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| Item Number | Policy/Procedure | Date Posted | Comment Period Closed | Status | Document Links |
|---|---|---|---|---|---|
| 2020-PHARM-42 | Acne Criteria | 5/15/20 | 6/29/20 | Approved | Acne Criteria |
| 2020-PHARM-41 | ADD-ADHD Stimulants and Related Agents | 5/15/20 | 6/29/20 | Approved | ADD-ADHD Stimulants and Related Agents |
| 2020-PHARM-40 | ADHD | 5/15/20 | 6/29/20 | Pending | ADHD |
| 2020-PHARM-39 | Antipsychotic Agents | 5/15/20 | 6/29/20 | Pending | Antipsychotic Agents |
| 2020-PHARM-38 | Antipsychotics | 5/15/20 | 6/29/20 | Pending | Antipsychotics |
| 2020-PHARM-37 | CGRP Antagonists | 5/15/20 | 6/29/20 | Pending | CGRP Antagonists |
| 2020-PHARM-36 | Colony Stimulating Factors | 5/15/20 | 6/29/20 | Pending | Colony Stimulating Factors |
| 2020-PHARM-35 | Diabetes Hypoglycemics Insulins and Related Agents | 5/15/20 | 6/29/20 | Pending | Diabetes Hypoglycemics Insulins and Related Agents |
| 2020-PHARM-34 | Digestive Disorders Antiemetic Antivertigo Agents | 5/15/20 | 6/29/20 | Pending | Digestive Disorders Antiemetic Antivertigo Agents |
| 2020-PHARM-33 | Hemodialysis Phosphate Binders | 5/15/20 | 6/29/20 | Pending | Hemodialysis Phosphate Binders |
| 2020-PHARM-32 | Oncology Agents Oral Breast | 5/15/20 | 6/29/20 | Pending | Oncology Agents Oral Breast |
| 2020-PHARM-31 | Oncology Agents Oral Hematologic | 5/15/20 | 6/29/20 | Pending | Oncology Agents Oral Hematologic |
| 2020-PHARM-30 | Opiate Dependence Agents | 5/15/20 | 6/29/20 | Pending | Opiate Dependence Agents |
| 2020-PHARM-29 | Other Behavioral Health Under 6 | 5/15/20 | 6/29/20 | Pending | Other Behavioral Health Under 6 |
| 2020-PHARM-28 | Pain Management Antimigraine Agents CGRP Antagonists | 5/15/20 | 6/29/20 | Pending | Pain Management Antimigraine Agents CGRP Antagonists |
| 2020-PHARM-27 | Pain Management-Non Steroidal Antiinflammatory agents | 5/15/20 | 6/29/20 | Pending | Pain Management-Non Steroidal Antiinflammatory agents |
| 2020-PHARM-26 | Pulmonary Arterial Hypertension Agents | 5/15/20 | 6/29/20 | Pending | Pulmonary Arterial Hypertension Agents |
| 2020-UHC-487 | Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes MCO retiring policy on 7/1/20 | 6/9/20 | 7/24/20 | Withdrawn | Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes |
| 2020-HBL-553 | PA Cont COVID19 Crisis Intervention | 6/9/20 | 7/24/20 | Withdrawn | PA Cont COVID19 Crisis Intervention |
| 2020-PHARM-25 | Hepatitis C DAA | 5/4/20 | 6/18/20 | Approved | Hepatitis C DAA |
| 2020-PHARM-24 | Infectious Disorders - Hepatitis C Agents | 5/4/20 | 6/18/20 | Approved | Infectious Disorders - Hepatitis C Agents |
| 2020-PHARM-23 | Colony Stimulating Factors | 5/4/20 | 6/18/20 | Approved | Colony Stimulating Factors |
| 2020-PHARM-22 | Vaccines for Adults | 4/17/20 | 6/1/20 | Approved | Vaccines for Adults |
| 2020-HPA-2 | Tobacco Cessation for Pregnant Women | 4/16/20 | 5/31/20 | Approved | HPA Tobacco Cessation for Pregnant Women |
| 2020-PHARM-21 | Colony Stimulating Factors | 4/2/2020 | 5/17/20 | Approved | Colony Stimulating Factors |
| 2020-BPE-1 | Batch Pharmacy Encounter – Basis of Cost Determination | 4/2/20 | 5/17/20 | Approved | Batch Pharmacy Encounter System Companion Guide |
