23 Miss. Code. R. 203-2.2 - Drug Rebates

A. In accordance with federal regulations, the Division of Medicaid collects Medicaid drug rebates from manufacturers on physician-administered drugs per the following:

1. Effective for all drugs administered on and after January 1, 2008, providers must submit the National Drug Code (NDC) of the drug administered in addition to the appropriate drug code for physician-administered drugs on claims.

a) An NDC is not required for vaccines or other drugs as specified by CMS.

b) The NDC of the drug administered must contain eleven (11) digits in the five (5) four (4) two (2) grouping and, if applicable, include "leading zeros (0)" to constitute an eleven (11) digit NDC code.

c) The NDC of the drug administered must be matched against a database to ensure its validity.

2. Providers reimbursed based on a fee-for-service must submit the NDC of the drug administered with the appropriate code(s) including, but not limited to, ambulances, independent radiology clinics, free-standing and hospital based dialysis facilities, nurse practitioners, optometrists, individual physicians, physician groups, physician assistants, and podiatrists.

3. Providers reimbursed based on a per diem, encounter or other type of rate are not required to submit the NDC or appropriate code(s) for drugs administered/dispensed by providers including, but not limited, to outpatient hospitals, federally qualified health centers (FQHC), rural health clinics (RHC), ambulatory surgical centers (ASC), home health agencies, nursing homes or other long term-term care facilities.

4. The Division of Medicaid only reimburses for physician administered drugs that are:

a) Subject to the federal rebate program, and

b) Not considered Drug Efficacy Study Implementation (DESI) drugs.

5. Providers participating in the 340B program must adhere to all the provisions in Miss. Admin. Code Part 200, Chapter 4, Rule 4.10.

B. The Division of Medicaid has the authority to recoup monies when an audit determines that the incorrect NDC number was billed.

Notes

23 Miss. Code. R. 203-2.2

Deficit Reduction Act of 2005; 42 U.S.C. § 1396r-8; Miss. Code Ann. § 43-13-121.

Revised eff. 07/01/2014. Amended 9/1/2015