Change in nursing home prescription drug reimbursement

Prescription drug costs that have been paid as part of the nursing home Medicaid rate will be removed from the rate and instead be billed directly to Medicaid by the dispensing pharmacy.  DOH anticipates this change to be effective on October 1, 2010.  This means that homes will receive the lower, Medicare Part D eligible rate for all Medicaid residents but will no longer have to pay for prescription drugs for their Medicaid residents who are not eligible for Medicare. 

DOH issued a Dear Administrator letter (DAL) (see Attachment 1) last week specifying that pharmacies that supply prescription drugs to nursing homes, including in-house pharmacies, must be enrolled in the Medicaid program to submit reimbursement claims.  Pharmacy enrollment questions should be addressed to Diane Filkins, 518-402-7032, while members with questions regarding changes to the Medicaid nursing home rate due to this provision should contact Al Fargione, 518-474-1057. 

Contact:   Darius Kirstein, dkirstein@nyahsa.org, 518-449-2707, ext. 104