NOTICES
GOVERNOR'S OFFICE
Catalog of Nonregulatory Documents
[29 Pa.B. 4213] Under Governor Ridge's Executive Order 1996-1, agencies under the jurisdiction of the Governor must catalog and publish all nonregulatory documents such as policy statements, guidance manuals, decisions, rules and other written materials that provide compliance related information. The following compilation is the fourth list of the Administration's nonregulatory documents. This list will be updated and published annually on the first Saturday in August.
This catalog is being provided to insure that the public has complete access to the information necessary to understand and comply with State regulations. Facilitating access to information is a critical component of the Ridge Administration's initiative to enhance the partnership between the regulated community and the State.
Governor
ADMINISTRATION
Editor's Note: The Index of Issuances, Manual M210.3, issued by the Governor's Office of Administration, Directives Management System, includes Executive Orders, Management Directives and Manuals. New or revised documents to the Index are published monthly in the PA Bulletin and the entire index is revised yearly in the PA Code.
AGING
INTERNAL GUIDELINES:
Pharmaceutical Program (PACE) Contact: Gretchen Beard, Chief of Compliance Division (717)-787-7313 • PACE Provider Bulletins: 1999 • 2/19/99: Kytril® and Zofran®: Reminder to providers that PACE will reimburse only on the 20% not reimbursed by DMER • 2/19/99: Optometrists's Prescribing Privileges: Provides PACE Providers with a list of medications permitted by Department of Health regulation to be prescribed by optometrists. Warns providers to not dispense and bill the Program for pharmaceuticals that are prohibited by regulation from being prescribed by optometrists. • 2/19/99: Optometrist's License Numbers: Notifies providers that Optometrists certified to prescribe and administer pharmaceutical agents for therapeutic purposes under section 4.1 of the Optometric Practice and Licensure Act are being issued a license with a suffix of ''T''. • 3/5/99: PACENET Deductible: Reminder to PACE Providers that the $500 PACENET deductible is accumulated based on each individual cardholder's enrollment year; not the calendar year. • 4/9/99: Notified PACE Providers that effective May 14, 1999, PACE will mandate substitution on the following medications: Lasix®, Depakene®, Mysoline®, Quinaglute Dura-tabs®, Mexitil®, Tegretol® and all sustained-release Theophylline preparations. • 4/9/99: Betoptic® Solution: Notified PACE Providers that Alcon Laboratories had informed PACE that it had discontinued production of Betoptic® solution in the 2.5 and 5 ml sizes. • 4/30/99: Propulsid® Drug to Drug Interactions: Notifies providers that effective May 10, 1999, PACE will review history across all providers and reject all prescriptions in the drug classes which are contraindicated for patients using Propulsid. • 5/7/99: Drug Utilization Review Program: Notified Providers that effective May 15, 1999, several new and revised maximum daily dose criteria, duration criteria and duplicate criteria will be added to the PACE ProDUR Program. • 7/2/99: Trovan®(Trovafloxacin/Alatrofloxacin Mesylate): Notified Providers that effective July 6, 1999, PACE will deny all claims for Trovan®. In accordance with FDA recommendations, PACE will reimburse for Trovan® only through the Medical Exception Process. • 7/2/99: Medicare Reimbursable Chemotherapeutics: Notified Providers that effective July 12, 1999, the following pharmaceuticals will be included with those products being reimbursed by the PACE/PACENET Program at 20%: Oaklide® and Neumega® PACE Provider Bulletins: 1998 • 2/13/98: PACENET Deductible: Reminder to Providers that the PACENET $500 deductible is accumulated based on each individual's enrollment year, not the calendar year. • 2/13/98: PACE Required Documentation for ''Brand Medically Necessary'' (DAW Code 1) Prescriptions: Reminder to Providers who are being reimbursed for a Brand Name product having an A-rated generic because the Program has granted a cardholder medical exception or because the Program has elected not to