DOH Medicaid Update January 2001 Vol.16, No.1

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Effective September 28, 2000, Medicaid coverage is available for mifepristone (brand name Mifeprex, also known as RU 486) and misoprostol when administered for medically necessary non-surgical abortions. Payment is available to physicians offering the medical abortion service in the private office setting, as well as to Article 28 certified clinics who may offer the service. Administration of the drug(s) should be in accordance with established medical protocols. Payment for the service will be available as follows:

Physician Office

• Payment of $30 each will be made for all medically necessary evaluation and management office visits;
• Payment for the drugs will be paid up to a maximum of $272. Procedure code W0486 should be used to bill for the drugs.

Clinic

• Payment will be made for all medically necessary clinic visits (rate code 1610 or 2870) associated with the service.
• Payment for the drugs will be paid up to a maximum of $272 using procedure code W0486.
• When billing for the drugs, diagnostic and treatment centers should use the Referred Ambulatory Category of Service (0163) and hospital based clinics should use the Hospital Ordered Ambulatory Category of Service (0282).

W0486 includes payment for both drugs up to a maximum of $272. All drugs used for this procedure should be billed on one claim line using procedure code W0486. A unit of one should be indicated, regardless of the number of tablets provided. Procedure code W0486 can be billed only one time per medical abortion.

Elective medical abortions continue to be covered only for New York City recipients.

Questions on Medicaid coverage for this procedure may be directed to the New York State Department of Health, Division of Policy and Program Guidance, at: 518-473-5873.

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Computer Sciences Corporation (CSC), the fiscal agent for the New York State Medicaid Management Information System (MMIS), announces the following schedule of Introductory Seminars. Topics will include:

• Overview of MMIS
• Explanation of MMIS Provider Manual
• Discussion of Medicaid Managed Care
• Overview of Billing Options
• Explanation of 90-day Regulation
• Explanation of Utilization Threshold Program

Please indicate the seminar(s) you wish to attend below:

March 1, 2001 [_______] 1 PM
Mexico, NY (address to be announced)

March 14, 2001 [_______] 10 AM
Putnam County Department of Social Services
Old Route 6
Carmel, NY

Additional seminars may be scheduled as new programs are implemented or changes to existing billing procedures are announced.

Please complete the following registration information:

Provider Name:__________________________________

Provider ID:__________________

Provider Category of Service:________________________________

Number Attending:__________

Contact Name:____________________________________

Phone Number:______________________

If the seminar address is not listed above, a CSC representative will contact you at least two weeks prior to the seminar date to confirm attendance and provide seminar address information. Each seminar will last approximately two hours. Providers who have questions about these seminars can call CSC at the following numbers:

Practitioner Services (800) 522-5518 (518) 447-9860
Institutional Services (800) 522-1892 (518) 447-9810
Professional Services (800) 522-5535 (518) 447-9830

To register, please mail this completed page to:

Computer Sciences Corporation
Attn.: Provider Outreach
800 North Pearl Street
Albany, NY 12204

Or, you may fax a copy of the completed page to: 518-447-9240

Note: Please keep a copy of your seminar choice for your records. No written confirmations will be sent.

Thank you for participating in New York State's Medicaid program.

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The Department of Health is promoting disease management for Medicaid recipients. The purpose of this program is to partner with the provider community in an effort to promote quality care.

In support of the disease management program, the Medicaid Update is being enhanced to include monthly articles on various health care issues. A special emphasis will be placed on providing practitioners with information regarding nationally accepted standards of care for treatment of acute and chronic conditions. Initially, the program will focus on asthma, diabetes, and smoking cessation.

This clinical enhancement to the Medicaid Update may be useful to Medicaid practitioners. We encourage readers to share these publications with their clinical practitioners. Please contact the New York State Department of Health, Bureau of Program Guidance, at (518) 474-9219 with suggestions on articles that would be of particular interest to you in improving health outcomes for your Medicaid patients.

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The Department of Health advised you in the August and September 2000 Medicaid Updates and in a subsequent December 18, 2000 letter that a series of clinic edits will soon be activated by Computer Sciences Corporation (CSC), the Medicaid fiscal agent, to verify the accuracy of servicing and referring provider numbers reported on your claims. In response to these communications, a number of you contacted the Department with concerns about the accuracy of your provider information. Therefore, a decision has been made to postpone implementation of these edits until April 2001, to give your billing offices time to correct any erroneous information, and to review Medicaid's billing procedures.

Please use this additional time to closely examine your computer files and billing procedures. The information previously provided to you should address the vast majority of your questions. If you have remaining questions, please call Mr. Sal Medak, Bureau of Performance Assessment and Reporting, at (518) 474-2239.

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The November 2000 Medicaid Update article concerning spacers and peak flow meters contained information that these items are available from category of service 0604 Transportation/DME. Please note that Transportation/DME is no longer a valid category of service.

Spacers and peak flow meters remain available from Medicaid enrolled pharmacies and durable medical equipment providers.

