Myth busters: Provider Status Legislation

Mario-CoronadoBy Mario Coronado, STLCOP Pharm.D. Candidate 2016

While this is not strictly a Missouri issue, I wanted to take some time with this blog to cover a few points on the current provider status legislation, HR 592 and S 314. This is the preeminent issue impacting pharmacists and pharmacy services today, and it is important that everyone understands the scope of what the bill is proposing.   Here are some common myths that I have been hearing:

  1. Provider status will only impact pharmacists in rural communities: This is my least favorite myth because it implies either that some pharmacists think it’s not worth the effort or that pharmacists in cities have different goals than pharmacists in rural communities. Most importantly, all pharmacists must have the same goal of providing patients with the best care possible, partly through expanded services; this legislation will allow financial support for those services through Medicare Part B reimbursement. Second, it’s just wrong. This bill allows Medicaid Part B reimbursement to pharmacists serving patients in any Medically Underserved Area (MUA) or Health Professional Shortage Area (HPSA). You can check your designation with this link, but to offer an example, my neighborhood in South St. Louis City is an HPSA1.
  2. Physicians are against pharmacists expanded services: Admittedly, this one is going to vary physician to physician, and I haven’t spoken with all of them, but my impression so far is that physicians appreciate pharmacists’ involvement. Notably, the American Medical Association does not oppose this legislation. And why would they? There is a known shortage of primary care physicians, and if a pharmacist is available to perform “services medically necessary to treat a condition or disease,”2 physicians will be able to see more patients. The health-care team is evolving rapidly to care for our expanding patient population. Our role in that team must evolve as well.
  3. Pharmacists are already performing these services OR Pharmacists won’t be performing these services anyway: These myths are two sides of the same coin, as HR 592/S314 does not expand the scope of services a pharmacist can provide. This comes down to the state level, which is an area for potential advocacy moving forward. We are lucky to live in Missouri which is expanding pharmacy services throughout MO HealthNet. MPA has worked extensively with the Pharmacist Service Expansion Project to give community pharmacies an avenue for reimbursement for the expanded services a pharmacist performs. The Diabetes Accreditation Standards-Practical Applications (DASPA) certification is just one example to ensure community pharmacists can receive the reimbursement they deserve for providing patient care beyond the traditional role of a pharmacist. The provider status bill would open up Medicare Part B reimbursement for pharmacists’ services. It will impact what clinical services we perform, rather, it will incentivize increased clinical services through reimbursement with federal dollars.
  4. Pharmacists provide different services than physicians or nurses, why should they be classified the same: Yes, doctors and nurses are providers under the Social Security Act that covers Medicaid Part B, but so are midwives, dieticians, social workers, and clergy. Clergy are considered healthcare providers and pharmacists are not. I’m not diminishing the importance of clergy, I’m just astounded that pharmacists are still not considered providers eligible for Part B reimbursement. HR 592/S 314 will finally place pharmacists among the list of providers like we belong. Again, the bill does not impact the scope of pharmacy practice, it just provides reimbursement for the services we perform.
  5. This will just increase the cost of healthcare: Technically, the jury is still out on this argument. The Congressional Budget Office “scores” every bill, meaning they estimate the potential cost it will have on the federal government. The Pharmacy and Medically Underserved Areas Enhancement Act has been submitted for a score, and this is currently pending. Rest assured though that expanded pharmacy services have been shown to decrease the overall cost of healthcare while improving quality. There are many legislators who have, appropriately, held off on co-sponsoring this legislation until a score has been posted. Hopefully a low score will bring a host of new co-sponsors that will help move this legislation forward through congress.
  6. My support won’t make a difference: This past October, the American Pharmacists Association with Pharmacists Provide Care led an advocacy effort to recruit more co-sponsors for this legislation, particularly within the House of Representatives. This important indicator of support jumped from 219 to 266 representatives promoting patient access to pharmacists’ services3. The bottom line is that everyone’s support adds up to make a great difference. Even without advocating to your legislators, ensuring that your community understands what services a pharmacist can provide is an important step towards ensuring that all patients have access to quality healthcare.

All pharmacists stand to benefit from this legislation, and it is important that we all understand the impact this will have on our profession. I urge everyone to voice their support for this bill and any initiatives that come up at the state and federal level that expand patient access to valuable pharmacy services.