require substitution must, by PACE regulation, have at the time of dispensing, a prescription on which the Prescriber has handwritten ''Brand Medically Necessary'' or ''Brand Necessary.'' • 2/13/98: Clozapine (Clozaril): Notified Providers that Clozaril is subject to the PACE Program's mandatory substitution requirement. Generic clozapine is available from Zenith Goldline Pharmaceuticals. • 2/13/98: Use of NDC Codes and Calculation of Reimbursement: Reminder to PACE Providers that all claims submitted to the Program for reimbursement must accurately report the labeler code and product code of the drug dispensed. Reimbursement paid by the PACE Program will be based upon the package size as reported by the Provider. • 2/20/98: Other Prescription Coverage: Notified Providers that EOB Message ''041--Billable to Other Payor'' will soon be rejected with an Error Code 041. • 2/27/98: Bromfenac Sodium Capsules (DURACT): Reminder to Providers that DURACT is only intended for the short term (10 days or less) management of acute pain and is not indicated for long term use. Notified Providers effective March 2, 1998 PACE will reject all claims for DURACT at the point of sale. A one-time medical exception will be considered, upon request from the Provider, for a maximum 10-day supply at a maximum dose that does not exceed 150 mg per day. Written correspondence from the cardholder's physician will be necessary for reimbursement beyond ten days. • 2/27/98: Mibefradil Dihydrochloride (POSICOR): Notified Providers of advisory issued by Roche Laboratories Inc. of reported cases of interaction of POSICOR with certain HMG-CoA Reductase Inhibitors. PACE claims for POSICOR identified as being coadministered with either lovastatin or simvastatin will reject with the NCPDP Error ''88, DUR Reject''; PACE Error Code ''706,'' accompanied with the Conflict Code ''DD,'' the free text message of ''DRUG-DRUG,'' and the NDC of the drug in conflict. • 4/10/98: PACE Cardholders Enrolled in Medicare HMO's: Reminder to Providers that PACE Cardholders enrolled in Medicare certified HMO's are entitled to the same prescription medications under the Medicare certified HMO as those covered under Medicare Part ''B.'' This entitlement is not affected by a cardholder's decision not to subscribe to supplemental HMO offered prescription coverage. • 4/17/98: Drug Utilization Review Program: Notified Providers effective April 22, 1998, several new maximum daily dose criteria, duration criteria and duplicate therapy criteria will be added to the PACE ProDUR Program. The criteria is as follows: Mibefradil HCl (POSICOR) 100 mg maximum dose/duplicate therapy edit; Carvedilol (Coreg) 100 mg maximum dose/duplicate therapy edit; Losartan (Cozaar) 100 mg maximum dose/duplicate therapy edit with the ACE Inhibitors; Quetiapine (Seroquel) 400 mg maximum dose; Hydrocodone and Ibuprofen (Vicoprofen) 37.5 mg maximum dose/duration edit: 10 days out of every 30. • 4/25/98: Mandatory Substitution Diltiazem Extended Release Capsules: Notified Providers effective April 29, 1998, the PACE Program will begin mandating substitution of Dilacor XR and Cardizem SR. This is a result of information received from the FDA granting therapeutic equivalence to capsules manufactured by Mylan Pharmaceuticals, Watson Labs, Andrx and Teva Pharmaceuticals. • 5/8/98: Early Refill Edit: Notified Providers effective May 19, 1998, the additional classes will be added to the early refill edit: Intranasal Steroids; Topical Corticosteroids--Single Entity; Anti-diabetic Agents--Insulins; Bronchodilators; Conjugated Estrogens; Estrogens--Transdermal Patches; and Opiates. Reimbursement will not be made until 75% of the medication has been used. • 5/22/98: Drug Utilization Review Program: Notified Providers effective May 26, 1998 several new criteria will be added to the PACE ProDUR Program and applied to all claims submitted on or after this date for the medication Viagra. The criteria added are: maximum daily dose of 50 mg. Claims submitted for greater than 50 mg daily will require a diagnosis and approval through the PACE medical exception process. Duration of therapy will be thirty tablets per month. PACE