Medicaid – A New Environment for NDs

As we hope you are aware, beginning in January 2014, naturopathic physicians will be eligible to participate in the Washington state Medicaid program – now also known as ‘Apple Health.’ This is a significant achievement for our profession in terms of recognition and inclusion of naturopathic medicine in the health care system. Since Medicaid serves those who can’t afford other healthcare, this also brings the promise of expanding the value of our medicine to a population that has not had much access to it in the past.

So what does this big change mean for our doctors?

At this point, we don’t really know.

Below is the information we have thus far, but be forewarned – these are uncharted waters and before you rush to ‘sign up for more patients’, we really encourage you to do your research. Medicaid is not just another insurance plan, and in fact there are a number of different organizations administering the Medicaid program, in addition to the state Health Care Authority throughout the state, usually by particular counties. Each of these may require a separate application. These include: Molina, Coordinated Care, and Community Health Plan of Washington.

In terms of fee schedules, unless you offer pro-bono care, Medicaid rates are about as low as you can get in the world of third-party reimbursement. So, please be sure to check the online fee schedule. This can be rather confusing. First, go to this link: http://www.hca.wa.gov/medicaid/rbrvs/Pages/index.aspx.

Scroll down to “Physician-Related/Professional and Emergent Oral Healthcare Services” and select the top link to the most current schedule (these are updated quarterly.) Once on the schedule you need to scroll way down to the CPT code section, such as for E/M office visits, 99201-99215 (line 10710.) Then, read column ‘D: Max Allowable NFS.’ Also note that there will be different rates for adults and children.

Your decision to participate in Medicaid will likely depend on a number of factors, including:  1) where you are located, 2) the patient population you serve, 3) the capacity of your practice to handle administrative functions, reporting and general bureaucratic process, and 4) the level of reimbursement.

The WANP is providing this information as a starting place.  It is by no means definitive and you will need to do your own research.  If you have further questions or need to verify fees, policies or any other details, please contact the Health Care Authority, or the managed care organization administering the program in your area.

One of our pioneers in this area is WANP member, and former board member, Dr. Stacy Bowker. She shares the following notes:

“Naturopaths are eligible to begin the application process for enrollment in Medicaid. The application process takes 60 days and January 1st, 2014 is the first day enrolled naturopaths will be covered under Medicaid.

The link for application information is: http://www.hca.wa.gov/medicaid/providerenroll/pages/enroll.aspx#2

The application process itself is mostly online, but you must fax or mail supporting documents listed on the website. (Follow the instructions, as this need to be faxed with appropriate coversheet.)

For Naturopaths, these include:
• Copy of Current Professional License
• Copy of Drug Enforcement Administration (DEA) certification (if applicable)
• Copy of Medicare Enrollment Approval letter (if enrolled with Medicare)
• Copy of State Business License (Washington State Master Business License).
• Copy of Internal Revenue Services (IRS) Form W-9
• Copy of Liability Insurance
• Trading Partner Agreement and Assignment Notice.
• Electronic Funds Transfer form

First, open an application and get an application number: https://www.waproviderone.org/ecams/jsp/common/pgNewPrvdrEnrollment.jsp

The database itself is not the most user-friendly. In each section, you must add and submit the requested information. Addresses will need to be verified before the database accepts them, so you will need to find the “address” button (located by the zip-code field) in order to enter and verify the address. Navigation of the site is also a bit primitive. The buttons to ‘add/close/submit’, etc. are at the top left. Once data is saved, selecting ‘close’ will take you back to the Navigation list, where the box will either say complete or incomplete for the item you just did. You must complete all of the “required” boxes. If you get stuck or don’t do something correctly, you will likely get a support email. There are also links on the main application page to application instructions, although some of the links within the document are broken or outdated. You can also contact support by calling: 1-800-562-3022, ext. 16137.

If you need to go back to your saved application or check the status, you can follow this link: https://www.waproviderone.org/ecams/jsp/common/pgTrackPrvdrApplctn.jsp

You will need your application number and SSN/EIN in order to open/track your application. Once completed with the online application and supporting documents have been faxed, you can submit the application for review. Remember, it takes up to 60 days to be enrolled as a provider, so if you plan to see patients starting in January, you should apply ASAP.”

These instructions may differ for those NDs working for organizations or clinics that already participate in Medicaid. Similarly, NDs who are licensed in another health care profession may have differing enrollment requirements and processes. If in doubt, please check with the Health Care Authority.

If, after reading all the materials, you too choose to be a pioneer and venture into the world of Medicaid, please let us know how it goes. The WANP can be an archive for our collective experience and your progress in the new system can benefit many of your colleagues.

Thank you, and watch for more updates in future issues of Vital News.

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