Participation in the State Drug Rebate Program. A. Contractor shall participate in the federal and State drug rebate program by including all utilization data for both current and retroactive outpatient drugs in its Encounter Data as necessary to meet federal requirements set forth in 42 USC section 1396r-8(k)(2).
1) Encounter Data for outpatient drugs shall comply with Section 1927(b)(1)(A) of the Social Security Act.
2) All outpatient drug Encounter Data shall include, at a minimum, the total number of units of each dosage form, strength, and package size, by National Drug Code, for each eligible Physician administered drug claim.
B. Pursuant to 42 CFR 438.3(s), Contractor shall ensure that Encounter Data for outpatient drugs from participants in the federal 340B program contains DHCS-required identifiers to maintain compliance with the requirements of 42 USC 256b(a)(5)(A)(i). Contractor shall also comply with the provisions of W & I Code 14105.46.
C. Contractor shall assist DHCS in resolving manufacturer rebate disputes due to Provider Network or Encounter Data submissions.
Participation in the State Drug Rebate Program. A. Contractor shall participate in the federal and State drug rebate program by including all utilization data for both current and retroactive outpatient drugs in its Encounter Data as necessary to meet federal requirements in Section 1927(k)(2) of the Social Security Act.
1) Encounter Data for outpatient drugs shall comply with Section 1927(b)(1)(A) of the Social Security Act.
2) All outpatient drug Encounter Data shall include, at a minimum, the total number of units of each dosage form, strength, and package size, by National Drug Code, for each claim, including eligible Physician Administered Drug claims.
B. Pursuant to 42 CFR 438.3(s), Contractor shall ensure that Encounter Data for outpatient drugs from participants in the federal 340B program contains DHCS-required identifiers to maintain compliance with the requirements of
Participation in the State Drug Rebate Program. A. Contractor shall participate in the federal and State drug rebate program by including all utilization data for both current and retroactive outpatient drugs in its Encounter Data as necessary to meet federal requirements in Section 1927(k)(2) of the Social Security Act.
1) Encounter Data for outpatient drugs shall comply with Section 1927(b)(1)(A) of the Social Security Act.
2) All outpatient drug Encounter Data shall include, at a minimum, the total number of units of each dosage form, strength, and package size, by National Drug Code, for each claim, including eligible Physician Administered Drug claims.
B. Pursuant to 42 CFR 438.3(s), Contractor shall ensure that Encounter Data for outpatient drugs from participants in the federal 340B program contains DHCS-required identifiers to maintain compliance with the requirements of 42 USC 256b(a)(5)(A)(i). Contractor shall also comply with the provisions of W & I Code 14105.46.
C. Contractor shall assist DHCS in resolving manufacturer rebate disputes due to Provider Network or Encounter Data submissions.
1. General Requirement Contractor shall implement an effective Quality Improvement System (QIS) in accordance with the standards set forth in Title 28, CCR, Section 1300.70 and 42 CFR 438.330. Contractor shall monitor, evaluate, and take effective action to address any needed improvements in the quality of care delivered by all Providers rendering services on its behalf, in any setting. Contractor shall be accountable for the quality of all Covered Services regardless of the number of contracting and subcontracting layers between Contractor and the Provider. This provision does not create a cause of action against the Contractor on behalf of a Medi-Cal beneficiary for malpractice committed by a Subcontractor.
