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Regulations

 

How Physicians Can Electronically Exchange in 2012

 

Alabama’s Health Information Exchange (HIE), called OneHealthRecord, is launching in April 2012 as a means for healthcare providers to exchange patient information electronically.  Is your practice ready to exchange?  The Alabama Academy of Family Physicians and the Alabama Chapter-American Academy of Pediatrics, through its Practice Management Association, are pleased to join forces to present this 60-minute webinar in order to meet meaningful use requirements and deliver more informed care.

 

This session, which is complementary benefit for AAFP and AL-AAP members, PMA members and family practice managers, features a presentation and Q&A with Dan Roach, MD, Alabama’s HIT Coordinator; Gary Parker, IT Project Director, Alabama’s OneHealthRecord, Alabama Medicaid Agency; and Kent Ogle, Client Program Director, Thomson-Reuters.  Participants will learn:

 

·         How Alabama’s OneHealthRecord will allow physicians to meet meaningful use criteria;

·         The methods available for a physician’s office to engage in electronic health information exchange;

·         How to evaluate the health information technology maturity level of your practice in order to begin exchanging

 

Simply click the link below and view the webinar, should you have questions please contact your AAFP staff.

https://cc.readytalk.com/r/4g9zn266h316

 

Change in Credits Awarded in ABFM SAMS Courses

February 09, 2011

The ABFM recently submitted data to the AAFP indicating that the average time in which diplomates reported completing the Self-Assessment Modules (SAMs) is 11.84 hours. The AAFP awards Prescribed credit on an hour-for-hour basis, based on quarter-hour segments, for time spent in formal education. Therefore, the 2011 SAMs courses will be awarded 12 Prescribed credits. AAFP Accreditation Requirements for Enduring Material can be found on the AAFP website. Additional information about ABFM SAM Modules can be found on the ABFM website under "Maintenance of Certification, Part II."

 

If you have questions, please contact the ABFM, or Chris Hodges , AAFP CME Accreditation Specialist.

 

ALABAMA REGIONAL EXTENSION CENTER (ALREC)

 - Moving Alabama Providers from Paper to Electronic Health Records

 

“This is an exciting opportunity for the providers in Alabama.  We understand that transitioning from paper to electronic records can be a daunting and expensive task.  Our job is to help make this a smoother and faster transition resulting in the potential for more efficient patient care.  This will ultimately translate to a better workflow for the providers and better quality of care for the patients.”

 

Dan Roach, MD

Project Director, ALREC;

Assistant Dean, COM Medical Informatics Education

Director Medical Informatics, USA CSHI

The University of South Alabama Center for Strategic Health Innovation (USA CSHI), representing a statewide consortium of partners and stakeholders, was recently awarded a cooperative agreement to serve as the Alabama Regional Extension Center, or ALREC. Partners and stakeholders include The University of South Alabama, Alabama Medicaid Agency, The University of Alabama at Birmingham, Auburn University, Alabama Hospital Association, Alabama Primary Healthcare Association, Alabama Academy of Family Physicians, Alabama Academy of Pediatrics, the JHD Group and Management and Medical Consulting Services, Inc. ALREC will serve as an advocate for Alabama physicians and deliver services to assist providers in moving from paper to electronic health records and in achieving Meaningful Use status.  

Membership in ALREC is open to all providers in Alabama and provides access to services such as group purchasing discounts, EHR adoption assistance, assistance with education and training, workflow analysis and project management, interfaces to HIEs and more.  ALREC will provide education and vendor neutral direct technical assistance to ensure that providers in Alabama will be eligible for Medicare and Medicaid incentive reimbursements.  Whether you already have an electronic health record in place or not, the comprehensive technical expertise available within ALREC will ensure your practice successfully implements EHR, meets Meaningful Use requirements, and receive incentives potentially up to $67,300 per provider.

