Opportunities to expand serivces, COVID19 testing
- Jonathan Jacobs
Here in New York, Independent Pharmacy was recently given the go-ahead by Governor Cuomo to begin testing for COVID19 and the Coronavirus. Yet, in NYS, testing via Community and Independent Pharmacies has moved along very slowly. For independent pharmacists in New York, news of in-store testing was initially well-received. Many expected that the tests would create opportunities for new business at a time when it was desperately needed. But they say there’s been little clarity since then about which tests to buy, how they would be reimbursed, and, crucially, whether staff other than the pharmacist on duty could be trained and allowed to administer them.
According to local pharmacists, most independent pharmacies in NYS have decided to await answers regarding the CLIA (Clinical Laboratory Improvement Amendment) waiver before taking the next step. Effectively, many store owners who “could” provide testing are awaiting the results of decisions by CMS to proceed. A CLIA waiver would allow a pharmacy to bill and be reimbursed for testing services outside of prescription dispensing. Pharmacists in Ohio are some of the first to be given the COW status (covered under waiver) in the nation. During on-site inspections by Ohio and Colorado of a random sample of 200 CLIA-COW and Provider Performed Microscopy Procedures (PPMP) laboratories, significant quality and certification problems were identified in over 50 percent of the laboratories.
Through the rollout in Ohio, roughly 2,000 community pharmacies across the state have been shut out, unable to provide the service. The state had not set up a system to reimburse them for the cost, which can run as much as $100. Lawmakers have criticized Medicaid for failing to implement legislation passed a year and a half ago to begin compensating pharmacists for medical services in addition to the reimbursements they receive to dispense medications. If the system were in place, billing for COVID-19 testing would not be an issue.
“The governor (of Ohio) in one of his recent press conferences talked about the importance of testing for COVID-19 and his commitment to pharmacies to enable billing for COVID-19 testing,” Medicaid Director Maureen Corcoran said Monday. Beginning next week, pharmacies will be able to bill for COVID-19 testing. Pharmacists will be able to administer the tests using the pharmacy’s existing provider number very similar to how we handle vaccinations.
CMS expanded the initial pilot to include 8 additional States across the nation, verifying the scope and seriousness of Colorado and Ohio’s initial findings and other studies. With the quality problems identified in those laboratories, CMS is initiating on-site visits to facilities enrolled in CLIA that have COW certificates. The promise is to visit at least 2% of CLIA’s. In order to ensure there is proper testing, the inspections will be from an educational approach and not cost the store anything from a monetary standpoint. Once this survey is done, more concrete information on future billing codes will be available. CMS is working with its partners and stakeholders to develop and ensure comprehensive educational programs through various mechanisms are available and provided to COW laboratories. CMS will also include educational information on its CLIA website at www.hcfa.gov/medicaid/clia/cliahome.htm
Additionally, CMS will work with manufacturers to provide initial training to testing personnel and provide clear instructions with the test system. If you have additional information or thoughts please contact us by commenting below, or emailing firstname.lastname@example.org.
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