will only reimburse claims submitted for male cardholders. Claims submitted for female cardholders will be reversed. • 6/1/98: Drug Utilization Review Program: Notified Providers that Pfizer, Inc. has recently reiterated that patients taking nitrates in any form, including nitroglycerin and long-acting nitrates commonly used for chest pain, should not take Viagra. PACE will reject prescriptions for Viagra and Nitroglycerin at the point-of-sale in order to comply with this guideline for appropriate use. • 6/12/98: RECALL: Notified Providers that a Voluntary Class I recall has been initiated by Meridian Medical Technologies, manufacturer of both Epipen and Epipen Jr. Auto-Injectors. All PACE cardholders for whom reimbursement was made during this period have been instructed to return their product to their pharmacy for a lot number review. • 6/12/98: RECALL: POSICOR--Notified Providers that Roche Laboratories Inc. is withdrawing POSICOR from the market effective June 8, 1998. The PACE Program will deny reimbursement for claims submitted with dates of service of June 9, 1998 or thereafter will be denied. • 6/19/98: Cholinesterase Inhibitors: Notified Providers that effective June 22, 1998, several new maximum initial dose and maximum daily dose criteria will be added to the PACE ProDUR Program. The criteria added are for Tacrine (Cognex®), initial maximum dose 40 mg/6 weeks; 80 mg/6 weeks; 120 mg/6 weeks and a maximum dose of 160 mg; and Donepezil (Aricept®), initial maximum dose 5 mg and a maximum dose of 10 mg. • 6/26/98: DURACT®: Notified Providers that effective June 22, 1998, Wyeth-Ayerst Laboratories is withdrawing Duract® capsules from the market. Accordingly, any Duract® claim submitted to PACE after June 22, 1998 is being denied. • 6/26/98: Early Refill Edit Applied to Ophthalmics: Notified Providers that effective July 6, 1998, PACE is applying the early refill edit criteria to ophthalmic preparations requiring that at least 75% of the medication, based on the day's supply submitted on the previous claim, has been used before PACE will consider reimbursement for a prescription refill. • 12/11/98: Meridia® Drug to Drug Interactions: Notified Providers that in order to comply with the manufacturers' warnings that Meridia® should not be used concomitantly with MAOI's (at least a two week interval after stopping an MAOI before commencing with Meridia®), PACE will review history across providers and reject all prescriptions for Nardil, Eldepryl and Parnate at the point of sale. • 12/31/98: Drug Utilization Review Program: Notified Providers that effective January 4, 1999, revised criteria will be added to the PACE ProDUR Program and applied to all claims submitted on or after this date for the medication Viagra®. The criteria is as follows: Maximum Daily Dose--50 mg; Duration of Therapy decreased from thirty to eight tablets per month. PACE Provider Bulletins: 1997 • 02/07/97: Brand Medically Necessary Update: Notified Providers that effective immediately PACE is no longer mandating generic reimbursement on the following brand medications: Lasix, Depakene, Tegretol, Mysoline, Quinaglute Duratabs (Quinidine Gluconate), Pronestyl SR, Mexitil, and All Sustained-Release Theophylline Preparations. • 02/14/97: Mandatory Substitution Nitroglycerin Transdermal Patch: Notified Providers that effective February 21, 1997, the PACE Program will being mandating substitution on both Nitro-Dur and Transderm-Nitro. • 03/01/97: PACENET: Reminder to Providers to encourage their older customers to make application for the new PACENET Program. Bulletin include income requirements, information regarding the crediting of out-of-pocket expenses; use of 1997 PACE applications to apply for both PACE and PACENET and a reminder to discard the old 1996 enrollment applications. • 03/28/97: Drug Utilization Review Program: Notified Providers that effective April 14, 1997, PACE will be adding new criteria to our Prospective Drug Utilization Review Program for HMG Co-A Reductase Inhibitors. • 05/09/97: PACENET Claim Submission: Provides explanation to Providers regarding the $500 deductible and submission of out-of-pocket prescription expenses