Federal funding under the cooperative agreement is targeted to “Priority Primary Care Providers” (PPCPs), or providers in practices of 10 or less who specialize in primary care, family practice, obstetrics, gynecology, geriatrics, or internal medicine.  However, all providers who join ALREC will receive adoption and implementation services at significantly reduced rates.

To encourage enrollment of PPCPs, ALREC has agreed to waive membership fees for the first 1,000 PPCPs through April, 2011.  This is a unique opportunity for primary care providers in Alabama, so act now to ensure you are able to take advantage of the services offered by ALREC. 

 

For more information, please contact ALREC:

 

Alabama Regional Extension Center (ALREC)

307 University Blvd./TRP III, Suite 1100

Mobile, Alabama  36688

Phone:  (251) 414-8170

Fax:  (251) 414-8171

Website:  www.al-rec.org          

Email: info@al-rec.org

 

State providers need to prepare for EHR incentive payment registration

While national registration for federal electronic health record incentive payments has begun on the national level, Alabama providers will need to wait until April 1, 2011, to register for the program, popularly known as “meaningful use.”  Alabama had originally hoped to participate in first-round testing with the federal National Level Repository; however, Alabama is now in line to test for state registration to begin in April.

State registration is the final step for Medicaid providers who hope to receive up to $63,750 over a five year period for implementing and using electronic health records and related technologies in a prescribed manner.  

To receive the payments, providers must begin the registration process at the national level, and then complete state-level registration and attestation.  State level registration, however, cannot be completed until the Alabama’s registration system is operational in April, according to Kim Davis-Allen, state health information technology coordinator.

During this interim period, Alabama providers are encouraged to prepare now to register by ensuring that they have all of the required numbers that will be needed to register.  Davis-Allen noted that eligible providers will need an active National Provider Identifier (NPI), and have a National Plan and Provider Enumeration System (NPPES) web user account. The CMS website contains comprehensive information of the information needed for the national registration process.

Other preliminary steps providers may want to consider include contacting the University of South Alabama, the state’s Regional Extension Center, for assistance in assessing the electronic health records needs of the practice, help in selecting a certified vendor and training and educational opportunities.

Updates, announcements and additional information is available at www.onehealthrecord.alabama.gov

Links:

Regional Extension Center:   http://www.al-rec.org/ or by phone at 251-414-8170

Federal site:  http://www.cms.gov/EHRIncentivePrograms/

 

Here is information received by the Alabama AFP on September 6, 2007 regarding the requirement that prescriptions written for Medicaid patients must be written on tamper proof paper.

To: Medicaid Physicians, Pharmacies, FQHCs, Rural Health Clinics, Optometrists, Nurse Practioners, Nursing Homes and Dentists

RE: Tamper-resistant Prescription Pads

The purpose of this notice is to clarify the Alabama Medicaid Agency’s implementation of a provision of Public Law 110-28 (Iraq War Supplemental Appropriations bill) that mandates all non-electronic outpatient prescriptions provided to Medicaid recipients on or after October 1, 2007 be executed on tamper-resistant pads.

For Alabama Medicaid Agency prescriptions written on and after October 1, 2007, a prescription must contain at least one of the characteristics listed below:

Required tamper-resistant characteristics

One or more industry-recognized features designed to:   Examples include but are not limited to:    

  1. Prevent unauthorized copying of a completed or blank prescription form: High security watermark on reverse side of blank; Thermochromic ink; Repetitive pattern (i.e. “void” or “illegal”) appears if copied
  2. Prevent erasure or modification of information written on the prescription by the prescriber: Tamper-resistant or “safety colored” background ink shows erasures or attempts to change written information   
  3. Prevent the use of counterfeit prescription forms: Sequentially numbered blanks; Duplicate or triplicate blanks 

Effective for prescriptions written on and after October 1, 2008, a non-electronic/written prescription must contain all three characteristics listed.

This requirement applies to all non-electronic, legend and over-the-counter, written outpatient prescriptions when Alabama Medicaid Agency is the primary or secondary payer.  Retrospective audits identifying non-compliant written prescriptions will result in recoupments from the servicing pharmacy as well as an assessment to the prescribing provider.  Medicaid is committed to ensure providers are proactively educated regarding this new provision.

