A looming debacle appears to have been averted involving a Medicaid mandate requiring the use of tamper-proof paper in printing prescriptions with electronic prescribing systems.
Physician informaticist Peter Basch, medical director of ambulatory clinical systems at MedStar Health, Columbia, Md., told attendees at the 17th annual Physician-Computer Connection Symposium in Ojai, Calif., about the breakthrough Thursday. Basch worked to overturn the CMS regulation interpreting a federal 2007 law that required tighter security on Medicaid prescriptions, a law Congress passed with the aim of saving taxpayers an estimated $100 million a year on fraudulent prescriptions.
The CMS has accepted recommendations that soon should be released by the National Council for Prescription Drug Programs, or NCPDP, to create anti-fraud measures using computerized printing technology deployable in electronic health-record systems and standalone e-prescribing tools as a substitute for expensive tamper-proof paper, which the CMS originally stipulated.
The mandate, which was slated to go into effect Oct. 1, would have required physicians using e-prescribing tools to print paper prescriptions on tamper-resistant paper, which costs many times what ordinary printer paper costs, Basch said. That mandate now has an alternative, he said. The NCPDP will issue a guideline to state Medicaid officials saying that the CMS will soon clarify its prior policy and unequivocally state that compliance for handwritten or printed prescriptions for fee-for-service Medicaid patients can be achieved without special paper.
Basch said at least two print technologies have been deemed acceptable by the CMS. One of them involves a patented process from Toronto-based firm, AdlerTech International, called Sentinel void pantograph, which incorporates a hidden security word or image into the background of a computer printed prescription. The image will show up when the document is copied or scanned. The other security technology is called micro printing, which uses a strip of tiny type that can be read with a 5X magnifying glass or loupe. The type appears to be smeared when photocopied by most copying machines.
The Scottsdale, Ariz.-based NCPDP is a standards-development organization for pharmaceutical claims-data interchange. An NCPDP task force has been working on the problem since January.
Michele Vilaret, director of telecommunications standards for the National Association of Chain Drug Stores, and an NCPDP board member, helped coordinate activities around the print-technology solution with various industry groups working under an NCPDP task force.
Vilaret said the CMS signed off Tuesday on the proposed print-technology solutions. An advisory letter to state Medicaid directors informing them of the acceptance by the CMS of the proposed guidelines is in the hands of NCPDP President Lee Ann Stember.
We just finished the documents yesterday, Vilaret said. They have been sent to the NCPDP. We are waiting for our president to sign it, then it will go off to the state Medicaid directors.
She also said Medicaid program officials from several states were involved in the NCPDP-convened work group, and that the group also is working on educational materials for pharmacists, physicians and patients it hopes to have distributed by the end of the month. -- by Joseph Conn