the State per 42 CFR 438.3(s)(3). Specific plans for excluding utilization data should be detailed and agreed upon between the Contractor and the State and may use tools including, but not limited to, modifiers, billing instructions, and processes to correctly identify a 340B patient. At any given point in time, the State may elect to require the use of 340B-related modifiers on claims. In such an instance, the Contractor shall require its providers to use the selected modifiers on their claims, and the Contractor will be required to deny payment for claims that do not contain necessary modifiers. The State will work with the Contractor in determining a mutually agreeable workplan and time line for implementation of use of modifiers by the Contractor’s providers. The Contractor shall, on an ongoing basis, monitor claims for provider compliance with federal and state billing requirements pertaining to 340B-sourced drugs. The Contractor shall be fully responsible for ensuring that its providers bill for 340B drugs completely in compliance with federal and state requirements, such as prevention of duplicate discounts. The Contractor must maintain records that are clear and auditable that include billing instructions and methods by which 340B claims are excluded from Medicaid reimbursement. The Contractor shall allow the State access to any data upon its request to records related to 340B purchased drugs, exclusion from Medicaid reimbursement, and utilization reports. In the event that a duplicate discount claim is pursued, the Contractor is responsible for working with the State’s designated rebate vendor and any involved providers to address the claim and resolve any manufacturer dispute or rebate invoice matter. In the event that a duplicate discount, diversion, or other impermissible utilization of drugs obtained through the 340B program derived from Contractor utilization is substantiated through appropriate means, the Contractor will be responsible for repayment of the duplicate discount and any sanction resulting therefrom. The State wil...
340B. The Contractor shall comply with 42 USC 256B and the requirements therein. Additionally, the Contractor shall comply with all policies and procedures set forth in IHCP Provider Bulletin BT201413, dated April 1, 2014, and any updates thereto. The Contractor must have procedures in place to exclude utilization data for drugs subject to discounts under the 340B Drug Pricing Program from the utilization reports submitted to the State per 42 CFR 438.3(s)(3). Specific plans for excluding utilization data should be detailed and agreed upon between the Contractor and the State and may use tools including, but not limited to, modifiers, billing instructions, and processes to correctly identify a 340B patient.
340B. The Contractor shall comply with 42 USC 256B and the requirements therein. Additionally, the Contractor shall comply with all policies and procedures set forth in IHCP Provider Bulletin BT201413, dated April 1, 2014, and any updates thereto.
340B. A notice is given to the Contractor pursuant to clause 340A shall specify- 340B.1. the date upon which the Contract is to be terminated; and
340B. Gross – Mediation Cost – Dispensing Cost = Net Income