Drug Enforcement Administration and Alabama Board of Pharmacy laws and regulations pertaining to written and electronic prescriptions still apply.

Although the Alabama Medicaid Agency will not endorse specific vendors that supply tamper-resistant pads, the Agency will strive to make available contact information for companies that provide compliant tamper resistant prescription pads at no charge to the prescriber.

1.      Exceptions to Tamper-resistant Rx Pads

Exemptions from the tamper-resistant requirement include prescriptions that are:

  • Provided in nursing facilities, intermediate care facilities for the mentally retarded (ICFMRs), and other inpatient institutional and clinical settings paid through the per diem
  • E-prescribed, faxed to the pharmacy from the provider’s office, or telephoned to the pharmacy by the provider
  • Refills for which the original prescription was written before October 1, 2007

2.      Emergency Fills

Emergency fills for prescriptions written on non-tamper resistant pads are permitted as long as the prescriber provides a verbal, faxed, electronic, or compliant written prescription within 72 hours after the date on which the prescription was filled. In an emergency situation, this allows a pharmacy to telephone a prescriber to obtain a verbal order for a prescription written on a non-compliant prescription pad, or to otherwise obtain a prescription in a compliant form.  If a compliant prescription cannot be obtained within 72 hours, the pharmacy must withdraw the claim.

3.      Additional Resources

For questions regarding this ALERT, please contact the Alabama Medicaid Agency Pharmacy Services division at (334) 242-5050.

FREQUENTLY ASKED QUESTIONS CONCERNING
THE TAMPER-RESISTANT PRESCRIPTION PAD LAW
(SECTION 7002(b) OF THE U.S. TROOP READINESS,
VETERANS’ CARE, KATRINA RECOVERY, AND IRAQ
ACCOUNTABILITY APPROPRIATIONS ACT OF 2007)

Effective Date of the New Law (Section 7002(b))

Q: Will the Centers for Medicare & Medicaid Services (CMS) delay the October 1, 2007 effective date of section 7002(b)?

A: No. Section 7002(b) does not give CMS the authority to delay the October 1 effective date. Only Congress may delay the effective date through new legislation. Therefore, the States are responsible for the full implementation and enforcement of the new law as of October 1.

Retroactive Eligibility

Sometimes, a person becomes eligible for Medicaid benefits after he has submitted a written prescription to a pharmacy and has had the pharmacy fill the prescription. In these retroactive eligibility situations, the recipient often will return to the pharmacy and present evidence of his eligibility in order to get reimbursed by the pharmacy for whatever money the recipient previously paid the pharmacy to fill the prescription. Many have asked whether, in order to submit a claim to Medicaid, the pharmacy must obtain a compliant prescription.

Q: When it is determined that a Medicaid recipient is retroactively eligible for Medicaid and the recipient’s original, written prescription was filled during a period when the recipient is now deemed to have been Medicaid eligible, must the pharmacy, prior to submitting a claim to Medicaid, obtain a tamper-resistant written prescription, a verbal order, a faxed prescription, or an e-prescription prior to submitting a claim to Medicaid?

A: When a Medicaid recipient is retroactively eligible for Medicaid after a pharmacy has already filled the recipient’s prescription, CMS will presume that the prescription was compliant with section 7002(b), unless there is evidence that the prescription was non-compliant. This presumption applies to the filling of the prescription that occurred before the recipient became retroactively eligible for Medicaid. This presumption does not extend to any refills that occurred after the date on which the recipient is determined to be eligible for Medicaid. Such refills require that the pharmacy obtain a new, tamper-resistant prescription in compliance with section 7002(b). Alternatively, the pharmacy may obtain verbal confirmation of the prescription from the prescriber or may obtain the prescription from the prescriber by facsimile or e-prescription.

