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Medicaid Reimbursement For Services By Pharmacists

Concerning reimbursement for pharmacists' services under the medical assistance act, and, in connection therewith, making an appropriation.
2021 Regular Session
Health Care & Health Insurance
Professions & Occupations
Bill Summary

The bill requires that a pharmacist receive reimbursement under the medical assistance program for providing services authorized in statute, which reimbursement must be equivalent to the reimbursement provided to a physician or advanced practice nurse for the same services rendered, including services delivered by a pharmacist through telemedicine. The department of health care policy and financing is directed to seek any federal authorization necessary to receive federal matching money for the reimbursements. Under the bill, a pharmacist is eligible for reimbursement under the medical assistance program for certain medically necessary pharmacist services, as described in the bill, that are not duplicative of other pharmacist services or programs reimbursed under the medical assistance program. The department of health care policy and financing shall include services reimbursed pursuant to the bill in the review of provider rates for the medical assistance program.

Further, the bill allows a pharmacist or pharmacy with authority to administer that dispenses or administers extended-release injectable medications for the treatment of mental health or substance use disorders to seek reimbursement for those medications under the medical assistance program as either a pharmacy benefit or as a medical benefit.The bill requires that costs associated with services provided by clinical pharmacists through a federally qualified health center (FQHC) be considered allowable costs for the purpose of the FQHC's cost report and included in the calculation of the reimbursement rate for a patient visit at an FQHC.

(Note: Italicized words indicate new material added to the original summary; dashes through words indicate deletions from the original summary.)

(Note: This summary applies to the reengrossed version of this bill as introduced in the second house.)




Bill Text