DOH Clarifies LTC Pharmacy Overrides for Medicaid Billing
In the February 2023 Medicaid Update, released last week, the Department of Health (DOH) clarified the use of early fill overrides by long term care (LTC) pharmacies for certain Medicaid beneficiaries who are newly admitted to, or departing from, a nursing home and need a medication supply. The new guidance applies only to:
- a new resident in a facility as well as available options for a New York State Medicaid member short leave of absence, or when a New York State Medicaid member was discharged to the community without medication supply;
- a readmitted resident in a facility for which there is no supply on hand;
- a New York State Medicaid member with a short leave of absence from the LTC facility; and
- a New York State Medicaid member who was discharged to the community without medication supply.
The guidance directs providers seeking assistance with a permitted override to contact the eMedNY Call Center at 800-343-9000. Questions regarding the policy should be directed to the New York State Medicaid Pharmacy Unit by email here or by phone at 518-486-3209.
The new guidance also includes a reminder to return “unused” medications – i.e., discontinued medications, missed doses, unused medication after patient transfers or discharges – to the dispensing/vendor pharmacy for credit to the New York State Medicaid program as indicated in Title 10 NYCRR §415.18 (f).
Contact: Karen Lipson, klipson@leadingageny.org