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Part 2 11-07-07 30-07-07 03-07-09 14-07-06 31-07-20 08-07-15 24-07-14 32-07-07 09-07-14 27-07-09 Ch 4285 NOTICES • Peek v. Department of Aging, 873 A.2d (Pa. Commw. GOVERNOR’S OFFICE 2005). Catalog of Nonregulatory Documents • Silo v. Commonwealth, 886 A.2d 1193 (Pa. Commw. 2005). Under Executive Order 1996-1, agencies under the • jurisdiction of the Governor must catalog and publish Commonwealth v. TAP Pharmaceutical Products, Inc., nonregulatory documents such as policy statements, guid- 885 A.2d 1127 (Pa. Commw. 2005). ance manuals, decisions, rules and other written materi- • Christian Street Pharmacy v. Department of Aging— als that provide compliance related information. The unreported Commonwealth Court Opinion—May 30, following compilation is the fifteenth list of the 2007. nonregulatory documents. This list is updated and pub- • lished annually on the first Saturday in August. Christian Street Pharmacy v. Pa. Department of Aging, 946 A.2d 798 (Pa. Commonwealth Court, April 10, This catalog is being provided to ensure that the public 2008). has complete access to the information necessary to • understand and comply with state regulations. We have Commonwealth v. TAP Pharmaceutical Products, et al., made every effort to ensure that the catalog includes all 212 MD 2004 documents in effect as of August 7, 2010; however, due to • Commonwealth v. Janssen Pharmaceutical Inc. Phila- the breadth and changing nature of these documents, we delphia Court of Common Pleas, Case #002181 cannot guarantee absolute accuracy. Facilitating access to information is important to enhancing the partnership INTERNAL GUIDELINES: between the regulated community and the state. PHARMACEUTICAL PROGRAM (PACE) Governor Contact: PACE Compliance Division (717) 787-7313 PACE PROVIDER BULLETINS: 2011 ADMINISTRATION • January 4, 2011—Medicare Part D Partner Plan As- Editor’s Note: The Index of Issuances, Manual signments: PACE, CRDP and SPBP Programs solicit M210.3, issued by the Governor’s Office of Administra- qualified Prescription Drug Plans who are interested in tion, Directives Management System, includes Executive partnering with the Program to provide a coordinated Orders, Management Directives and Manuals. New or benefit. revised documents to the Index are published monthly in • the Pennsylvania Bulletin and the entire index is revised January 6, 2011—Medicare Part D Additional yearly in the Pennsylvania Code. Cardholders: Enclosed is an additional list of Medicare Part D cardholders. AGING • January 14, 2011—Part D Partner Plan Update: Wellcare PCN. DECISIONS: • January 21, 2011—Other Payer BIN: When submitting Office of Chief Counsel a claim to PACE/CRDP/SPBP as the secondary payer, Contact: Anne H. Kapoor, Assistant Counsel (717) be sure the BIN entered in the primary claim is the 783-1609 same as the BIN entered in the COB segment. • Reynolds v. Department of Aging, 570 A.2d 1373 (Pa. • January 28, 2011—Part D Primary Plan Edit: Effective Commw. 1990). Tuesday, February 1, 2011, claims billed to the • Pennsylvania Department of Aging v. Lindbergh, 469 cardholder’s incorrect primary plan will deny with A.2d 1012 (Pa.1983). NCPDP Reject Code 7C—Missing/Invalid Other Payer ID. • Suburban/Bustleton v. Department of Aging, 579 A.2d 426 (Pa. Commw. 1990). • April, 2011—Non-Participating Manufacturer: Effective April 1, 2011, Fresenius Medical Care, labeler code • McGuire v. Department of Aging, 592 A.2d 830 (Pa. 49230, has terminated its manufacturer’s rebate agree- Commw. 1991). ment with the Commonwealth. • Dickey v. Department of Aging, 615 A.2d 990 (Pa. • May 16, 2011—Same Cycle Voids: The PACE processing Commw. 1992). system will be implementing a change effective October • In the Interest of M.B., 686 A.2d 87 (Pa. Commw. 1996). 1, 2011, affecting claims paid and voided with the same processing cycle. • Calabro v. Department of Aging, 689 A.2d 34 (Pa Commw. 1997). • May 16, 2011—Chain Provider Voids: The PACE Pro- cessing system will be implementing a change effective • Calabro v. Department of Aging, 698 A.2d 596 (Pa. October 1, 2011, that may impact chain providers. 1997). PACE PROVIDER BULLETINS: 2010 • Schaffren v. Philadelphia Corporation for Aging, 1997 • U.S. Dist. Lexis 17493 (M.D. Pa., 1997). January, 2010—2010 Medicare Part D Partner Plans: PACE is conducting its annual assignment of cardhold- • Scanlon v. Department of Aging, 739 A.2d 635 (Pa. ers into Part D partner plans. Commw. 1999). • February 1, 2010—New PACE Cardholder ID Number: • Nixon v. Com. of PA, 789 A.2d 376 (Pa. Commw. 