for PACENET cardholders. • 06/20/97: Claim Timeliness: Reminder to Providers that PACE claims are to be submitted on the date of dispensing. • 07/11/97: Fragmin: Notified Providers that on July 18, 1997, PACE would reimburse claims submitted for Fragmin only when being prescribed for the prevention of deep venous thrombosis, which may lead to a pulmonary embolism following abdominal surgery or hip replacement. Further, since Fragmin is indicated for short-term treatment (five to ten days), PACE would apply a duration of therapy edit of not greater than 14 days to all incoming claims. • 8/7/97: Generic Update: Ranitidine: Notified Providers that Ranitidine currently being manufactured by Novopharm and Geneva is now available as a therapeutically equivalent generic for Zantac and effective Friday, August 15, 1997, PACE would be mandating substitution on Ranitidine. • 8/7/97: 1997 Pharmacy Licensure: Reminder to Pharmacies that current pharmacy licenses expire August 31, 1997 and that PACE Regulations mandate that, ''Only pharmacies and dispensing physicians that are currently licensed by the Commonwealth are eligible to participate as providers in the PACE Program.'' • 8/15/97: PACENET Claims: Reminder to Providers that they must submit all PACENET Cardholder prescription claims on POCAS to permit the accurate recording of the amount accumulating toward the $500 deductible. • 8/15/97: Other Prescription Coverage: Reminder to Providers that, by statute, the PACE Program is the payor of last resort and will accept responsibility only for those costs not covered by the cardholder's other prescription drug benefit program. • 8/15/97: Notified Providers effective August 18, 1997, several new maximum dose criteria will be added to the PACE ProDUR Program. These new additions are: 1) Maximum daily dose and duplicate therapy (with ACE inhibitors) edit for angiotensin II antagonist inhibitor: Valsartan (Diovan) 320 mg; 2) Maximum initial dose and maximum daily dose for antipsychotic agent Olanzapine (Zyprexa) 2.5 mg (initial) 10 mg (maximum); 3) Maximum daily dose and duplicate therapy for the HMG Co-A Reductase Inhibitor: Atorvastatin (Lipitor) 80 mg (maximum); 4) Maximum daily dose and duplicate therapy for the beta blocker: Cavedilol (Coreg) 100 mg (maximum); 5) Maximum initial dose and maximum daily dose for the antidepressant: Mirtazapine (Remeron) 15 mg (initial) 45 (maximum); 6) Maximum dose and duplicate therapy for the calcium channel blocker Nisoldipine (Sular) 60 mg (maximum); and 7) Maximum initial dose and maximum daily dose for the antipsychotic: Clozapine (Clozaril) 25 mg (initial) 100 mg (maximum). • 8/29/97: Updated listing of Non-Participating Manufacturers. • 9/12/97: Reinstatement of Common Package Size: Notified Providers effective September 15, 1997, PACE will reinstitute the Common Package Size pricing which was discontinued in November, 1996. • 9/19/97: Audit Issues: Reminder to Providers their responsibilities regarding voiding claims' payments for prescriptions that are not picked up by cardholders as well as maintaining an accurate, current signature log to identify the individuals who are receiving the PACE prescriptions dispensed by the Provider. • 9/19/97: DAW/Product Selection Code: Reminder to Providers of the five codes used by POCAS. • 10/3/97: Injectable Chemotherapy Antineoplastics: Reminder to Providers that Injectable chemotherapeutic antineoplasic claims are only reimbursed based on the 20% not covered by Medicare. • 10/3/97: Claim Submission Timeliness: Reminder to Providers that they are required by contract to submit claims prior to dispensing. • 10/17/97: Other Prescription Coverage: Notification to Providers effective November 3, 1997, PACE is implementing edit criteria to ensure compliance with the Program's requirement of billing other prescription plans prior to billing PACE. Providers entering a TPL indicator identifying ''no other coverage'' for a cardholder identified as having other prescription coverage will have the claim denied with the NCPDP Error Code 41 ''Submit Bill to Other Payor.'' • 11/14/97: Drug Utilization Review Program: Notified Providers effective November 24, 