New rules in WV

Buprenorphine Post
Jeremy K
Posts: 109

Postby Jeremy K » Tue Apr 12, 2016 8:22 am

"In order to receive cash payments from a pt with Medicaid, you must not be a Medicaid provider for this or any other service"...
Unless you are employed by someone who does not have a contractual relationship with Medicaid; then your services can be charged to the patient on a cash basis. E.g.: a family physician has contracts with Medicaid; when he sees, e.g., a pt w HBP who has Medicaid, he bills Medicaid for this. However, he also works for a separate entity who does NOT have a contractual relationship with Medicaid. This entity charges cash for certain services that the physician provides, regardless of the coverage of the patient. Ordinarily this does not violate the contractual relationship the physician has with Medicaid.
Interestingly enough, the KY legislature took it upon themselves to unilaterally change that for those with KY Medicaid, such that, regardless of the setting, if a Medicaid-enrolled provider (not necessarily just a physician) provides a service normally covered by Medicaid to a Medicaid pt, and the pt is charged cash for said service, said provider is liable to be disenrolled from Medicaid. This has resulted in (rumor has it) ~ 50% of those who had been providing Bup/Nal treatment to KY Medicaid pts in KY to drop their Medicaid patients, since Medicaid pays a pittance.

drpasser
Posts: 1404

Postby drpasser » Tue Apr 12, 2016 8:22 am

If Medicaid pts are seen and their Medicaid is billed and is paying for these pt's medical care; one must accept the Medicaid payments as payments in full.
It is not legal to bill Medicaid pts anything other than what their Medicaid pays.

As long as Medicaid is accepted, you are stuck with accepting that amount.

In order to receive cash payments from a pt with Medicaid, you must not be a Medicaid provider for this or any other service.

Best
Kevin

jmosby1469
Posts: 104

Postby jmosby1469 » Tue Apr 12, 2016 8:22 am

Good grief! I live in such a sheltered corner of the universe that it's frightening just to read of such realities. BTW, as an avowed Libertarian myself I am aligned with much of your thinking,Jeremy K, including the realism about what our general society seems to sanction.

Jeremy K
Posts: 109

Postby Jeremy K » Tue Apr 12, 2016 8:22 am

jmosby:
I agree that such regs are well-intentioned. As a Constitutionalist/Libertarian, I deplore any gov't involvement in medical care at all, including treatment for addiction. As a realist, I know they're in there to stay for the foreseeable future. Therefore I am actually glad, somewhat, for the Fed monthly prescribing limits: they make it illegal at the Federal level to run anything like a 'pill mill'. Oh, certainly there's many a MAT prescriber who prescribes cash, does not seem to us to be doing things 'right', has a 'fly-by-night' setup, etc. But such things pale in comparison with the true 'pill mills' we used to have in KY before the 'pill mill bill': a few hundred patients A DAY, stacks of cash (and sometimes guns and drugs) in the backroom, crime connections, etc. So, at least in KY, the 'pill mill bill' specifically did NOT cover Buprenorphine, since (I****ume) they knew that this was controlled at the Fed level. At least, I hope they knew that...

jmosby1469
Posts: 104

Postby jmosby1469 » Tue Apr 12, 2016 8:22 am

The only sense I can make of the avoidance of a cash-for-drugs exchange is to better regulate potential "pill mill" setups. I'm naive enough to imagine that not all such regulations are created with an evil (as we see it) purpose. I continue to believe that such a s sumptions are unrealistic. (love that new way of getting around the silly censoring)

mattkeene
Posts: 32

Postby mattkeene » Tue Apr 12, 2016 8:22 am

Tell me how on earth this Bill would survive court challenge? Shoot, even when I was doing Gen Psych, I didn't take insurance. Why should a Doc be forced to then take insurance for an even more challenging population. As I have said before, the data coming from TennCare makes a pretty compelling argument that folks who get completely free treatment are often the most likely to divert bup/nal. As harsh as it may sound, having some financial investment in your recovery is therapeutic.

alinad
Posts: 28

Postby alinad » Tue Apr 12, 2016 8:22 am

There seem to be two different currents. One promotes expanding access to Suboxone by increasing patient limits and allowing PAs and Nurse Practitioners to prescribe Suboxone. The other one vilifies Suboxone in general and especially providers who charge cash for services: "ask for money in exchange for narcotics".

This new Bill that passed in WV legislature sets a myriad of rules and regulations, licensing authorities and inspections.

Each MAT is required to designate certified counselors with master level education or bachelor level working under the direct supervision of an advanced alcohol and drug counselor.

The Bill stipulates that directly charging a patient is not allowed. A claim must be submitted to the insurance or to WV Medicaid.

In West Virginia there is already a huge shortage of substance abuse providers- Suboxone prescribers and counselors. This Bill imposes so many limitations that only the large agencies will be able to comply and all small Suboxone Clinics will close their doors.

drpasser
Posts: 1404

Postby drpasser » Tue Apr 12, 2016 8:22 am

Did you know, Relistor is over $100/dose?

drpasser
Posts: 1404

Postby drpasser » Tue Apr 12, 2016 8:22 am

Who among us is surprised? This is WEST VIRGINIA we're talking about :-)

Jeremy K
Posts: 109

Postby Jeremy K » Tue Apr 12, 2016 8:22 am

Well, that's what we get for letting the government have anything to do with it. I am in KY on the border with WV; I already see a substantial number of WV patients; I expect that demand to grow...


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