Q: Will Utilization Review time frames (3 business days) be extended?
A. Not at this time. These are generally paper reviews. Peer to peer contact is not required for these reviews to happen. If this is an issue, please provide some data to explain what has changed.
Q: The bulletin authorizes payments to pharmacies up to a 90-day supply for any prescription medication. Does this include refills?
A: If the prescription allows for a 30-day prescription of a medication and three refills, the pharmacy could provide and be reimbursed for one 90-day supply, and the remainder of medication per the prescription (30 pills) could be issued as the final refill.
Q: Can MMI/IR services be delivered via telehealth/telemedicine?
A: No. Codes 99455 and 99456 are not among the CMS covered list of telehealth/telemedicine services in Texas.