1997, the following new maximum daily dose criteria will be added to the PACE ProDUR Program: Maximum daily dose edit for the centrally acting analgesic Tramadol (Ultram) 300 mg maximum for individuals 75 years of age or older and 400 mg for individuals younger than 75 years. • 11/14/97: Drug Utilization Review Program: Notified Providers effective November 24, 1997, the following new maximum daily dose criteria will be added to the PACE ProDUR Program: Edits for the miscellaneous sedative/hypnotics are as follows: Amobarbital (Amytal) 200 mg; Butabarbital (Butisol) 100 mg; Chloral Hydrate 1 mg; Pentobarbital (Nembutal) 100 mg; Ethchlorvynol (Placidyl) 500 mg; Secobarbital (Seconal) 100 mg; Amobarbital/Secobarbital (Tuinal) 50/50 mg. • 11/21/97: Reminder to PACE Providers to review their Remittance Advice and to pay particular attention to those claims with Message Codes 041 and 918, which address those claims for cardholders with other prescription coverage. • 11/21/97: Oral Anti-Nausea Medication: Notified Providers effective December 1, 1997, PACE will being reimbursing only 20% of the Average Wholesale Price of oral formulations of Kytril and Zofran. Remaining cost of the drug will have to be submitted to the regional Medicare carrier, United Health Care in Wilkes-Barre for reimbursement. • 12/26/97: Reminder to PACE Providers that claims submitted for brand name pharmaceuticals having an A-rated generic therapeutic equivalent will be denied unless a medical exception is granted or PACE does not mandate substitution for the product. PACE does not require substitution on these products with A-rated generics Warfarin Sodium (Coumadin); Carbamazepine (Tegretol); Phenytoin (Dilantin); or Furosemide (Lasix). PACE Provider Bulletins: 1996 • 1/08/96: Prilosec and Prevacid: Notified Providers these drugs would be edited for maximum duration for all claims dispensed on or after January 8, 1996. • 1/26/96: Non-Participating Manufacturer List. • 5/24/96: Biaxin Filmtabs (NDC: 00074248660): Notified providers of an error on the formulary file from 1/22/96 to 3/21/96. • 5/24/96: Solopak Pharmaceuticals: Notified providers that Labeler Codes 39769 and 59747 would be participating in the PACE Program. • 7/12/96: PACE Cardholders with PEBTF Prescription Coverage: Notified Providers that PACE Cardholders with drug coverage through the Commonwealth's Retired Employees Health Plan had been notified they were being canceled from the PACE Program. • 8/2/96: Other Insurance Coverage: Reminder to Providers to exercise reasonable diligence in ascertaining the existence of other prescription benefits before billing the PACE Program. • 10/18/96: Injectable Chemotherapeutics: Reimbursement restrictions (20% of Average Wholesale Price) applied to injectable chemotherapy medications when administered through a home infusion pump or in a physician's office. • 10/18/96: Vaccine Reimbursement: Notified Providers of a change in the reimbursement of vaccines to be implemented on November 11, 1996 for claims with a date-of-service on or after that date. The change is as follows: Vaccines used to provide immunization against pneumococcal pneumonia and influenza will no longer be reimbursed by the PACE Program. Vaccines used to provide immunization against hepatitis B will be reimbursed at 20% of the Average Wholesale Price. • 10/18/96: Bronchodilator Drugs: Notified Providers that effective November 11, 1996, PACE will begin reimbursing only 20% of Average Wholesale Price for the following products: Acetylcysteine 10%; Acetylcysteine 20%; Albuterol Sulfate 0.083%; Albuterol Sulfate 0.5%; Cromolyn Sodium; Isoetharine HCI 0.1%; Isoetharine HCI 0.125%; Isoetharine HCI 0.167%; Isoetharine HCI 0.2%; Isoetharine HCI 0.25%; Isoetharine HCI 1.0%; Isoproternol HCI 0.5%; Isoproternol HCI 1.0%; Metaproternol Sulfate 0.4%; Metaproterenol Sulfate 0.6%; and Metaproterenol Sulfate 5.0%. • 11/21/96: PACE Legislative Changes: Notified Providers of increased income limits ($14,000 maximum for singles and $17,200 maximum for married); and Mandatory Substitution of A-Rated Multiple-source products. • 11/21/96: PACENET Requirements: Notified Providers of income limits