Section 29-2711. [RESERVED]

 

2711.1Effective January 1, 2006, pharmacy claims for a nursing home pharmacy provider shall be reimbursed at the lower of the following:

 

(a) The allowable cost, established pursuant to the methodology described in this chapter, as appropriate, plus a dispensing fee of four dollars and fifty cents ($4.50) per non-IV (intravenous) prescription; or seven dollars and twenty-five cents ($7.25) per IV prescription; or seventeen dollars and twenty-five cents ($17.25) for cassette, Total Parental Nutrition (TPN) or container-related prescriptions; or

 

(b) The pharmacy’s usual and customary charge for non-Medicaid residents.

 

2711.2The allowable cost for drugs purchased by a nursing home pharmacy provider who is also a federally approved 340-B (Public Health Service) provider for Medicaid shall not exceed the actual acquisition cost for each 340-B purchased drug.  Pharmacy claims for 340-B providers shall be excluded from any manufacturer’s rebate.   

 

2711.3An additional supply of medications may be dispensed for use by a nursing facility resident during a short-term medically approved trip away from the facility during holidays or family trips.

 

2711.4Prescribed drugs for purposes of nursing home pharmacy reimbursement shall not include OTC medications, syringes for diabetic preparations, geriatric vitamin formulations, or senna extract single dose preparations except when required for diagnostic radiological procedures performed under the supervision of a physician.

 

authority

The Director of the Department of Health Care Finance (DHCF), pursuant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and for other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2006 Repl. & 2011 Supp.)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6) (2008 Repl.)).

source

Notice of Final Rulemaking published at 59 DCR 2298, 2308 (March 23, 2012).