2001), Beginning March 4, 2010, PACE will be mailing new affirmed by 576 Pa. 385 (Pa. 2003). PACE Cards to all current PACE/PACENET members. PENNSYLVANIA BULLETIN, VOL. 41, NO. 32, AUGUST 6, 2011 4286 NOTICES • February 2, 2010—NEW PACE/PACENET CARD: All • December 14, 2010—Prospective Drug Utilization Re- Cardholders will receive a new PACE/PACENET card view (ProDUR) Criteria Additions: Effective December and ID number. Effective Tuesday, May 4, 2010, only 14, 2010, the following maximum daily dose, duration, the new PACE/PACENET ID will be accepted. The old age and step therapy criteria have been added to the number will reject with the NCPDP error 07 M/I Department of Aging’s Prospective Drug Utilization Cardholder ID number. Review Program in the following drug classes. • February 19, 2010 New Edits: Effective February 23, • December 17, 2010—340B Pricing Retraction: Effective 2010, PACE will implement the following edits:... immediately the Department of Aging is withdrawing • the June 21, 2010, Bulletin mandating that providers March 1, 2010 New PACE/PACENET Card Implemen- submitting claims using pharmaceuticals purchased tation Revision: The PACE/PACENET card implemen- through the 240B Drug Discount Program bill the tation has been delayed until April. Program a Usual and Customary price that reflected • March 10, 2010—CMS Termination of Fox Insurance: the 240B discounted price. Effective March 9, 2010, CMS terminated Fox Insur- • December 28, 2010—Medicare Part D Partner Plans: ance as a Medicare Part D plan. PACE is sending lists of PACE cardholders and their • March 29, 2010—PPI EDIT: Effective Tuesday March Part D partner information to the cardholder’s phar- 30, PACE will implement a PPI edit for cardholders macy to enable cardholder primary payer information enrolled in either MemberHealth Community CCRX or to be updated as quickly as possible. Ovations AARP Rx Saver plans. PACE PROVIDER BULLETINS: 2009 • April 9, 2010—Osteopathic Assistants (OA’s): The State • September 23, 2009—Valid Claim Data: The May 2009, Board of Osteopathic Medicine has amended its regula- Provider Bulletins (included with this transmission) tions whereby the supervising physician may delegate reminded providers that the responsibility for the valid- to the physician assistant (Osteopathic Assistant) the ity of their claim data lies with them. prescribing, dispensing, and administering of drugs and • therapeutic devices. July 1, 2009—MemberHealth CCRX and First Health Premier Claim Submissions: Enclosed is a list of • April 23, 2010—Osteopathic Assistants (OA’s): As cardholders that frequent your pharmacy and are en- stated in the previous bulletin, the State Board of rolled in either MemberHealth CCRX or First Heath Osteopathic Medicine amended its regulations whereby Premier Part D Plans. This list contains the correct the supervising physician may delegate to the physician BIN, PCN, Member ID and Group for each member and assistant (Osteopathic Assistant) the prescribing, dis- is a duplicate of the list sent in early January. pensing and administering of drugs and therapeutic • devices. July 1, 2009—PACE Claim Submissions: The Pennsyl- vania Pharmaceutical Assistance Contract for the El- • June 7, 2010—NEW PACE/PACENET CARD EDIT: derly Program (PACE) has received bulletins forwarded The new PACE/PACENET card mailing has been com- by Pennsylvania pharmacy providers. pleted. Distribution of pharmacy cardholder lists was • completed in early April. May 29, 2009—Future Provider Notifications: As an- nounced, this week’s Remittance Advice is the last • June 11, 2010—New PACE/PACENET Card NCPDP paper R/A for PACE, SPBP, CRDP, PAP and SWIF. To Error 07. inform providers of Program changes or initiatives in • the future, Provider Bulletins will continue to be June 21, 2010—340B Pricing: Providers are advised e-mailed to pharmacy associations, chain corporate that pharmaceuticals billed to the Commonwealth that offices as well as being available on the Department of are eligible for 340B pricing are being reviewed. Aging’s website at www.aging.state.pa.us. • June 24, 2010—Workers’ Compensation Security Fund, • May 29, 2009—Prospective Drug Utilization Review Catastrophic Loss Benefits Continuation Fund Pro- (ProDUR): Criteria Additions: The following list con- grams: All PACE Providers have been mailed packets of tains recommended initial maximum dose, maximum information inviting their participation as a pharmacy daily dose and duration criteria which have been added provider in the above mentioned Programs. to the Department of Aging’s Prospective Drug Utiliza- • August 23, 2010—Remittance Advice Name Change: In tion Review program in the following drug classes: September the sender ID value and the electronic R/A • May 29, 2009—Validity of Claim’s Information: Provid- file name will be changing. ers are responsible for the validity of their claims’ data. • September 14, 2010—Prescription Imaging: The De- The PACE Provider Agreement states. partment has reviewed the practice of scanning (imag- • May 15, 2009—Claim Reversal Specification Revision: ing) a prescriber’s
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