| 2020-PHARM-20 | POS DUR May 2020 Posting | 3/13/20 | 4/27/20 | Approved | POS DUR May 2020 Posting |
| 2020-PHARM-19 | POS Document for January 2020 May Implementation | 3/13/20 | 4/27/20 | Approved | POS Document for January 2020 May Implementation |
| 2020-PHARM-18 | Oral Glucocorticoids | 3/13/20 | 4/27/20 | Approved | Oral Glucocorticoids |
| 2020-PHARM-17 | Miscellaneous Agents with POS Req | 3/13/20 | 4/27/20 | Approved | Miscellaneous Agents with POS Req |
| 2020-PHARM-16 | Other Behavioral Health Under 6 | 3/13/20 | 4/27/20 | Approved | Other Behavioral Health Under 6 |
| 2020-PHARM-15 | Kalydeco | 3/13/20 | 4/27/20 | Approved | Kalydeco |
| 2020-PHARM-14 | Symdeko | 3/13/20 | 4/27/20 | Approved | Symdeko |
| 2020-PHARM-13 | Orkambi | 3/13/20 | 4/27/20 | Approved | Orkambi |
| 2020-PHARM-12 | Exondys | 3/13/20 | 4/27/20 | Approved | Exondys |
| 2020-PHARM-11 | Cytokine and CAM Antagonists | 3/13/20 | 4/27/20 | Approved | Cytokine and CAM Antagonists |
| 2020-PHARM-10 | Hepatitis C DAA | 3/13/20 | 4/27/20 | Approved | Hepatitis C DAA |
| 2020-PHARM-9 | Mytesi | 3/13/20 | 4/27/20 | Approved | Mytesi |
| 2020-PHARM-8 | Samsca | 3/13/20 | 4/27/20 | Approved | Samsca |
| 2020-PHARM-7 | Jynarque | 3/13/20 | 4/27/20 | Approved | Jynarque |
| 2020-PHARM-6 | Penicillamine | 3/13/20 | 4/27/20 | Approved | Penicillamine |
| 2020-PHARM-5 | Buphenyl Carbaglu Ravicti | 3/13/20 | 4/27/20 | Approved | Buphenyl Carbaglu Ravicti |
| 2020-PHARM-4 | Vyondys | 3/13/20 | 4/27/20 | Approved | Vyondys |
| 2020-PHARM-3 | Trikafta | 3/13/20 | 4/27/20 | Approved | Trikafta |
| 2020-PHARM-2 | Zulresso | 3/13/20 | 4/27/20 | Approved | Zulresso |
| 2020-UHC-126 | Behavior Health Supportive Criteria | 3/13/20 | 4/27/20 | Approved | Behavior Health Supportive Criteria |
| 2020-SCG-2 | Addition of new codes to Evidence Based Practice Codes: EB06 and EB07 | 3/6/20 | 4/20/20 | Complete | MCO SCG v 57 |
| 2020-HBL-357 | Non-Par Opioid Policy | 3/6/20 | 4/20/20 | Approved | Non-Par Opioid Policy |
| 2020 HBL-333 | Medical Transportation | 3/4/20 | 4/18/20 | Approved | Medical Transportation |
| 2020-HPA-1 | Revised Hysterectomy Acknowledgement Form | 3/3/20 | 4/17/20 | Approved | HPA Hysterectomy Acknowledgement Form |
| 2020-IB-1 | Revised Hysterectomy Acknowledgement Form | 3/3/20 | 4/17/20 | Approved | IB Hysterectomy Acknowledgement Form |
| 2020-HBL-121 | POA HCAC Article and Policy | 2/26/20 | 4/11/20 | Approved | POA HCAC Article and Policy |
| 2020-HBL-321 | Behavioral Health Adverse Incidents Monitoring and Reporting | 2/26/20 | 4/11/20 | Approved | Behavioral Health Adverse Incidents Monitoring and Reporting |
| 2020-HBL-332 | Prior Authorization Liaison (PAL) Policy | 2/26/20 | 4/11/20 | Approved | Prior Authorization Liaison (PAL) Policy |
| 2020-HBL-358 | Behavioral Health – Nursing Facility Services | 2/26//20 | 4/11/20 | Approved | Behavioral Health – Nursing Facility Services |
| 2020-LHCC-339 | Network Adequacy | 2/17/20 | 4/2/20 | Approved | Network Adequacy |
| 2020-UHC-369 | ADAKVEO (CRIZANLIZUMAB-TMCA) | 2/13/2020 | 3/29/20 | Approved | ADAKVEO (CRIZANLIZUMAB-TMCA) |
| 2020-UHC-370 | GIVLAARI (GIVOSIRAN) | 2/13/2020 | 3/29/20 | Approved | GIVLAARI (GIVOSIRAN) |
