The new provider contracts being offered by the State Health Plan need to be returned by Monday, July 1st, 2019, in order for providers/practices to remain in-network beginning January 1, 2020. Effective Jan. 1, 2020, the Plan will be moving to a reference-based pricing model and will use Medicare rates as the reference point and pay providers a percentage above that rate. Practices/providers that do not wish to participate in the network in 2020 will be considered a non-network provider.
In other State Health Plan developments, the Plan has now finalized the reimbursement levels for vaccines to include drug and administrative reimbursement methods. The administrative codes will be set at 2018 CMS Rates at 160% in the Reimbursement Exhibit. The vaccines themselves will be paid 125% of the CDC Private Sector Price list. The Reimbursement Exhibit will be updated to reflect this change. For additional information, please refer to information posted online.