 

References

  1. Find Shortage Area by Address. Health Resources and Services Administration Data Warehouse. Updated May 29, 2015. Accessed February 29 at http://datawarehouse.hrsa.gov/GeoAdvisor/ShortageDesignationAdvisor.aspx.
  2. What Part B Covers. Medicare.Gov. The Official U.S. Site for Medicare. The Centers for Medicare and Medicaid Services. Accessed February 29 at https://www.medicare.gov/what-medicare-covers/part-b/what-medicare-part-b-covers.html.
  3. Pharmacists Provide Care. American Pharmacists Association. Accessed February 29 at http://www.pharmacistsprovidecare.com/.

My first day of rotation with the Missouri Pharmacy Assocation

Mario-CoronadoAfter making my drive from St. Louis to Kansas City on Monday, I had just enough time to drive to and settle into my apartment in Jefferson City Tuesday night before beginning my first day of rotation with the Missouri Pharmacy Association. Wednesday morning was hit the ground running for me, as, without any food in the apartment yet, I decided it would be best to stop for breakfast at the local Café Via Roma on my way in. I’ve met the MPA team on several occasions before this, and could have safely assumed they have coffee available at the office, but you can never be too careful. Finally, I made my way in and had the chance to introduce myself more formally to the team.

My name is Mario Coronado, St. Louis College of Pharmacy Class of 2016. I will be a second generation pharmacist and alumni of STLCOP. I have been interested in this rotation for some time, having already done some advocating with my professional pharmacy fraternity, Alpha Zeta Omega, so I am very excited to be here.

Throughout this rotation, I plan to dive head first into all of the behind the scenes work going on within the Missouri Pharmacy Association that protects our profession. We are all familiar with the most public results of this hard work, such as Legislative Day and the Missouri Pharmacist publication. This is my chance to see how that work gets done, in between trips to the Capitol.

Along with these opportunities, I want to understand how one gets involved with the consulting work that my preceptor has established himself within. I appreciate what chances I get to problem-solve, and I anticipate many opportunities will present themselves throughout this rotation.

After introductions on Wednesday, we jumped right to work, and through Friday afternoon the team kept me busy with meetings around Jefferson City and on conference calls with pharmacists from around the country. This was a three day crash course in just a handful of the many initiatives in progress here in Jefferson City. The scope of the work these teams perform is greater than I could have imagined without coming here. This is truly an exciting time for pharmacy in Missouri, and I look forward to my opportunity to contribute.

Mario Coronado
St. Louis College of Pharmacy
Pharm.D. Candidate 2016

My First Day with the Missouri Pharmacy Association

erica-schenewerkI was a little nervous entering my first day of the rotation. I was not sure what the rotation would entail, other than a very different perspective of pharmacy than what I was familiar with. I have been a member of the Missouri Pharmacy Association (MPA) for several years during pharmacy school, but I never fully understood the role MPA played in pharmacy practice. I was excited to be able to experience this different but important part of the pharmacy profession.

There were a couple of things that I knew I wanted to take away from the rotation. I want to learn all I can learn about the legislative side of pharmacy and what the MPA specifically does. I also want to learn how I can do my part as a pharmacist to remain involved and be a voice for pharmacists in the future. I believe it is very important for pharmacists to continue to develop and promote the profession. It is important that we as pharmacists stay in tune with the issues the profession is facing and up to date with the ever changing pharmacy world.

Going forward into the rotation, I am ready to learn everything I can about the MPA. I am excited to have an opportunity to learn what the MPA does for Missouri pharmacists and how the association operates. I will be spending some time with various staff members who work each day to carry out the mission of the MPA. I am excited to learn what each of their roles consists of and how it fits in to the MPA as a whole. I have no doubt that I will learn everything there is to know about the MPA and how to remain involved as I continue on my journey as a future pharmacist.

Erica Schenewerk
St. Louis College of Pharmacy
Pharm.D. Candidate 2016

Revolutionizing the MPA Membership Model: Change for the Good

The Missouri Pharmacy Association has been faithfully serving pharmacists since the 1800s. From advocacy to continuing education to networking and everything in between, the MPA has been your source for professional advocacy, resources and growth. As your association continues to ensure improvements in the value we provide to our members, we wanted to take the opportunity we have in front of us to reach more pharmacists in the state.

