Medicaid Standing Order For Mosquito Repellent To Fight Zika
Texas now covers select mosquito repellents under the Medicaid , Childrens Health Insurance Program , and Healthy Texas Women programs. The Kidney Health Care program does not cover these products.
On June 1, 2016, the Centers for Medicare & Medicaid Services released an informational bulletin on Medicaid benefits available for the prevention, detection, and response to the Zika virus. The CMS bulletin allows state Medicaid programs to choose to cover mosquito repellents when prescribed by an authorized health professional and provided as a pharmacy benefit.
The Texas Medicaid Medical Director has issued a Texas Medicaid Standing Order for Mosquito Repellent for use by pharmacies. Eligible Superior members that use pharmacies that dispense mosquito repellent under this Standing Order will not require a prescription to be written by their healthcare provider. The Texas Medicaid Standing Order for Mosquito Repellent is available for Texas Medicaid and CHIP clients, at participating pharmacies.
Eligible women in the Healthy Texas Women program may obtain mosquito repellent without a prescription.
Read the full HHSC notice and benefit information by clicking below:
New York State Medicaid Fee
In accordance with New York State Education Law, pharmacists are authorized to administer the following vccines to patients 18 years of age and older: zoster, pneumococcal, meningococcal, tetanus, diphtheria, and pertussis vaccines. For patients two years of age and older, pharmacues may administer influenza vaccines. Additional information can be found on the “NYS Education Department Administration of Immunizations” web page.
Only Medicaid enrolled pharmacies will receive reimbursement for immunization services and products. Services must be provided and documented in accordance with NYS Education laws and regulations, including the reporting of all immunizations administered to members less than 19 years of age to either the NYS Department of Health , using the NY State Immunization Information System , or to the New York City Department of Health and Mental Hygience using the New York Citywide Immunization Registry .
Pharmacies will only be able to bill for Medicaid non-dual eligible members. Dual eligible members will continue to access immunization services through Medicare. Medicaid Managed Care enrollees will continue to access immunization services through their health plans. For Medicaid Managed Care Organization billing guidance, providers must contact the individual plan. Providers can access individual plan information via the “NYS MMC Pharmacy Benefit Information Center” web page, then select the individual plan and choose “Pharmacy Vaccine Billing Guidance”.
Questions And Additional Information:
- Medicaid FFS coverage and policy questions should be directed to the Office of Health Insurance Programs Division of Program Development and Management by phone at 4732160 or by email at .
- MMC general coverage questions should be directed to the OHIP Division of Health Plan Contracting and Oversight at or 4731134.
- MMC reimbursement and/or billing requirements questions should be directed to the enrollee´s MMC Plan. For an MMC directory by plan, providers can refer to the
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Medicaid Consumer Fact Sheets Now Available
Following a recommendation from the Medicaid Redesign Team II, the New York State Department of Health Office of Health Insurance Programs created Medicaid consumer fact sheets focused on chronic health conditions. Each fact sheet provides information regarding how a condition can be prevented or managed, as well as relevant Medicaid benefits that can be used to help members stay healthy. Topics include sickle cell disease, diabetes, high blood pressure, asthma control, HIV-PrEP , and smoking cessation. Fact sheets can be found on the MRT II Policies and Guidance web page, and are available in English, Spanish, Traditional Chinese, Russian, Haitian Creole, Bengali, and Korean. The most recently added Sickle Cell Disease fact sheet is also available in Simplified Chinese, Polish, Yiddish, Arabic, and Italian.
New York State Medicaid Expansion Of Non
Effective September 1, 2021 for New York State Medicaid fee-for-service and effective November 1, 2021 for Medicaid Managed Care Plans , coverage of non-invasive prenatal trisomy screening using cell-free fetal DNA will be expanded to include pregnant members age 30 and older. Additionally, this coverage now includes twin pregnancies, but not higher multi-gestational pregnancies. Consistent with current policy, non-invasive prenatal trisomy screening will continue to be covered when at least one of the following criteria is met:
- either parent has a family history of aneuploidy in a 1st* or 2nd** degree relative
- standard serum screening or fetal ultrasonographic findings indicate an increased risk of aneuploidy
- parent have a history of a previous pregnancy with a trisomy and/or
- either parent is known to have a Robertsonian translocation.
