Attachment E-MDR CMS Certification Outcomes and Metrics.pdf
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- Attached to
- Medicaid Drug Rebate System (MDR)
- Solicitation number
- 124528 ON
- Issued by
- Lancaster County, Nebraska
About this file
This file is a CMS Certification Outcomes and Metrics document for RFP #124528, issued by the State of Nebraska Department of Health and Human Services for the Medicaid Drug Rebate (MDR) System. The document outlines the certification requirements and performance metrics that the new MDR system must meet to comply with federal Medicaid regulations and state-specific objectives. The MDR system is expected to capture and process manufacturer rebate data to ensure timely invoicing of participating drug manufacturers within 60 days of each quarter's end, track rebates to promote beneficiary cost savings, and support accurate and efficient drug rebate processing. The system must comply with Section 1927 of the Social Security Act and applicable Code of Federal Regulations provisions (42 CFR 447.509, 447.511, and 447.520) regarding Medicaid drug rebate management.
The document specifies six core certification outcomes: PBM03 requires the system to capture necessary rebate data for timely processing and beneficiary cost savings; PBM04 mandates the capability to generate manufacturer invoices within 60 days of quarterly periods; PBM05 requires tracking, monitoring, and reporting of pharmacy drugs and rebate savings; and FM07 demands accurate and quick rebate processing. Additionally, four state-specific metrics (STPBM01 through STPBM04) require the system to provide timely web portal access to rebate invoices, implement an improved dispute resolution process, offer manufacturer self-service functionality, and facilitate enhanced quality assurance capabilities for accurate drug rebate invoicing.
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ATTACHMENT E - CMS Certification Outcomes & Metrics
RFP #124528 ON
Medicaid Drug Rebate (MDR) System State of Nebraska, Department of Health and Human Services
Please reference MES Certification Repository.
Outcome
Reference
Outcome Description CMS Required Regulatory
Source(s) or State Specific
Outcome Applicability
PBM03
The system captures the necessary data to ensure timely processing of manufacturer rebates as well as the capability to track rebates to promote beneficiary cost savings.
Section 1927 of the
SSA
42 CFR 447.509
PBM03 is applicable to this module. The Medicaid Drug Rebate system captures the necessary data to ensure timely processing of manufacturer rebates as well as the capability to track rebates to oƯset beneficiary expenditures.
PBM04
The system has the capability to support cost savings by capturing, storing, and transferring data to the payment process system to generate invoices of participating drug manufacturers within 60 days of the end of each quarter.
42 CFR 447.520
Section 1927(b)(2) of the SSA
42 CFR 447.511
PBM04 is applicable to this module. The Medicaid Drug Rebate system supports cost savings by capturing, storing, and transferring data to the payment process system to generate invoices of participating drug manufacturers within 60 days at the end of each quarter.
PBM05
The system supports cost savings by enabling the tracking, monitoring, and reporting of manufacturer's pharmacy drugs and rebate savings.
42 CFR 447.520
Section 1927(b)(2) of the SSA
42 CFR 447.511
PBM05 is applicable to this module. The Medicaid Drug Rebate system supports cost savings by enabling the tracking, monitoring, and reporting of manufacturer's pharmacy drugs and rebate savings.
FM07
The system processes drug rebates accurately and quickly.
42 CFR 447.509
FM07 is applicable to this module. The Medicaid Drug Rebate system processes drug rebates accurately and quickly.
STPBM01
Timely access to Drug Rebate invoices through a web portal.
State Specific Applicable
STPBM02 Improved dispute resolution process. State Specific Applicable
STPBM03
Portal provides a manufacturer self-service option.
State Specific Applicable
STPBM04
The system facilitates enhanced quality assurance capabilities to ensure accurate drug rebate invoicing.
State Specific
Applicable
File details come from the government source that posted it. Updated .