With a mindset to provide more value to a broader group of pharmacists, we’re revolutionizing our membership with an additional category: Business Members. The goal of the business member is to provide increased value for a great price! For $360, a business member would sign up for a year long membership and every pharmacist and technician in that individual pharmacy location will receive the benefit of being an MPA member (Individual member pricing: $280/year). Each additional location will also pay $360 and receive the benefit of membership for all pharmacists and technicians that work in that facility.

Our desire is two fold. We want to connect with more pharmacists and expand our member numbers to be more effective in our advocacy efforts. Secondly, since the MPA is the strongest state wide pharmacy organization focused on promoting pharmacists as the medication expert in Missouri, we wanted to ensure that we made it as easy as possible for not only the store owner/pharmacist in charge/manager to be a member of the MPA, but also any staff members who are pharmacists and technicians. This effectively broadens our base of members and strengthens the voice of pharmacy in our state.

The new model will allow you to provide value to your employers as well. Wouldn’t it be nice to tell employees in your store that they’ll be able to join the Missouri Pharmacy Association because you purchased a business membership that covers all pharmacists and technicians? These new members will receive all of our award winning communications, emails, education resources, networking opportunities, discounts to MPA partners resources, etc. that come along with being an MPA member. The cost? $80 per year more per store location than an individual membership ($360 for business membership compared to $280 for an individual membership).

Upgrade your membership, today!

Sincerely,

Missouri Pharmacy Association Board of Directors and Staff

Becoming a Missouri Medicaid Provider

IMG_4809Last week’s blog discussed how we as pharmacists can better utilize the MTM tool of Direct Care Pro (DCPro). DCPro is designed exclusively for patients with MO HealthNet (Missouri Medicaid). DCPro encourages pharmacist collaboration with providers as it focuses on topics such as gaps in care, insufficient screening, medication management, self-care, etc. By completing these interventions, we as pharmacists are able to work closely with providers to ensure that our patients have numerous opportunities to improve their chronic health condition(s) and overall health.

There may be barriers currently preventing you from participating in DCPro such as difficulty in finding the time to perform interventions, making an area of your pharmacy HIPAA compliant, etc. Last week’s blog provides guidance and strategies to overcoming these barriers.

There are two major requirements a pharmacist must first meet in order to perform DCPro interventions. In addition to holding a certificate of medication therapeutic authority issued by the Missouri Board of Pharmacy, you must be a MO HealthNet provider in order to provide this service for your patients.1 Becoming a MO HealthNet provider can be a complicated task, if you are not familiar with the process. This blog entry will take you step by step through the process of becoming a MO HealthNet provider.

Before you can even begin the enrollment process, you must possess a certification of medication therapeutic authority issued by the Missouri Board of Pharmacy.2 If you are a Pharm.D, obtaining this certificate is quite easy as the degree itself meets the requirements of the certificate. However if you are not a Pharm.D, you must participate in a Missouri Board of Pharmacy approved Medication Therapy Services (MTS) training course before applying for the certificate. This can be any medication therapy certificate course or program accredited or granted by ACPE, ASHP, ASCP or APhA.1 In addition to the cost of the MTS training course, there is a $50 application fee for this certification. You must also obtain an NPI number prior to beginning the MO HealthNet provider process.3

Once you have received your certificate and NPI number, you may begin the application to become a MO HealthNet provider. One must enroll via Missouri Medicaid Audit and Compliance (MMAC) on MO HealthNet’s website. For the purposes of utilizing DCPro, pharmacists enroll under provider type 35, disease management.4 It is important not to confuse provider types as there is also a provider type 60 called “pharmacy” which is an institutional provider type, not an individual provider type. Additionally, there are two subsets under provider type 35: disease state management training services (to use DCPro) and diabetes self-management training services. For this reason, it important to decide upon the extent of services you wish to provide prior to completing the application.

The application for provider status is available online and may be submitted there. A caveat; it is only available using the Internet Explorer web browser! If unable to access the application online, you may request a paper application from MMAC Provider Enrollment. At this time, there is no application fee for individual providers for either the online or paper application.

