Private Pay Agreement For Medicaid

What if my state does not have « command and right » status? Can I register and be under a private contract? Private contract – Is it legal for a CPD physician to enter into private contracts with a Medicaid patient for covered benefits? A provider who does not participate in Medicaid service charges but has a contract with one or more managed care plans to serve Medicaid Managed Care or FHPlus members cannot charge Medicaid a service fee for services. Similarly, a provider cannot charge a recipient for benefits covered by the recipient`s Medicaid Managed Care or FHPlus contract, unless there is a prior agreement with the recipient to be considered a private salaried patient, as described above. The provider must inform the recipient that benefits can be obtained free of charge from a provider participating in the recipient`s managed care plan. usually. Unfortunately, recent changes to Medicaid in the Affordable Care Act (which apply even if your state has not expanded Medicaid) make it difficult to answer this question. Unlike Medicare, where doctors have to actively opt-out to make it legal to privately accept « covered services » with patients, in the case of Medicaid, if you have not formally « signed, » the assumption is that you are not enrolled in the program and that you are free to enter into private contracts with Medicaid patients for covered services. There are state exceptions to this general rule, and Kentucky is one of the most monstrous examples (where an earlier executive decision of the governor made it illegal to enter into private contracts with Medicaid patients in one way or another). Make sure you do your homework! In 2014, AAPS had an excellent Q-A exchange with CMS, during which cms made it clear that they currently felt there should be no problem with the awarding of private contracts with patients with Medicaid. Other states, such as Missouri, have made it clear that such private contracts are allowed. Some of my unanswered questions – if I signed up as a Medicaid provider and then I see Medicaid patients under private contract without « accepting » them as Medicaid patients, will they have trouble if patients fill prescriptions, lab orders, etc.? I know that every Medicaid patient will have a particular PCP, and I wonder what that means. Would I be (or could I) be a designated PCP and is it important from an Ordering Labs/meds/radiology/referral perspective? By enrolling in the Medicaid program, a provider agrees to accept Medicaid payments as a full payment for the services provided.