On January 1, 2017, pharmacy claims for most Nebraska Medicaid patients will no longer be processed by Magellan Medicaid Administration. The pharmacy benefit will transition into Nebraska's Medicaid Managed Care program called Heritage Health
. The three plans available to Medicaid patients and their respective pharmacy benefits managers are Nebraska Total Care (Centene) & US Script/CVS-Caremark, UnitedHealthcare Community Plan & Optum, and WellCare of Nebraska & CVS-Caremark. Medicaid patients will be able to choose their health plan for next year during an open enrollment process this fall. Each PBM must issue a new, Medicaid-specific contract to pharmacies for their Nebraska Medicaid pharmacy claims. Many pharmacies have already received a contract addendum from Optum. To continue to care for Medicaid patients, pharmacies will need to make sure they are enrolled with Medicaid as a provider, as well as sign contracts with each of the PBMs that they plan to accept. Please sign-up
to receive email information about Heritage Health and important provider and program information, including Provider Bulletins, and frequently asked questions.
The final rule prohibits sex discrimination in health care including by:
• Requiring that women must be treated equally with men in the health care they receive. Other provisions of the ACA bar certain types of sex discrimination in insurance, for example by prohibiting women from being charged more than men for coverage. Under Section 1557, women are protected from discrimination not only in the health coverage they obtain but in the health services they seek from providers.
• Prohibiting denial of health care or health coverage based on an individual's sex, including discrimination based on pregnancy, gender identity, and sex stereotyping.
It also includes important protections for individuals with disabilities and enhances language assistance for people with limited English proficiency including by:
• Requiring covered entities to make electronic information and newly constructed or altered facilities accessible to individuals with disabilities and to provide appropriate auxiliary aids and services for individuals with disabilities.
• Requiring covered entities to take reasonable steps to provide meaningful access to individuals with limited English proficiency. Covered entities are also encouraged to develop language access plans.
to read more.
What does this mean to you?
Pharmacies, hospitals, and other healthcare facilities are covered entities and are subject to these rules.