*1st degree relatives: Parents, children, siblings
**2nd degree relatives: Grandparents, aunts and uncles, nieces and nephews, and grandchildren
Note: This is an update to the October 2014 Medicaid Update.
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Medicaid Mosquito Repellent Benefit Reinstated
The Texas Health and Human Services Commission issued a news release today regarding the reinstatement of the Texas Medicaid Mosquito Repellent Benefit. According to the release, the benefit begins 11/29/2016 and will be in place through December.
“Eligible Texas women can go to participating pharmacies to pick up mosquito repellent, as Texas Medicaid has a standing order for mosquito repellent prescriptions for women who are between the ages of 10 and 45 or pregnant.
The benefit includes two cans per month per eligible beneficiary. Women are encouraged to call the pharmacy ahead of time because supply can vary by location.
Women eligible for the Medicaid, CHIP and CHIP-Perinate programs are covered. Women covered under the Healthy Texas Women and Children with Special Health Care Needs programs also can receive the benefit.
The following Zika-related items also are covered under current Texas Medicaid benefits:
- Family planning services
Louisiana Medicaid To Cover Mosquito Repellent For Zika Prevention
On June 1, the Centers for Medicare and Medicaid Services announced that it is now allowing states to pay for mosquito repellent for Medicaid enrollees as a Zika virus prevention measure.
Following this announcement, the Louisiana Medicaid program adopted a policy to allow physicians to prescribe mosquito repellent to their Medicaid patients. The Department of Health has identified which mosquito repellents are acceptable for use during pregnancy, and has disseminated this information to providers as well as to the public via the LDH website.
According to Dr. SreyRam Kuy, chief medical officer for the Medicaid program, the agency worked with its pharmacy team and Medicaid health plans as well as the CDC and the Office of Public Health to develop the policy.
With this policy, we now offer coverage for mosquito repellents for pregnant women and beneficiaries who are actively planning to conceive. Although our plan was for this coverage to begin as soon as there was local transmission documented in Louisiana, some of our health plans have already started reimbursing for mosquito repellent, and in light of the rapid growth of local transmission cases in Florida, we are now pre-emptively activating our coverage of repellents. said Dr. Kuy.
Louisianas Medicaid program already provides prenatal care, family counseling and contraception, which are the programs primary Zika virus prevention measures, to its enrollees given the risks Zika virus poses to unborn children.
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State Medicaid Agencies Could Spend Up To $5 Million To Cover Mosquito Repellent
With more reports of non-travel related Zika cases popping up in the U.S., state Medicaid agencies are preparing to spend millions to prevent spread of the virus. But some experts say that money could be better spent elsewhere.
In the past few weeks, Louisiana, Texas, Pennsylvania, Mississippi, Ohio and Virginia have all said they plan to cover mosquito repellent in an effort to prevent contraction of the virus. Delaware has posted a proposed rulemaking to do the same.
Texas officials believe they may spend as much as $12.6 million in federal and state funding as a result of the new coverage. Louisiana estimates it will spend more than $5 million. The other states did not immediately respond to requests for cost projections.
Earlier this summer, the CMS granted states permission to cover repellents if they were prescribed by an authorized health professional.
Advocates and providers called the coverage critical to decreasing the chances of transmission among lower income people who already are more at risk for contracting the virus, according to Georges Benjamin, executive director of the American Public Health Association. Zika causes a mild illness in most people but can lead to severe brain-related birth defects if women are infected during pregnancy.
âWhen living paycheck to paycheck, mosquito repellent is just like medication. Necessary, but discretionary over rent, food and transportation to get to work,â Benjamin said.