Emergency Prescription Fills

Q: Page two of CMS’ August 17, 2007 State Medicaid Director letter (the "SMD Letter") allows a pharmacy to fill prescriptions on an emergency basis and, within 72 hours after the fill date, obtain a written prescription that complies with section 7002(b) or obtain the prescription by verbal communication from the prescribing doctor, by facsimile, or by e-prescription. Will CMS define "emergency fill," as discussed in the SMD Letter? Is the emergency fill provision limited to certain drugs or to instances when the individual has no supply left?

A: CMS will not further define the "emergency fill" provision of the SMD Letter. Each State should refer to its own statutes, rules, and regulations to define the term.

Q: May the pharmacy provide the full prescription to the patient in the emergency fill situation, or must the pharmacy only provide a 72-hour supply?

A: The pharmacy may provide the full prescription to the patient in the emergency fill situation, so long as the pharmacy obtains a compliant prescription in writing, or by telephone, fax, or e-prescription, within 72 hours.

Q: Do States have the authority to implement a "hold harmless" provision for pharmacies that document their pharmacists’ calls, faxes, or other efforts to obtain a compliant prescription but that do not receive a response from the prescriber within the 72-hour period?

A: No. Section 7002(b) does not contain a "hold harmless" provision.

Drug Orders in Certain Institutional Settings

As noted on page one of the SMD Letter, section 1927(k)(3) of the Social Security Act describes certain institutional settings, including nursing facilities, where outpatient drugs are not subject to section 7002(b). CMS has received many questions about drugs prescribed in institutional settings referred to in section 1927(k)(3) that are ordered by way of drug orders written in patient charts or in other written formats, where these orders are not written on prescription pads.

Q: Must a written order provided in an institutional setting described in section 1927(k)(3), and separately reimbursed by Medicaid, that is written into the medical record and conveyed by medical staff to a pharmacy be executed on a tamper-resistant prescription pad?  

A: CMS has concluded that a written order prepared in an institutional setting where the doctor or medical assistant writes the order into the medical record and then the order is given by medical staff directly to the pharmacy is considered "tamper resistant," so long as the patient never has the opportunity to handle that written order.

Prescriptions for Controlled Substances

Q: Federal law and many State laws require that all prescriptions for Schedule II controlled substances be written. If a non-tamper-resistant controlled substance prescription that complies with Federal and State law is presented to a pharmacy, may the pharmacy obtain verbal confirmation from the prescriber in order to satisfy the tamper-resistant requirement of section 7002(b)?

A: Yes. As long as the Schedule II requirements are satisfied, section 7002(b) can be satisfied through any of the methods set forth in the SMD letter, that is, through a prescription that is transmitted verbally, sent by facsimile, or sent through an e-prescription, or is written on compliant, tamper-resistant prescription pad.

Q: Does CMS’ reference to "controlled dangerous substances" include State schedules of controlled substances?

A: Yes.

Physician-Provided Drugs

In many cases physicians provide prescription drugs directly to patients (e.g., via samples).

Q: If the prescriber provides a drug directly to a Medicaid recipient, is a tamper-resistant prescription required?

A: No.

Communication between Physician/Prescriber and Pharmacy

As noted on page one of the SMD letter, section 7002(b) does not apply to non-written prescriptions, that is, it does not apply to: e-prescriptions; prescriptions transmitted to the pharmacy by facsimile; and prescriptions communicated to the pharmacy by telephone.

Q: Does the physician/prescriber have to be the individual who transmits a non-written prescription to a pharmacy?

A: No. A nurse or administrative staff person who is authorized to act on the prescriber’s behalf may phone the pharmacy the order, send the order by facsimile, or electronically transmit the order to the pharmacy.

Q: Will the action of a pharmacist calling back a physician/prescriber and making appropriate documentation on the original, non-compliant written prescription make the prescription compliant for purposes of a subsequent Medicaid audit?

A: Yes. Documentation by the pharmacy of verbal confirmation of a non-compliant written prescription satisfies the requirements of section 7002(b).