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Secondhand smoke affects the general population. A large number of adults and children are routinely exposed to secondhand smoke at home and elsewhere. Healthcare providers can have a profound effect on patients who want to stop smoking or who will stop smoking for the health of their children. Please remember to Ask, Advise and Assist your patients to become tobacco-free.

• The Environmental Protection Agency has classified secondhand smoke as a "Group A Carcinogen", the same as asbestos, arsenic and radon.
• Since some of the more toxic and carcinogenic compounds in tobacco smoke are present in higher concentrations in secondhand smoke, scientists estimate that the health hazards of regular exposure to secondhand smoke are comparable to being a "light" active smoker.
• The particles in secondhand smoke are also smaller than those inhaled by smokers and therefore generally penetrate deeper into the lungs where they are more likely to cause damage.

• Children exposed to secondhand smoke through parental smoking face an increased risk for middle ear disease and for respiratory infections, such as bronchitis and pneumonia. These children take longer to recover from such illnesses.
• Secondhand smoke increases the number of asthma attacks and the severity of asthma in about 20% of this country's two million to five million asthmatic children. Each year, U.S. parents who smoke at least 10 cigarettes a day can actually cause between 8,000 and 26,000 new cases of asthma among their children.
• Because children's bodies are still developing, exposure to the poisons in secondhand smoke puts children in danger of severe respiratory disease and can hinder the growth of their lungs.

The NYS Smokers Quitline 1-866-NYQUITS (1-866-697-8487) offers a cost-free Secondhand Smoke Packet for patients and medical providers which includes the following information:

• American Cancer Society - Smoke Around You
• Facts About Secondhand Smoke Fact Sheet
• Secondhand Smoke in Your Home
• The Smoker Next Door
• 4,000 Chemicals
• "Give Me Breathing Room" Secondhand Smoke Newsletter
• This is a Smoke Free Vehicle sticker
• This is a Smoke Free Environment sticker
• Quitline Information Sheet

Reminder: NYS Medicaid covers both prescription and non-prescription smoking cessation agents. For more information on Medicaid's smoking cessation coverage policy, contact the New York State Department of Health, Pharmacy Policy and Operations Unit, at 518-486-3209. Thank you for your assistance in providing quality healthcare to the residents of New York State.

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Foot ulcers and amputations are a major cause of morbidity, disability, and costs for people with diabetes. The early recognition and management of risk factors for ulcers and amputations can prevent or delay the onset of these adverse outcomes. The following recommendations are adapted from the American Diabetes Association and outline the best means to identify and manage risk factors before a foot ulcer occurs or an amputation becomes imminent. These recommendations apply to people who do not currently have foot ulcers.

• Foot Examination - All individuals with diabetes should receive a thorough foot examination at least once a year to identify high-risk foot conditions. People with one or more high-risk foot conditions should be evaluated more frequently for the development of additional risk factors. This examination should include an assessment of protective sensation, foot structure and biomechanics, vascular status, and skin integrity. People with neuropathy should have a visual inspection of their feet at every visit with a health care professional.
• Risk Identification - Risk identification is fundamental for effective preventive management of the foot in people with diabetes. The foot-related conditions associated with an increased risk of amputation are: (1) peripheral neuropathy, (2) altered biomechanics (i.e. evidence of increased pressure, limited joint mobility), (3) peripheral vascular disease, (4) history of ulcers or amputation.
• Prevention of High-Risk Conditions - Distal symmetric polyneuropathy is one of the most important predictors of ulcers and amputation. The development of neuropathy can be delayed significantly by maintaining glycemic levels to as near normal as possible. Smoking cessation should also be encouraged to reduce the risk of vascular disease complications.
• Management of High-Risk Conditions - Patients should be educated on the implications of sensory loss and the ways to substitute other sensory modalities (i.e. hand palpation, visual inspection) for surveillance of early problems. In addition, they should be made aware of the importance of properly fitting shoes.
• Patient Education - Patients with diabetes and high-risk foot conditions should be educated regarding their risk factors and appropriate management. Patients at risk should understand the implications of the loss of protective sensation, the importance of foot monitoring on a daily basis, the proper care of the foot, including nail and skin care, and the selection of appropriate footwear.
• Provider Education - All health care providers of people with diabetes should be able to conduct a simple screening exam of the neurological, vascular, dermatological, and musculoskeletal systems.

Please note that foot care services are covered when performed by a primary care provider for all Medicaid recipients, and by podiatrists only for children under 21 with a physician's referral, and for Qualified Medicare Beneficiaries.

Medicaid practitioners should routinely perform a comprehensive foot examination for their patients with diabetes. For further information regarding preventive foot care for people with diabetes, the following websites are available:

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The State Department of Health welcomes your comments or suggestions regarding the Medicaid Update.

Please send suggestions to the editor, Timothy Perry-Coon:

NYS Department of Health
Office of Medicaid Management
Bureau of Program Guidance
99 Washington Ave., Suite 720
Albany, NY 12210
(e-mail MedicaidUpdate@health.state.ny.us)

The Medicaid Update, along with past issues of the Medicaid Update, can be accessed online at the New York State Department of Health web site: http://www.health.state.ny.us/health_care/medicaid/program/main.htm