The Centers for Medicare and Medicaid Services (CMS) recently extended the Medicaid provider re-enrollment deadline from March 24, 2016 to Sept. 24, 2016 to allow states additional time to process applications. In an effort to ensure Texas Medicaid complies with the federal requirement, HHSC has established a plan to provide assurance to providers that they will meet this deadline.

To avoid potential disruption in payment, a complete re-enrollment application must be received on or before June 17, 2016 in order to be revalidated by Sept. 24, 2016. Complete applications that are received on or before June 17, 2016, will most likely complete the reenrollment process by Sept. 24, 2016. In the event that the re-enrollment process is not completed by Sept. 24, 2016, and the provider is still working toward addressing identified deficiencies at that time, the provider will continue to remain enrolled in Texas Medicaid as long as the provider responds to the deficiency notifications within the defined time frame for response. Enrollment is contingent upon continuing to meet deficiency correction timelines and receiving final application approval. Providers are encouraged to submit their applications today. For complete details, please visit: http://www.hhsc.state.tx.us/medicaid/re-enrollment/index.shtml.

This notification is to advise pharmacy providers of future formulary changes in the MedImpact Healthcare Systems, Inc. Medicare Part D Formularies. A list of drugs along with the description of the change and effective date is included in the formulary change portion of this notification which is available on the ChainDrugStore.net network (www.chaindrugstore.net). These changes will go into effect in 60 days coinciding with CMS required 60 days notice to Beneficiaries of any negative formulary changes.

Thank you,

MedImpact Healthcare Systems, Inc.

Effective January 1, 2016 This notice is to provide you with information on the actions taken by OptumRx to implement Maximum Allowable Cost (MAC) pricing and disclosure requirements that are effective beginning January 1, 2016. On April 6, 2015, CMS issued “Announcement of Calendar Year (CY) 2016 Medicare Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter.” In the Final Call Letter, CMS codified the MAC pricing requirements included in CMS-4159-F (final rule). The final rule added MAC pricing to existing prescription drug pricing standards, which requires pharmacy drug cost pricing to be updated at least every seven calendar days. Sponsors are also required now to disclose MAC prices to applicable pharmacies in advance of their use for reimbursement. The portion of the Final Call Letter that speaks to the MAC pricing disclosure requirement is below:

As you may have heard, CMS released a preview of the 2016 Medicare Part C & D Star Ratings (see attached) to Part D plan sponsors, which included the Star Rating cut points for the new Part D Star measure—MTM Program Completion Rate for Comprehensive Medication Reviews (CMRs). As performance expectations heighten with the release of this new data, pharmacies with limited resources may begin to look at outsourcing MTM opportunities to a vendor.

Date: December 21, 2015 Effective: January 1, 2016 Summary • Effective January 1, 2016, CMS requires that claims for covered Medicare Part D drugs must include active and valid prescriber NPIs; claims for both new prescriptions and refills without a qualifier for NPI and a valid NPI number will reject.