How are medical benefits regulated in West Virginia?
This chapter provides an overview of various types of reimbursement methodologies utilized by the Bureau for Medical Services (BMS) to reimburse providers for West Virginia (WV) Covered Medicaid services. Information is also provided regarding Medicaid as a secondary payer, and Medicaid’s relationship to Medicare.
Where can I get help with addiction treatment in West Virginia?
West Virginia Medicaid is now able to pay for Peer Recovery Support Services. West Virginia Medicaid will work to create a system of Peer Recovery Support Specialists, including training, certification and reimbursement for services provided. A peer is an individual who shares the direct experience of addiction and recovery.
Who is covered under West Virginia Workers’ Compensation Laws?
West Virginia Drug Rehab Centers That Accept Medicaid Alcohol And Drug Rehabilitation Programs That Accept Medicaid . If you are addicted to drugs and alcohol, it is crucial that you receive rehabilitation before it is too late. However, many addicts often have money troubles arising from their persistent alcohol and drug abuse over the long ...
What are my disability rights under West Virginia law?
Jun 18, 2020 · Addiction in West Virginia According to documents released by the National Drug Intelligence Center, cocaine is a significant drug of abuse in West Virginia, as the drug was responsible for more drug-related offenses than any other illicit drug in 2002. Prescription medications, however, are also becoming serious targets of abuse within the ...
What is substance use disorder Samhsa?
Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.
Does WV Medicaid cover Suboxone?
These medications require prior authorization for use. West Virginia covers Suboxone, buprenorphine/naloxone tablets, and buprenorphine tablets as a pharmacy benefit under both FFS and managed care plans.
Does WV Medicaid cover telemedicine?
West Virginia Medicaid covers and reimburses a limited number of Telehealth services that are provided to enrolled members by enrolled practitioners via a telecommunication system. West Virginia Medicaid utilizes the Centers for Medicare and Medicaid Services (CMS) guidance for Telehealth Services.
Does Medicaid cover methadone in Illinois?
Illinois Medicaid does not cover methadone for the treatment of opioid use disorder. Methadone used to treat opioid use disorder is covered with state-only funds by the state Department of Alcohol and Substance Abuse.
Does WV Medicaid pay for prescriptions?
The West Virginia Medicaid Pharmacy Program is an optional fee-for-service benefit offered to all eligible members, including those who are enrolled in Medicaid Managed Care plans. In Calendar Year 2014, WV Medicaid reimbursed more than 6.5 million prescription claims for a total of over $377.6M.
Does WV Medicaid cover vivitrol?
products. Virginia Medicaid covers injectable naltrexone (Vivitrol®) under both FFS and MC plans. Patients must be enrolled in, or have documented proof of, SUD* counseling for Vivitrol coverage under MC plans only. Vivitrol is covered as a medical benefit under FFS plans and a pharmacy benefit under MC plans.
How is telemedicine regulated?
Who Regulates Telemedicine? There is no one-stop shop for federal telehealth regulations. Telemedicine and telehealth standards are established by the same state-specific regulatory institutions that establish standards for in-person clinical treatment.Jul 2, 2020
What is the drug Zubsolv?
This medication contains 2 medicines: buprenorphine and naloxone. It is used to treat opioid dependence/addiction. Buprenorphine belongs to a class of drugs called mixed opioid agonist-antagonists. Buprenorphine helps prevent withdrawal symptoms caused by stopping other opioids.
Is methadone an opiate?
Opioids include heroin and prescription pain relievers such as hydrocodone, oxycodone, morphine, fentanyl, and methadone. Though methadone is in the same family as opioids, its long activity in the body makes it suitable for reducing cravings for other opioids and easier to taper a person off of these drugs.
What is Sublocade?
INDICATION: SUBLOCADE® (buprenorphine extended-release) injection, for subcutaneous use (CIII) is a prescription medicine used to treat adults with moderate to severe addiction (dependence) to opioid drugs (prescription or illegal) who have received an oral transmucosal (used under the tongue or inside the cheek) ...
What is the ASAM in West Virginia?
The West Virginia Department of Health and Human Resources (DHHR), through the Bureau for Medical Services (BMS) is required to designate the ASAM® level of care for all licensed residential treatment facilities.
What is residential adult services?
Residential adult services are available to all Medicaid members 18 years of age or older who have a diagnosis of substance use disorder and/or co-occurring disorder that cannot be treated on an outpatient basis.
How many hours of therapy does a therapist need?
Requires a minimum of 15 clinical service hours per week.
Is SBIRT a CPT?
The SBIRT is now a required documentation component regardless of the suspected diagnosis of the following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes for ages 10 and up:
Does West Virginia Medicaid pay for peer recovery?
West Virginia Medicaid is now able to pay for Peer Recovery Support Services. West Virginia Medicaid will work to create a system of Peer Recovery Support Specialists, including training, certification and reimbursement for services provided.
Alcohol And Drug Rehabilitation Programs That Accept Medicaid
If you are addicted to drugs and alcohol, it is crucial that you receive rehabilitation before it is too late. However, many addicts often have money troubles arising from their persistent alcohol and drug abuse over the long term - which may affect their ability to earn a living due to job loss and the escalating cost of drugs and alcohol.
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What is FQHC in Medicare?