| 2020-UHC-371 | REBLOZYL (LUSPATERCEPT-AAMT) | 2/13/2020 | 3/29/20 | Approved | REBLOZYL (LUSPATERCEPT-AAMT) |
| 2020-UHC-372 | INTRAVENOUS IRON REPLACEMENT THERAPY (FERAHEME & INJECTAFER) | 2/13/2020 | 3/29/20 | Approved | INTRAVENOUS IRON REPLACEMENT THERAPY (FERAHEME & INJECTAFER) |
| 2020-ACLA-230 | Avesis Utilization SOP | 2/13/2020 | 3/29/20 | Approved | Avesis Utilization SOP |
| 2020-UHC-312 | Intensity-Modulated Radiation Therapy | 2/6/2020 | 3/21/20 | Approved | Intensity-Modulated Radiation Therapy |
| 2020-HBL-365 | Coordinated System of Care (CSoC) Waiver | 2/6/2020 | 3/21/20 | Approved | Coordinated System of Care (CSoC) Waiver |
| 2020-HBL-363 | Drug Screen Testing | 2/5/2020 | 3/20/20 | Approved | Drug Screen Testing |
| 2020-HBL-364 | Drug Screen Testing Article | 2/5/2020 | 3/20/20 | Approved | Drug Screen Testing Article |
| 2020-UHC-252 | Intraoperative Neuromonitoring Policy | 2/5/2020 | 3/20/20 | Approved | Intraoperative Neuromonitoring Policy |
| 2020-ABA-4 | Aplied Behavior Analysis Fee Schedule Coding Update | 1/31/20 | 3/15/20 | Complete | Applied Behavior Analysis Fee Schedule Coding Update |
| 2020-UHC-310 | Total Artificial Disc Replacement Spine | 1/28/20 | 3/12/20 | Approved | Total Artificial Disc Replacement Spine |
| 2020-UHC-311 | Transcatheter Heart Valve Procedures | 1/28/20 | 3/12/20 | Approved | Transcatheter Heart Valve Procedures |
| 2020-UHC-313 | Bariatric Surgery Policy | 1/28/20 | 3/12/20 | Approved | Bariatric Surgery Policy |
| 2020-ABH-233 | Opioid Use Disorder | 1/24/20 | 3/9/20 | Approved | Opioid Use Disorder |
| 2020-HBL-320 | Emergency and Post Stabilization Services | 1/24/20 | 3/9/20 | Approved | Emergency and Post Stabilization Services |
| 2020-LHCC-237 | Opioid Use Disorder Treatment in Opioid Treatment Programs | 1/24/20 | 3/9/20 | Approved | Opioid Use Disorder Treatment in Opioid Treatment Programs |
| 2020-ACLA-236 | Opioid Use Disorder Treatment in Opioid Treatment Programs | 1/23/20 | 3/8/20 | Approved | Covered Benefits and Services Standard and Urgent Prior Authorization |
| 2020-HBL-235 | Reimbursement in Opioid Treatment Programs | 1/23/20 | 3/8/20 | Approved | Reimbursement in Opioid Treatment Programs |
| 2020-LHCC-249 | Ambulatory Insulin Pump | 1/23/20 | 3/8/20 | Approved | Ambulatory Insulin Pump |
| 2020-UHC-234 | Opioid Use Disorder Treatment in Opioid Treatment Programs | 1/23/20 | 3/8/20 | Approved | Opioid Use Disorder Treatment in Opioid Treatment Programs |
| 2020-PHARM-1 | Pharmacy Lock-In Program | 1/17/20 | 3/2/20 | Approved | Pharmacy Lock-In Program |
| 2020-HBL-244 | Assertive Community Treatment Billing | 1/16/20 | 3/1/20 | Approved | Assertive Community Treatment Billing |
| 2020-UHC-248 | Vertebral Tethering for Scoliosis | 1/14/20 | 2/28/20 | Approved | Vertebral Tethering for Scoliosis |
| 2019-PHARM-15 | Spinraza Single PDL | 1/14/20 | 2/28/20 | Approved | Spinraza Single PDL |
| 2020-HBL-121 | POA HCAC Article | 1/15/20 | 2/29/20 | Approved | POA HCAC Article |
Medicaid Managed Care Policies & Procedures Archive Continued (2020)
"Policy or procedure" shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.
Below are items previously posted for public comment:
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