Is There a Time Limit for States to Submit Invoices to Manufacturers?

By: Barb Lutz, CIS Senior Compliance Consultant
barbaralutz@cis-partners.com

A question has come up from various manufacturers regarding the time limits on states to submit Medicaid invoices to manufacturers. According to the original Medicaid Drug Rebate Operations Guide, states were required to submit invoices no later than 60 days after each rebate period. Several of my colleagues, who previously worked processing Medicaid invoices, remembered receiving invoices several years after the fact. Several manufacturers have started receiving state invoices much older than 60 days, so there has been some question about whether CMS had actually amended this requirement since 2005. Have you noticed that you are also receiving invoices later than 60 days after each rebate period? If so, have you asked the states why?

CIS recently contacted the CMS MDR Operations Department with this question to get some clarification on the subject. CMS responded as follows: “Initial invoices are sent within 60 days. Invoices to account for changes/corrections may be submitted at any time and for as long as the MDR Program has been in existence.” So with this said, what could be causing all these prior quarter invoices to be sent?

CIS’ opinion on this subject is that since “The Final Rule” dictates that states are now required to submit invoices for J-Code products, many of them are likely submitting J-Code invoices retroactively as well, which is creating an increase in invoices for many prior quarters. CIS feels the increase in J-Code invoices will increase over the next few quarters, and then start to filter out as the states catch up on submitting the retroactive invoices. So when you receive invoices from the states, pay special attention to the invoice dates. If you feel that invoices were sent after their 60 day rebate period expired, contact the states to find out why.

If you would like to discuss this issue further, feel free to contact Barb Lutz any time!

CMS Releases and the Final Rule can be found at our PCX website: http://www.cis-pcx.com/