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Can You Use Medicaid To Cover The Cost Of Mosquito Repellent Feds Say ‘yes’
While Congress bickers over emergency Zika funding, other agencies are starting to step up to the plate when it comes to protecting people from being infected with the virus. On Wednesday, the Centers for Medicare & Medicaid Services wrote a letter saying that Medicaid would cover the cost of insect repellant. As anyone who has ever dealt with Medicaid should expect of course, there are a few caveats.
As a general matter, over the counter insect repellents would not be covered byMedicaid. However, state Medicaid programs may choose to cover mosquito repellents whenprescribed by an authorized health professional and these products would be eligible for FederalFinancial Participation under such circumstances.
Romper has reached out to the regional New York State Medicaid Office for comment on the different kinds of insect repellants patients may ask for and is awaiting a response.
Because lest anyone think that Medicaid is going all out to protect people from Zika, it’s worth a closer look. According to the letter, CMS will “allow” states to cover:
Condoms and other methods of contraception that prevent or delaypregnancy. States may also cover items such as oral contraceptives, condoms,diaphragms, foams, gels, patches, rings, injections, tablets, emergency contraceptives,and long-acting reversible contraception.
To Fight Zika Texas Medicaid Will Pay For Mosquito Repellent
Texas officials announced on Wednesday they would allow Medicaid to pay for mosquito repellent for women in the hopes of preventing the Zika virus.
With federal funding to fight Zika stuck in Congress, and amid news that mosquito-to-human transmission of the virus has reached the continental United States, Texas officials announced on Wednesday they would allow Medicaid to pay for mosquito repellent for women, in the hopes of preventing the disease.
The decision comes two months after the Obama administration first told states they could allow Medicaid, the federal-state health insurance program for the poor and disabled, to pay for Zika prevention services, including mosquito repellent and family planning.
Women who are pregnant or are between the ages of 10 and 45 are eligible so long as a doctor prescribes the mosquito repellent and the patient picks it up at a pharmacy. State officials say women should not schedule an office visit to receive mosquito repellent unless it is medically necessary.
“The best way to protect yourself from Zika is by avoiding mosquito bites,” said Charles Smith, executive commissioner of the Texas Health and Human Services Commission, in a statement. “There is currently no vaccine to prevent the disease or drug to treat it, making it essential that people use mosquito repellent to protect women and unborn babies.”
Eligible women can get up to two cans of repellent per month through Oct. 31, according to state officials.
Healthy Texas Women Program To Require Prescription For Mosquito Repellents Beginning Feb 18
Texas Health and Human Services covers mosquito repellents for the prevention of the Zika virus. Covered programs include:
- Children’s Health Insurance Program
- Children with Special Health Care Needs Services Program
- Healthy Texas Women Program
Beginning Feb. 18, people enrolled in the Healthy Texas Women Program will now require a prescription to receive mosquito repellents.
Texas HHS issued the Texas Medicaid Standing Order for Mosquito Repellent to be used for people enrolled in Medicaid, CHIP, and the Healthy Texas Women Program. This order serves as a prescription and allows pharmacists to dispense mosquito repellent under the terms of the order. Pharmacies are encouraged to use this order instead of contacting the persons healthcare providers for individual prescriptions for mosquito repellent.
To request a copy of the standing order, or for other questions about this benefit, email .
More information about the mosquito repellent benefit is available in on the Vendor Drug Program website, including prescription template and claim submission guidelines. The Pharmacy Provider Procedure Manual includes the list of covered mosquito repellents.
You have subscribed to get updates about Texas Health and Human Services . For more information about HHS, please visit our website.