for PACENET cardholders (Between $14,000 and $16,000 if single; Between $17,200 and $19,200 if married); Annual Deductible ($500 per person) which PACE Providers are expected to enter PACENET Enrollee's out-of-pocket prescription expenses in POCAS; Mandatory Copayments ($8 per prescription for non-innovator, multiple-source (generic) products; and $15 per prescription for single-source and innovator multiple-source products); Mandatory Substitution of A-Rated Multiple-source products after deductible is met; and the claims reimbursement formula for PACENET claims would be AWP--10% + $3.50 dispensing fee. • 11/22/96: Third Party Liability: Notified Providers that a PACE cardholder's I. D. card could currently contain two indicators that may affect coverage. The first indicator is a ''Y'' appearing in the lower right quadrant of the I. D. card meaning the cardholder has informed PACE that they have other third party insurance that is to be billed before PACE. The second indicator is an ''L'' appearing in the lower right quadrant of the I. D. card. This ''L'' means the cardholder has been restricted into receiving their PACE benefits at one specific provider. • 11/22/96: Lovenox: Notified Providers that effective December 9, 1996, PACE will reimburse claims submitted for Lovenox only when being prescribed for the prevention of deep venous thrombosis, which may lead to a pulmonary embolism following hip or knee replacement surgery or general surgery which includes abdominal, gynecologic, urologic or thoracic. Further, since Lovenox is indicated for short-term treatment (seven to ten days), the Program will apply a duration edit of not greater than 14 days to all incoming claims. • 11/22/96: Oral Vancomycin: Notified Providers that PACE would be applying a duration of therapy edit of not greater than 14 days for all incoming claims for oral Vancomycin. • 11/22/96: Bronchodilator Drug Update: Reminder for Providers that reimbursement for the bronchodilator solutions used in either IPPB machines or nebulizers is limited to 20% of the Average Wholesale Price by PACE and suggested that Providers who do not currently have a Medicare provider number contact the National Supplier Clearinghouse in North Carolina to request an application. • 11/22/96: Non-Participating Manufacturers effective November 27, 1996. • 12/01/96: Processing PACENET Claims: Provides information to assist pharmacies in the processing of claims for cardholders enrolled in PACENET. • 12/13/96: Imitrex Tablets: Notified Providers that effective December 30, 1996, all claims for Imitrex will not be reimbursed for a quantity greater than nine or a days' supply less than or equal to 25. • 12/13/96: Nimotop: Notified Providers that effective December 30, 1996, claims for Nimotop will be denied at the point-of-sale. After determining the diagnosis, providers can contact the POCAS operators and obtain a Medical Exception. Although this medication is approved only for use in subarachnoid hemorrhage, there are several other off-label uses for which reimbursement will be made. • 12/13/96: Revision: Non-Participating Manufacturer List. • 12/20/96: Mandatory Generic Substitution: Advises providers to direct cardholder questions about the new mandatory substitution policy to the Cardholder Services toll-free number (1-800-225-7223). PACE Provider Bulletins: 1995 • 1/6/95: Drug Utilization Review Program: Addition of new criteria for antidepressants, antipsychotics and benzodiazepines. • 2/17/95: Antidepressants, Antipsychotics and Benezodiazepines: Reminder to Pharmacy to carefully review both the reject codes and accompanying messages. • 2/24/95: Toradol: Reimbursement restrictions. • 2/24/95: Minitran: 30-day supply limit. • 3/95: PACE Drug Utilization Review Criteria. • 3/3/95: Medicare Update: Extended coverage for prescription drugs used in immunosuppressive therapy to three years following hospital discharge for an organ transplant. • 3/3/95: Maximum Initial Dose for selected antipsychotic, antidepressant or benezodiazepine agents. • 3/27/95: Non-Sedating Antihistamines and Oral Antifungals Coadministration is Contraindicated. PACE will reject claims for