
What's New
Mississippi Medicaid
Attention Providers: Effective May 1, 2023, the Mississippi Division of Medicaid (DOM) is eliminating all Medicaid copayments for pharmacy and health care services. DOM plans to submit MS State Plan Amendment (SPA) 23-0011 to allow the agency to remove copays from Medicaid services. While DOM will continue to pay providers for their services, providers will no longer be able to collect copays from beneficiaries beginning Monday, May 1, 2023. Pharmacy point-of-sale paid claims will reflect a $0.00 amount in the copayment field. This change will apply to both fee-for-service and MississippiCAN claims.
Notification: Notification: Cigna will delay the implementation to require the submission of documentation to support the use of modifier 25 when billed with E/M CPT® codes 99212 – 99215 and a minor procedure. Cigna will continue to review for future implementation.
DEA News & Updates
Semaglutide News
Insurers Poised to Crack Down on Off-Label Ozempic Prescriptions by Lisa O'Mary on June 13, 2023 posted in WebMD
Insurance companies are starting to send warning letters to health care providers suspected of a practice known as off-label prescribing for the drug Ozempic. The warning letters, first reported by The Washington Post, include threats such as the possibility of reporting "suspected inappropriate or fraudulent activity … to the state licensure board, federal and/or state law enforcement." READ MORE.....
03/2023 Novo Nordisk has issued a formal letter regarding "semaglutide" and compounding that is NOT FDA approved.
On 04/11/2023, the MS Board of Pharmacy issued a statement regarding the use of compounded semaglutide.
The MS Board of Nursing regulations regarding the prescribing of weight loss medications can be found on pages 10-12 and must be in strict compliance with FDA labeling and indications.
04/13/2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) alerted the public to the noticeable rise of xylazine, a non-opioid agent increasingly found in combination with opioids such as fentanyl. Known by its street name, “tranq” or “tranq dope,” the drug is approved only for veterinary use; in humans, the powerful sedative, analgesic, and muscle relaxant can depress breathing, blood pressure, heart rate, and body temperature to critical levels. The overdose antidote naloxone does not reverse its effects. Additionally, people who inject drugs containing xylazine can develop severe skin wounds that easily become infected and, if left untreated, may lead to amputation.
New Medical Cannabis regulations, HB 1158 was signed by the Governor and are effective upon passage per MS Legislature website.
State Telehealth Laws and Reimbursement Policies Spring 2023 Summary Chart
CMS Releases Article on CY2022 Telehealth Update to the Medicare Physician Fee Schedule
In Mid-January, the Centers for Medicare and Medicaid Services (CMS) sent out an article to providers regarding telehealth billing changes in the Medicare Physician Fee Schedule (PFS), including two new modifiers and a Telehealth Services List update. The update mostly covers recent expansions to mental health treatment via telehealth. For instance, telehealth mental health services are no longer limited to patients in rural areas, can be provided to a patient at home, and in certain circumstances can be provided via audio-only if certain conditions are met. However, these new policies such as the requirement for an in-person visit 6-months prior to the telehealth-delivered services related to mental health will only become active at the end of the federal public health emergency (PHE). Until then, the PHE waivers on telehealth in Medicare are still in place. The letter clarifies the timing for these requirements including when the 6-month prior in-person visit will need to be met. Limited exceptions to the in-person requirements are described, including travel hardships or provider unavailability.
The update also includes 2 new modifiers for telehealth mental health services:
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FQ - A telehealth service was furnished using real-time audio-only communication technology
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FR - A supervising practitioner was present through a real-time two-way, audio/video communication technology
Additional information is included regarding updates to the Medicare Telehealth Originating Site Facility Fee and the addition of new Cardiac Rehabilitation (CR) codes 93797 and 93798 as Category 3 codes on the Telehealth Services List and available through December 31, 2023. Review the full article for additional details.
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State-Level Projections of Supply and Demand for Primary Care Practitioners: 2013-2025
Department of Internal Revenue State of MS
Medical Clinic Fact Sheet.pdf
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