Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter II - Specific Policies By Service
Section 144-101-II-45 - Hospital Services
Subsection 144-101-II-45.13 - REPORTING REQUIREMENTS
Acute Care Critical Access Hospitals and Private Psychiatric Hospitals must submit National Drug Codes (NDC) for all outpatient claims for all single source drugs (as defined in 42 CFR 447.502) and all multiple source drugs (as defined in 42 CFR 447.502) .
Drugs purchased through Section 340B of the Public Health Service Act (referred to as 340B hospitals) are exempt from this requirement.
Hospitals are responsible for updating their enrollment
applications, and submitting an updated 340B Provider Agreement to reflect 340B
status when it changes. Hospitals participating in 340B shall comply with
42 USC
§
256b(a)(5)(A)(i),
which prohibits duplicate discounts or rebates (manufacturers are protected
from giving a 340B discount and a Medicaid rebate on the same drug). In
accordance with
42 USC
§
256b(a)(5)(A)(ii),
hospitals participating in 340B shall comply with a CMS-established mechanism,
or establish their own mechanism, to ensure that they are in compliance with
the duplicate discount prohibition. For more information on duplicate discounts
refer to the following website
MaineCare will not pay for drugs that do not have a CMS rebate agreement unless they are medically necessary and any PA that is required under Section 90 of the MaineCare Benefits Manual has been approved in accordance with that Section.