Seldane, Seldane-D, Hismanal, Claritin, Claritin-D, Diflucan, Nizoral and Sporanox. • 3/95: Third Party Billing Reminder: PACE is payer of last resort, pharmacy must bill other third parties first. • 5/5/95: Brand Patent Expirations/Generic Substitutions. • 7/95: CellCept Billing Instructions. • 7/1/95: Claims Submissions: 90-day limit to file claims for reimbursement. • 8/1/95: Injectable Chemotherapeutics: Effective 9/1/95 PACE Reimbursement for list of injectable chemotherapeutics limited to 20% of AWP. • 8/18/95: Non-Participating Manufacturer List. • 8/18/95: Drug Utilization Review Program: New maximum dose criteria added to the PACE ProDur Program effective 8/28/95--Nefazodone (Serzone) 600 mg/day; Fluvoxamine (Luvox) 50 mg/day (initial) and 300 mg/day (maximum); Lansoprazole (Prevacid) 30 mg/day. • 9/1/95: Common Package Size Reimbursement Listing. • 9/1/95: Epoetin Alfa (EPO) Injections: Effective 9/11/95 PACE reimbursing only 20% of AWP for Epogen and Procrit. • 9/6/95: Early Refill Edit: Additional classes added to the Early Refill Edit. • 9/22/95: Drug Utilization Review Program: Effective 9/25/95 duplicate therapy edit applied to the following class of drugs: Proton Pump Inhibitors--Prilosec and Prevacid. • 10/95: PACE POCAS Telecommunications Number: New direct number available to pharmacy providers for Primary Claim Submission: 950-5545. PACE Provider Bulletins: 1994 • 2/8/94: Reimbursement Criteria for Temazepam (effective 3/1/94). • 5/23/94: Glyburide: Mandatory Substitution of Micronase and Diabeta. • 5/94: Prograf Billing Instructions • 5/94: Ophthalmics: Days Supply Provisions • 5/94: Betaseron Billing Instructions • 7/1/94 Ophthalmics: Noted billing discrepancies regarding pharmacies reporting of the days supply. • 7/23/94: Narrow Therapeutic Index Exemption Listing (Revised) • 8/94: Incorrect Physician License Numbers: Notice to Pharmacy Providers of Procedures to Disallow Claims Submitted with Wrong Prescriber I. D. • 8/19/94: Physician/Medical Assistants: PACE Reimbursement of Prescriptions Written by Physician Assistants. • 9/23/94: Serevent: PACE will no longer reimburse for more than 13 mg of Serevent per prescription. • 9/26/94: Febatol--No PACE Reimbursement after 12/26/94. • 9/30/94: Manufacturers' Rebate Update • 10/3/94: DAW/Product Selection Code (Revised) • 10/21/94: Oral Contraceptives: Effective 10/30/94 PACE no longer reimburses except through the Medical Exception process. • 10/21/94: New Maximum Dose Criteria Added to the PACE ProDUR Program: Maximum daily dose and duplicate therapy criteria for NSAIDs (Trilisate; Disalcid; and • Cataflam) and maximum daily dose criteria for miscellaneous anti-ulcer preparations (Propulsid and Reglan). • 11/18/94: Oral Chemotherapeutics: Effective 12/15/94 PACE reimburses only 20% of AWP for Cyclophosphamide 25 mg/oral; Cytoxan 50 mg/oral; Etoposide/Vepesid 50 mg/oral; and Melphalan/Alkeran 2 mg/oral. • 12/2/94: 30-Day Supply Requirement: Humulin and Solganal. PACE Provider Bulletins: 1993 • 1/1/93: PACE Legislative Changes Effective 1/1/93 --Dispense as Written (DAW) Codes --Mandatory Generic Substitution when an ''A'' rated generic therapeutically equivalent drug is available. --Pricing Information --Consultation Fee Discontinued • 2/28/93: Deadline for PACE Provider Reenrollment and Conversion to 3.2 NCPDP Telecommunications Standard for PACE. Telecommunications Standard for Claims Submission. • 3/1/93: Standard Error Codes • 3/1/93: Early Refill Edit • 3/1/93: Halcion Error Code Revisions • 3/1/93: Processing Requirements: Conversion to NCPDP Version 3.2 • 3/19/93: POCAS System Maintenance on 4/10/93 and 4/11/93. • 5/14/93: Delay in Provider Reimbursement • 5/21/93: Change in the ProDUR screening criteria for H2 Receptor Antagonists effective 6/1/93. • 6/28/93: Implementation of PACE ProDUR Changes: --Maximum daily dose for NSAIDs --Maximum daily dose for Omeprazole, Sucralfate and Misoprostrol. --Maximum daily dosage allowed for Famotidine (Pepcid) changed from 80 mg/day to 40 mg/day. • 6/28/93: Claims Processing Procedures When POCAS Is Not Available. • 7/1/93: Non-Participating Manufacturers List • 7/23/93: 30-Day Supply Requirements • 7/23/93: