Page 2182

West Virginia Income Maintenance Manual Chapter 28

West Virginia Income Maintenance Manual Page 6 Chapter 28 Special Pharmacy

28.3.11 EXPEDITED PROCESSING Applications must be processed as soon as possible after the Worker becomes aware of the need for immunosuppressant/anti-rejection/antipsychotic drugs. 28.3.12 CLIENT NOTIFICATION Once the eligibility decision is made, the local office is notified by the BMS Medicaid Policy Unit. The local office must notify the client of the decision in writing. BMS notifies the service provider of the approval and appropriate billing procedures. The service provider notifies the client of the following: • Covered medications; • How to obtain payment for drugs and services; • The Special Pharmacy ID number; and • Dates of coverage. 28.3.13 REDETERMINATION VARATIONS The redetermination process is as follows. 28.3.13.A Redetermination List Special Pharmacy is reevaluated in the sixth month of eligibility. The Supervisor is notified by the BMS Medicaid Policy Unit of the upcoming review in the fifth month of eligibility. 28.3.13.B Date of Redetermination The Worker is responsible for scheduling the redetermination so that it is completed prior to or during the sixth month of eligibility.

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Page 2182

Official source

West Virginia Income Maintenance Manual Chapter 28

West Virginia Income Maintenance Manual Page 6 Chapter 28 Special Pharmacy

28.3.11 EXPEDITED PROCESSING Applications must be processed as soon as possible after the Worker becomes aware of the need for immunosuppressant/anti-rejection/antipsychotic drugs. 28.3.12 CLIENT NOTIFICATION Once the eligibility decision is made, the local office is notified by the BMS Medicaid Policy Unit. The local office must notify the client of the decision in writing. BMS notifies the service provider of the approval and appropriate billing procedures. The service provider notifies the client of the following: • Covered medications; • How to obtain payment for drugs and services; • The Special Pharmacy ID number; and • Dates of coverage. 28.3.13 REDETERMINATION VARATIONS The redetermination process is as follows. 28.3.13.A Redetermination List Special Pharmacy is reevaluated in the sixth month of eligibility. The Supervisor is notified by the BMS Medicaid Policy Unit of the upcoming review in the fifth month of eligibility. 28.3.13.B Date of Redetermination The Worker is responsible for scheduling the redetermination so that it is completed prior to or during the sixth month of eligibility.