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New Billing Requirement For Home Health Agencies: Demand Billing No
On January 1, 2021, the Centers for Medicare and Medicaid Services implemented a new Medicare billing requirement for Home Health Agencies requiring a No-Pay Request for Anticipated Payment for all dual-eligible Medicare/Medicaid recipients prior to billing each final claim. The No-Pay RAP must be submitted within five calendar days after the start of care date for the first 30-day period of care in a 60-day certification period and within five calendar days after the “from date” for the second 30-day period of care in the 60-day certification period. This CMS billing requirement must be satisfied for all dual-eligible Medicare/Medicaid recipients even if the final claim is not intended to be billed to Medicare. Effective immediately, all HHAs must submit No-Pay RAPs to Medicare for all services rendered to dual-eligible Medicare/Medicaid recipients.
The Office of the Medicaid Inspector General has contracted with the University of Massachusetts Medical School to perform Home Health Medicare Maximization Services. This contract seeks to maximize Medicare reimbursement for dual-eligible Medicare/Medicaid recipients who have received home health care services paid by Medicaid. Under this OMIG project, HHAs may be directed to demand bill claims to Medicare to ensure Medicaid remains the payor of last resort.
Medicaid Can Pay For Mosquito Repellent Condoms In Effort To Curb Zika
The Centers for Medicare & Medicaid Services sent the guidance to states to clarify how money could be used to fight the virus. In other news, underlying issues with Texas women’s access to health care could complicate its efforts against Zika, and Florida’s governor wrote a letter to President Barack Obama warning of a “disaster” if funding isn’t approved.
USA Today:Feds Say Medicaid Can Pay For Mosquito Repellent To Prevent ZikaMedicaid can be used to cover mosquito repellent to prevent the spread of the Zika virus, federal regulators told state and private Medicaid officials in a letter sent Wednesday. Coverage of repellent when prescribed by a health professional with the federal matching dollars given other Medicaid-covered treatments is the primary change in the new Department of Health and Human Services guidance. The letter is intended to clarify how low-income people covered by Medicaid can protect themselves so they don’t contract the virus or get tested and treated in case they do. HHS alerted about 50,000 people involved in Medicaid plans.
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Clarification And Reminder: Pharmacy Providers Servicing Medicaid Fee
New York State Medicaid fee-for-service and Medicaid Managed Care require member/enrollee consent prior to requesting a renewal or new prescription from a prescriber and before submitting a claim for a refill. The article titled published in the May 2021 issue of the Medicaid Update directed pharmacies to document consent for renewals and refills. This guidance is to clarify that most software systems and methods of outreach or intake can capture the details of request and consent.
Pharmacies should not directly outreach to prescribers for renewals, or refill a prescription, without a member/enrollee or member/enrollee designee´s request first. Additionally, pharmacies may not enroll their Medicaid FFS members or MMC enrollees in automatic refill programs.
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Billing Instructions For Medicaid Ffs
Consistent with Medicaid immunization policy, pharmacies may bill the vaccine administration fee and, when applicable, acquisition cost of the vaccine using the appropriate procedure codes. To view a list of procedure codes, providers can refer to the NYS Medicaid Pharmacy Services Fee Schedule.
Please note: National Drug Codes are not to be used for billing the vaccine product through Medicaid FFS. Reimbursement for the cost of the vaccine for members 19 years of age and older will be made at no more than the actual acquisition cost to the pharmacy. No dispensing fee or member co-payment applies. Pharmacies will bill with a quantity of “1” and a daily supply of “1”.Table A: Vaccine claims submitted via the National Council for Prescription Drug Programs D.0 format
|NCPDP D.0. Claim Segment Field||Value|
|436-E1||Enter value of “09” which qualifies the code submitted in field 407-D7 as a procedure code.|
|407-D7||Enter an applicable procedure code listed in Table B and/or C. Up to four claim lines can be submitted with one transaction.|
|Enter Prescriber National Provider Number number.|
|454-EK||Enter Enter serial number “99999999” when applicable for non-patient specific orders*.|
|419-DJ||Enter origin code “5”*.|
The NCPDP D.0 Companion Guide can be found on the “eMedNY 5010/D.0 Transaction Instructions” web page.