Narrow Therapeutic Index Exemption Listing (Revised) • 9/28/93: Manufacturers Rebate Update (Non-Participating Manufacturer List, effective 10/5/93 was attached.) PACE Provider Bulletins: 1992 • 4/92: Provider Training Seminars (5/11/92 through 7/2/92) • 5/29/92: Manufacturers' Rebate News: Center Laboratories • 6/19/92: Manufacturers' Rebate News: Roxane Laboratories, Inc. • Astra Pharmaceutical Products • Ocumed • IPR Pharmaceutical • Immunex Corporation • 8/16/92: PACE Rescue Plan: Implementation of ProDUR; NCPDP Version 3.2 and related Program Changes • 9/92: Dixon-Shane recoupments/pharmacy credits. • 11/9/92: PACE Pharmacy Provider Manual • 12/23/92: Narrow Therapeutic Index Exemption Listing • 12/92: Generic Substitution on Oral Prescriptions (Included Poster and Informational Flyers). PACE Provider Bulletins: 1991 • 6/21/91: Co-Pay Change ($4 to $6 effective 7/1/91) • 8/14/91: General Program Issues: • Claims Payment • Cardholder Eligibility Changes (Income Eligibility Changed to $13,000 for Single and $16,200 for Married Couples) • Nursing Home Providers • Cosmetic Drugs (Effective 10/1/91 claims for Rogaine and Retin-A no longer paid) • Paper Claims (Only claims for Compound Drugs or claims whose Quantity is in Excess of 9999 accepted as paper claims) • Persantine and Dipyridamole (These two drugs must have an indication on the prescription that it is being used as an adjunct to Coumadin anticoagulants for the prevention of postoperative thromboembolic complications of cardiac valve replacement in order to be allowed payment by (PACE). • Audit Issues (Telephone Prescriptions and Brand Medically Necessary Requirements). • 8/21/91: Final Instructions Concerning the PACE On-line Claims Adjudication System (POCAS). • 9/27/91: Billing Instructions • Cosmetic Drugs • Exception Claim Processing • POCAS, post payment review • Nursing Home Claims Division of Program & Regulatory Coordination Contact: Robert Hussar, Division Chief (717)-783-8975 Current Aging Program Directives Provided below is a comprehensive list of current Aging Program Directives and LAMP/OPTIONS Bulletins. Directives which do not appear on the list are no longer in effect. Current directives are as follows: Program Area 01--''AAA Administration'' • 88-01-07 Personnel Action Plan for Private Non-Profit Area Agencies on Aging (AAA) • 90-01-05 Contract Management and Direct Service Provision by AAAs • 91-01-01 Certification and Disclosure Regarding Lobbying • 91-01-05 Area Agency on Aging Involvement in Corporate Eldercare Activities • 92-01-01 Single Audit Act Audit Requirements • 92-01-06 Minimum Standards for Governing Boards of Private Non-Profit Area Agencies on Aging • 93-01-04 Providing AAA Funded Services to Domiciliary Care and Personal Care Home Residents • 94-01-02 Indirect Cost Policy for Department of Aging Contracts • 94-01-04 Department of Aging Heat Emergency Plan • 95-01-05 Emergency Cooling Project • 95-01-08 FY 1996-99 Three Year Plan Requirements • 95-01-09 Assessments of Persons With ''An Other Related Condition'' Who Are Exceptional Admissions • 97-01-02 Accounting Manual For AAA Programs • 97-01-03 Interim Revision of the OPTIONS Assessment Reporting Forms OPT01 and OPT 01X • 98-01-01 OPTIONS Procedures Manual • 98-01-02 Area Agency on Aging Program Income Polices • 98-01-03 1997-98 Aging Block Grant Amendment: Final Funding Allocations • 98-01-04 AAA Program Requirements, Planning Allocations and Aging Services Block Grant Format for FY 1998-99 • 99-01-01 1998-99 Aging Block Grant Amendment: Final Funding Allocations • 99-01-02 FY 1999-2000 AAA Program Requirements, Planning Allocations and Aging Services Block Grant Format • 99-01-03 FY 1999-2000 Program and Financial Reporting Requirements Program Area 02--''Home Delivered Meals'' See Program Area 03. Program Area 03--''Congregate Meals'' • 90-03-01 Policies and Standards for the Department of Aging Funded Nutrition Service Programs Program Area 04--''Socialization/Recreation/Education/Health Promotion'' • 96-04-01 Senior Community Center And Satellite Center Policies and Standards • 98-04-01 Primetime Health Program
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