For pharmacists wishing to utilize provider status solely for utilization of DCPro, you must submit a copy of your current license with the MTS designation in addition to the application. If you wish to also use your MO HealthNet provider status for diabetes education, you must submit a copy of your current license as well as a copy of your appropriate diabetes education certification form. This certification may be in the form of completion of either the NCPA “Diabetes Care Certification Program” or the APhA/AADE certification program “Pharmaceutical Care for patients with Diabetes” or be a current CDE.4

Every application for provider status is reviewed and subject to the audit process. Applications are processed in the order in which they are received. As the application itself is quite detailed and lengthy5, it is very important to double check that the information you submitted is correct and complete. If material is missing, MMAC will likely be contacting you!

If you have heard about DCPro from your colleagues, one thing you may remember about the program is how lengthy the enrollment process can be. Happily, in the past few months, the enrollment process has become much more expedited. The majority of new applications are being processed in fewer than 30 days whereas the process formerly lasted months. If this was the barrier that was keeping you from becoming a MO HealthNet provider, hesitate no more and begin the enrollment process today.

Once the enrollment process is complete, you will receive an email containing your name, address, NPI number and effective date of approval. If for some reason you have not received this email 30 days after submitting your application, reach out to the MMAC to verify the status of your application.

Upon receiving confirmation of your MO HealthNet provider status, there is still the opportunity to gain access to CyberAccess and the DCPro module. You must contact the Xerox help desk via e-mail or telephone to receive access to DCPro via CyberAccess as they are the subcontractor responsible for maintaining the web portal.1 Additionally, it may be beneficial to participate in the web-based training sessions that Xerox offers to learn how to reserve, perform and bill for DCPro encounters.

Xerox and MO HealthNet also recommend subscribing to MO HealthNet News6 in order to stay up to date on notifications such as provider bulletins, provider manual updates and other official MO HealthNet news. The provider manual for pharmacists is a very lengthy document, yielding 247 pages of details.7 Therefore it would be much easier to subscribe to the updates than to read through the manual itself periodically.

Pharmacists who have obtained MO HealthNet provider status have the unique opportunity to help our Medicaid patients improve their health utilizing Direct Care Pro. By involving and coordinating patient care utilizing the patient, their physician and their pharmacist, in addition to promoting self-care, we are ensuring that the patient has all resources available to them in order to be successful in managing their own health condition(s). It is much like the famous saying, “give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.”

For more information on Direct Care Pro, including a detailed list outlining the next steps to utilize this service, simply follow the link: http://www.mo-pcn.com/pharmacistopportunities/direct-care-pro/

If you are interesting in exploring more MTS opportunities, follow the link to the Pharmacist Service Expansion Project. This program allows pharmacists to apply for a scholarship grant to cover program participation costs for MTS, Diabetes Accreditation Standards- Practical Applications (DASPA), DSME site accreditation, and various disease-specific programming: http://www.morx.com/index.php?option=com_content&view=article&id=208:pharmacist-service-expansion-project&catid=20:site-content#.Vg1XQvlVikp

Sarah Robinson

St. Louis College of Pharmacy

2016 Pharm.D. Candidate

 

References

  1. Missouri Pharmacist Care Network. Direct Care Pro. Accessed September 16th, 2015 at http://www.mo-pcn.com/pharmacistopportunities/direct-care-pro/
  2. Missouri Board of Pharmacy. Pharmacist Application for a Certificate of Medication Therapeutic Plan Authority. Accessed September 21st, 2015 at http://pr.mo.gov/boards/pharmacy/IMTSAPP.pdf
  3. National Plan and Provider Enumeration System. National Provider Identifier. Accessed October 5th, 2015 at https://nppes.cms.hhs.gov/NPPES/Welcome.do
  4. Missouri Department of Social Services. Missouri Medicaid Provider Enrollment Information Guide. Accessed September 21st, 2015 at https://peu.momed.com/peu/momed/presentation/providerenrollmentgui/Internetman121103.htm
  5. Missouri Department of Social Services. Missouri Medicaid New Provider Enrollment Application. Accessed September 21st, 2015 at https://peu.momed.com/peu/momed/presentation/providerenrollmentgui/BaseQuestionaireWindow.jsp
  6. Missouri Department of Social Services. MO HealthNet News Electronic Newsletters. Accessed October 5, 2015 at http://dss.mo.gov/mhd/global/pages/mednewssubscribe.htm
  7. State of Missouri MO HealthNet Manuals. State of Missouri Pharmacy Manual. Accessed September 24th, 2015 at http://manuals.momed.com/collections/collection_pha/print.pdf

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