Heads Up: OMFS to Be Adjusted to Reflect Aug 1 Updates to ACA Federal Upper Limits

Medicaid has released updated Affordable Care Act federal upper limits (FULs) and states, including California, must implement the updated FULs in their Medicaid programs (Medi-Cal in California) within 30 days from the August 1, 2016 effective date.  Please note that under Labor Code section 5307.1 (g)(1)(A), the California workers’ compensation Official Medical Fee Schedule must be adjusted to conform to these relevant changes in the Medi-Cal payment system no later than 60 days after the effective date of those changes.

The updated FULs, calculated in accordance with the Medicaid Covered Outpatient Drug final rule g, are posted at www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Pharmacy-Pricing.html. More information on the FUL program is posted on the Federal Upper Limits page at www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/prescription-drugs/federal-upper-limits.html.

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