Any other Kentucky providers?

Buprenorphine Post
adavid
Posts: 64

Postby adavid » Sun Mar 15, 2015 8:08 am

I work in Pennsylvania. I have been informed that if a doc is Medicaid contracted (participating) then even a doc-in-the-box that is not Medicaid contracted, cannot take money from a Medicaid pt for his services even if that doc just moonlights there.

mack86
Posts: 70

Postby mack86 » Sun Mar 15, 2015 8:08 am

tdwoz13 -Are you seeing medicaid or medicare pts in your private practice and accepting cash? ZDon't you have to formally "Opt-out" of medicare/caid to accept cash from this group? Is it ok to take medicaid at one place and cash at another?

I have "opted-out" and so my medicare/caid pts can pay cash. I was thinking about working with another doc, but I'd have to accept medicare and medicaid if I did. Not sure how that would affect my other patients

Jeremy K
Posts: 109

Postby Jeremy K » Sun Mar 15, 2015 8:08 am

Thanks all for the responses here. To 'tdwoz13', since you're a psychiatrist, and hence (I presume) not as dependent on Medicaid or Medicare for income, I would guess your approach will 'work' for you. Howsomever, for those of us who are 'primary care', the fear (at least for me) is that not only could we be kicked out of KY Medicaid, but that the status of 'having been excluded from a Medicaid program' could carry over if/when applying or being recertified for any number of things, including hospital staff membership, being a Medicare provider, state licensure, etc.

And by way of update, paperwork has been initiated to affiliate with a local BHSO, but they are in a 'logjam' situation; unable to take in any significant percentage of my KY Medicaid patients at present, uncertain whether they will be able to do so. I suspect the problem is a combination of having enough counselors, and successfully contracting with the various KY Medicaid 'carriers' at a rate sufficient to allow them to pay me as well as their counselors.

tdwoz13
Posts: 2

Postby tdwoz13 » Sun Mar 15, 2015 8:08 am

Jeremy, I'm a psychiatrist in Ky but I'm not on this forum much. I made lots of phone calls with this new law because I do not take insurance in my private practice, but I do occasional locum work with an inpatient facility and have to be a Medicaid participating provider there. I was told the worst that could happen is that I get dropped by Medicaid, so I've continued to see patients in my outpatient practice on a cash basis. We try to weed out the Medicaid patients, but most of them have learned that they just shouldn't tell potential providers if they have it. Pretty sad that it's come to that, in my opinion.

Jeremy K
Posts: 109

Postby Jeremy K » Sun Mar 15, 2015 8:08 am

Here's a link; I think it's accurate:
http://chfs.ky.gov/nr/rdonlyres/657b4da0-bda5-4438-8b7a-0c4a5deb14b0/0/3005e81814.pdf
and
http://www.lrc.ky.gov/kar/907/003/005.htm (focus on section 2, 2.c)

The gist, I think, is this: up til now if a Medicaid 'participating provider' for non-addiction medical services in one 'persona' (e.g. in his own office) was also employed by an entity that was not a 'participating provider' providing treatment for addiction on a cash basis, this did not constitute violation of the 'participating provider' agreement. Now, for KY Medicaid purposes, such a situation will result in the practitioner being 'kicked out' of the Medicaid program.

My guess is that if this was all that was done, there'd be very little OST with buprenorphine provided in KY to Medicaid pts. However along with the stick, there's a carrot. I'm given to understand that KY Medicaid will reimburse organizations called 'Behavioral Health Service Organizations' (BHSO) at a rate such that they can partner with physicians who could prescribe buprenorphine as part of addiction treatment and pay said physicians sufficiently to be at least attractive enough to encourage some of us.

I'm seeking to partner with a local BHSO so that I can continue to see my Medicaid patients. Vague rumor suggests that ~ 1/2 the docs in KY who treat addiction with Buprenorphine will drop their Medicaid pts, the rest will (presumably) partner with or become a BHSO.

drpasser
Posts: 1404

Postby drpasser » Sun Mar 15, 2015 8:08 am

Do you have a link to the new regs?

Best
Kevin
P.S. The first Passer above was good, the second, not as much. :-)

rickbennettmd
Posts: 90

Postby rickbennettmd » Sun Mar 15, 2015 8:08 am

Dr Passer

Dr Paaser

Kentucky has recently passed several regulations directed at Suboxone care in our state.

This topic therefor is of some general interest to all Buprenorphine prescribers.




Richard Bennett

rickbennettmd
Posts: 90

Postby rickbennettmd » Sun Mar 15, 2015 8:08 am



Curious: do the new regs affect your practice? Is your site already a 'BHSO' (or whatever the acronym is) or are you affiliating with one?

Jeremmy --

When the new Medicaid decree came out last fall we had to drop ur Medicaid patients. This was 1/3 of our patients. Ours is dedicated Suboxone clinic, and our 100 patient limits would not allow the mandated $30 maximum reimbursement.

We gave them all free visits, prescriptions, taper plans, and references to other clinics.

We now are making sure our patients are at or below the 16 mg daily dose that was mandated.

As for the mandated psychiatric consultation, we are very fortunate to have a psychiatrist in our group. I'm sure that's a difficult mandate for many clinics and patients.

Your experience with this?






Richard Bennett

drpasser
Posts: 1404

Postby drpasser » Sun Mar 15, 2015 8:08 am

Ah, I get it now. Kentucky providers on this site, right?

Duh :-)

Best
Kevin

Jeremy K
Posts: 109

Postby Jeremy K » Sun Mar 15, 2015 8:08 am

Rick Bennett:

Curious: do the new regs affect your practice? Is your site already a 'BHSO' (or whatever the acronym is) or are you affiliating with one?

Jeremy


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