Acupuncture Coverage. Effective January 1, 2017, acupuncture services for low back pain and migraines became a covered service. On January 1, 2018, acupuncture services will be expanded to include new provider types along with electrical stimulation. Projected acupuncture expenditures are estimated to be immaterial. APRN Prescribing. Effective with the passage of the most recent budget xxxx, there was a provision (MCDMD49) allowing an Advanced Practice Registered Nurse (APRN) who is certified in psychiatric mental health by a national certifying organization to prescribe atypical antipsychotics and antidepressant drugs without going through prior authorization. This provision already exists for psychiatrists. Based on the existing high rate of prescribing for preferred agents, we do not anticipate a material shift in volume to more expensive agents.
Acupuncture Coverage. Effective January 1, 2017, acupuncture services for low back pain and migraines will be a covered service.
Acupuncture Coverage. Effective April 1, 2021 ODM will require coverage of additional acupuncture services. At this time, we anticipate that this change is immaterial to the MMC program.
Acupuncture Coverage. Effective January 1, 2017, acupuncture services for low back pain and migraines became a covered service. On January 1, 2018, acupuncture services will be expanded to include new provider types along with electrical stimulation. Projected acupuncture expenditures are estimated to be immaterial. • Advanced Imaging Reimbursement Changes. Effective January 1, 2017, ODM modified its reimbursement policy for radiology services that occur when more than one radiology procedure is performed by the same provider or provider group for an individual patient on the same date. Payment for the primary procedure is made at 100% of the Medicaid fee schedule amount. Each additional professional component of the procedure is reduced to 95% of the Medicaid fee schedule amount, compared to the prior policy of paying each additional professional procedure at 75% of the Medicaid fee schedule amount. • Dental Program Changes. Effective January 1, 2018, coverage for tobacco cessation and counseling services will be a covered dental benefit. Based on information provided by ODM, coverage of SDF and tobacco cessation is estimated to be budget neutral. • ESRD Reimbursement Changes. Effective July 1, 2017, reimbursement for End-Stage Renal Disease (ESRD) clinics are based on the CY 2016 prospective payment system (PPS) base rate published by the Centers for Medicare and Medicaid Services (CMS). Reimbursement for services were established as follows: o Chronic maintenance dialysis performed in an ESRD dialysis clinic: 58.75% of PPS base rate; o Chronic maintenance dialysis performed in a home setting: 25.18% of PPS base rate; o Dialysis support services: 33.75% of PPS base rate; and, o Dialysis with self-care training: 67.75% of PPS base rate. We reviewed CY 2016 experience data for applicable services and believe that this program change is not material to the CY 2018 rate development process. • Insect Repellant Coverage. Effective June 6, 2016, ODM began requiring the coverage of insect repellent for enrolled members. Based on a review of the coverage requirements, estimated expenditures for this service coverage are immaterial. • IMD as an “In Lieu of” Service. Effective July 1, 2017, ODM began permitting the use of IMDs as an “in lieu of” service for the 21 to 64-year-old population for up to 15 days per month. This “in lieu of” service setting was implemented in compliance with the conditions outlined in the final Medicaid managed care regulations. Authorization of this setting ...
Acupuncture Coverage. Effective April 1, 2021 ODM will require coverage of acupuncture services for additional conditions.
Acupuncture Coverage. Effective January 1, 2018, acupuncture services were expanded to include new provider types along with electrical stimulation. We do not anticipate making a service coverage adjustment for this program change as projected expenditures are estimated to be immaterial.
