The federal health agency has rejected Louisiana’s latest plans for Medicaid reimbursement of pharmacists for prescription drugs.
The federal Centers for Medicare and Medicaid Services recently notified Louisiana officials of its objection to the payment methodology.
On Thursday, Louisiana Medicaid Director Ruth Kennedy received notice that the federal agency is deferring payment of $2.25 million billed for the quarter ending June 30 because of the disapproved reimbursement plan. CMS associate regional administrator Bill Brooks wrote that the Medicaid expenditure report contained expenditures under state plan amendments that have not been approved by CMS and therefore by federal regulations could not be paid.
“We are going to appeal the denial,” said Calder Lynch, state Department of Health and Hospitals chief of staff.
Lynch said DHH had stopped paying pharmacists based on initial federal objections in October.
DHH will not seek to recover the funds from pharmacists, Lynch said.
Lynch said the pharmacy plan the state submitted involved two parts: an enhanced dispensing fee and a small mark-up on the ingredient costs of drugs. He said the ingredient costs plan gave CMS pause.
“We do feel it’s an appropriate step for us to take,” Lynch said. “There was precedent for that. ... We have certainly been in conversation with them (CMS).”
While appealing, Calder said the state will revise and resubmit the plan.