Recent News

New regulations restrict opioid cough and cold prescriptions

Effective April 2, opioid cough and cold medications will not be covered by Texas Medicaid fee-for-service for individuals 17 years and younger. The new restriction is based on the U.S. Food and Drug Administration’s recent decision to require safety labeling that limits the use of prescription cough cold medication containing codeine or hydrocodone to individuals 18 years and older.

Consult the Health and Human Services Vendor Drug Program for more information and a list of drugs on the Medicaid formulary that are affected by the change. Physicians and pharmacists should consult a patient’s Medicaid managed care organization for claim limitation requirements.

Hurricane Harvey resources for Medicaid providers

Texas Health and Human Services has launched a web page to provide pertinent Hurricane Harvey information to Texas Medicaid and CHIP providers. The web page provides updated links and resources for health-care and pharmacy providers who serve people affected by the hurricane. Information applies to patients who are covered by Medicaid fee-for-service and managed care. The web page will be regularly updated throughout the emergency situation.

A companion web page is available to assist members of the public who need disaster assistance.

LeadCare Analyzers not approved for venous blood testing

Texas Health Steps providers should not use Magellan Diagnostics’ LeadCare analyzers for venous blood lead tests. The Centers for Disease Control and Prevention (CDC) issued a Health Advisory warning that the analyzers may underestimate blood lead levels and provide falsely low test results. The FDA recommends against using LeadCare analyzers for venous blood samples.

The safety alert does not apply to capillary blood lead test results collected by fingerstick or heelstick. Texas Health Steps providers may continue to use LeadCare II Analyzers for point-of-care blood lead screening when testing capillary samples.

Visit the CDC Health Advisory website for more information about the safety alert.

RSV season ends April 14

The 2016-17 Respiratory Syncytial Virus (RSV) season will end April 14 for all Texas counties. No extensions were granted this season based on recommendations from the Texas Pediatric RSV Task Force.

Coverage of Synagis (palivizumab) will end April 14 for people enrolled in Medicaid (both traditional and managed care) and the Children with Special Health Care Needs services program. Pharmacy claims and prior authorization requests will not be accepted or reviewed after that date.

Got Transition, AAP release new transition coding and reimbursement tip sheet

Improving transition from pediatric to adult health care is a national priority, medical home standard, and meaningful use requirement for electronic health records. A new tip sheet from Got Transition and the American Academy of Pediatrics (AAP) supports delivery of recommended health-care transition services in pediatric and adult primary and specialty care settings.

The tip sheet includes:
• An updated list of transition-related CPT codes.
• Clinical vignettes with recommended CPT and ICD-10 codes.
• Detailed CPT coding descriptions for transition-related services with selected coding tips.

More information is available from the Got Transition website.