Prescription Transfers between Pharmacies

Q: When Pharmacy # 1 transfers a tamper-resistant prescription to Pharmacy # 2 to be filled, will a facsimile or telephone call from Pharmacy # 1 to Pharmacy # 2 satisfy section 7002(b), or must Pharmacy # 2 obtain direct confirmation from the physician/prescriber?

A: Pharmacy # 2 need only obtain a phone call or a facsimile from Pharmacy # 1 in order to confirm the authenticity of the tamper-resistant prescription that was previously delivered to Pharmacy # 1. There is no need for Pharmacy # 2 to obtain direct confirmation of the original prescription from the physician/prescriber.

Record Retention

Page two of the SMD letter states that section 7002(b) "does not impose additional requirements on States regarding retention of hard copy prescriptions. States may follow current State and Federal laws and regulations for record retention." Several States only require a pharmacy to retain a scanned copy of the original prescription.

Q: If a pharmacy notes in writing on the original prescription that it is tamper resistant and then scans the prescription, will this comply with section 7002(b) for purposes of a later audit?

A: It depends upon the law of the individual State. Each State will determine what, if any, changes the State will require to its record retention policies in light of section 7002(b).  

Characteristics of tamper-resistant prescription pads

Q: Will CMS provide examples of existing State practices that meet CMS requirements?

A: The tamper-resistant prescription pad characteristics set forth by the several States that currently have tamper-resistant prescription laws and/or regulations in effect are all acceptable examples of all three of the characteristics set forth on page two of the SMD Letter. These States are California, Florida, Indiana, Kentucky, Maine, New Jersey, New York, Texas, and Wyoming. (Idaho’s regulations currently require one tamper-resistant feature; therefore, Idaho’s law is compliant with the guidance given in the SMD Letter through September 30, 2008, but not thereafter.)

Q: What are the "industry-recognized features" that CMS recognizes for the prevention of copying, erasure, or counterfeiting?

A: The tamper-resistant prescription pad characteristics set forth by each of the States that currently have tamper-resistant prescription laws and/or regulations in effect are all acceptable examples of existing State practices that meet the requirements set forth by the SMD Letter.

Q: Does the requirement of the use of an ink pen satisfy the second characteristic set forth on page two of the SMD Letter (i.e., a feature that "prevent[s] the erasure or modification" of information on a prescription)?

A: No, it does not. Ink can be erased and modified, and in part for those reasons, the use of an ink pen is not an industry recognized standard.

Q: How do the characteristics set forth on page two of the SMD Letter apply to computer-generated prescriptions that are printed on plain paper and are then signed by the prescriber? Is there an industry-recognized feature to address computer printer paper?

A: A computer-generated prescription that is given to the patient to take to the pharmacy must be printed on compliant, tamper-resistant paper. Such compliant paper is available in the marketplace.

Q: Will CMS publish a list of approved vendors that print prescription pads on compliant, tamper-resistant paper?

A: No. As long as the prescription pads meet the requirements of the guidance in the SMD Letter, providers are free to choose whatever vendor they wish.

Q: Is there any restriction on who may supply prescribers with compliant tamper-resistant prescription pads?

A: Each State may determine the vendors from which a prescriber may obtain tamper-resistant prescription pads.

Compliance

Q: Who will be responsible for ensuring that there is compliance with the requirements of section 7002(b)?

A: Primary responsibility for auditing Medicaid providers rests with the States. However, there are some circumstances in which CMS, the Office of the Inspector General of the U.S. Department of Health & Human Services, or some other Federal agency may have occasion to audit a pharmacy provider. When that occurs, the Federal agency will have authority to determine compliance with section 7002(b).

Medicaid as Secondary Payor

Q: Will there be resources to help pharmacists identify Medicaid as the secondary payor to help limit the number or prescriptions that may need to be reprocessed if the prescription was non-compliant?

A: Pharmacist-providers should consult with their State Medicaid agency for assistance in this area.

 

 

Simply click the link below and view the webinar, should you have questions please contact your AAFP staff.