The FQHC rate is a benefit under Medicare that covers Medicaid and Medicare patients as an all-inclusive, per-visit payment, based on encounters. Tribal organizations must apply before they can bill as FQHCs. Allowable expenses vary by state. Each tribe and state must negotiate the exact reimbursement rate.
How does Medicaid work?
Many states deliver Medicaid through managed care organizations, which manage the delivery and financing of healthcare in a way that controls the cost and quality of services. More states are joining this trend because they think it may help manage and improve healthcare costs and quality.
How many beds does a CAH have?
A qualified CAH: participates in Medicare, has no more than 25 inpatient beds, has an average length of patient stay that is 96 hours or less, offers emergency care around the clock, and is located in a rural setting. Learn more about critical access hospitals.
What is MA rate?
The Medical Assistance (MA) rate is a state's standard reimbursement for Medicaid-covered services. Each state sets how it will reimburse Medicaid recipients. For example, some states reimburse for each service provided during an encounter (a face-to-face interaction between the patient and the healthcare provider), rather than setting a flat fee for each encounter.
What is capitated rate?
A capitated rate is a contracted rate based on the total number of eligible people in a service area. Funding is supplied in advance, creating a pool of funds from which to provide services. This rate can be more beneficial for providers with a larger client base because unused funds can be kept for future use.
What is a FQHC?
A Federally Qualified Health Center (FQHC) is a program that provides comprehensive healthcare to underserved communities and meets one of several standards for qualifying, such as receiving a grant under Section 330 of the Public Health Service Act. Health programs run by tribes or tribal organizations working under the Indian Self-Determination Act, or urban Indian organizations that receive Title V funds, qualify as FQHCs. The FQHC rate is a benefit under Medicare that covers Medicaid and Medicare patients as an all-inclusive, per-visit payment, based on encounters. Tribal organizations must apply before they can bill as FQHCs.
What is the purpose of the information below?
The information below is intended to provide you with a basic understanding of the issue so that you can move forward with choosing the right approach to ensure a strong funding strategy for your program.
Rehab Centers
Rehab describes structured programs designed to help people stop using drugs or alcohol and learn to live a healthy life. More on rehab.
Ambrosia of the Palm Beaches
One of America's Best Addiction Treatment Centers according to Newsweek (2020, 2021). A 13-year track of success and over 10,000 success stories from people just like you. Physician-owned. Accredited by the Joint Commission. West Palm Beach, FL
All Points North Lodge
Comprehensive wellness and personal development campus located just outside of Vail, CO. Mental health and recovery services with a trauma emphasis and family focus. Make progress in both mental and physical health. Stay connected long-term with our community. Edwards, CO.
What is vocational rehabilitation in West Virginia?
All such rehabilitation providers must be approved and qualified under the rules. Vocational rehabilitation’s goal is to return the claimant to his or her pre-injury job with the time-of-injury employer. However, as that is not always possible, the rules provide a hierarchy of what the vocational rehabilitation program’s ultimate goal should be. The plan should attempt to achieve the first goal in the hierarchy. The next option on the list may only be considered if the prior options are all untenable:
What is a partial disability in West Virginia?
Losses of body parts “by severance” (or “total and irrevocable loss” in regards to hearing and sight in one or both eyes or ears) will automatically entitle a claimant to certain Permanent Partial Disability ratings . West Virginia Code Section 23-4-6 (f) provides the schedule of total body disability ratings for loss of such body parts and functions. The loss of multiple body parts, or the loss taken in conjunction with other injuries, may entitle the claimant to Permanent Total Disability status.
What is an OP claim in Charleston, WV?
When an “OP” claim is filed, the injured employee is sent to Charleston, WV for an examination, including a chest x-ray and pulmonary function test . If the tests show scarring of the lungs or pulmonary problems, the Claimant may be entitled to a permanent disability award. Eligibility is determined by the OP Board, consisting of five physicians (three internal medicine specialists and two radiologists).
How long does it take to get compensation for occupational disease?
To entitle any employee to compensation for occupational disease, the application for compensation must be filed within three years from and after the day on which the employee was last exposed to the particular occupational hazard involved or within three years from and after the employee’s occupational disease was made known to him or her by a physician or which he or she should reasonably have known, whichever last occurs, and unless filed within the three year period, the right to compensation will be forever barred. W.Va. Code Section 23-4-15.
When did West Virginia privatize workers compensation?
In 2005 the State of West Virginia approved the privatization of the State Fund. Pursuant to the passage of Senate Bill 1004, which became effective January 29, 2005, the West Virginia Workers’ Compensation market was privatized. The State fund had previously been the sole workers’ compensation provider.
Is a fire department an employer in West Virginia?
The state, all governmental agencies or departments created by it, county boards of education, political subdivisions of the state, any duly incorporated volunteer fire department or company and emergency service organizations organized under the West Virginia Code, and all persons, firms, associations and corporations regularly employing another person or persons for the purpose of carrying on any form of industry, service or business in the state, are employers within the meaning of the act. W.Va. Code Section 23-2-1.
What is permanent hearing loss?
Permanent hearing loss as a result of exposure to noise in the workplace: claimant must file for OHL benefits, being examined by a certified otolaryngologist (who will complete part of the OHL/WC-125 form), and then if compensable, claimant will be reimbursed for cost of examination and potentially for cost of hearing aids (in addition to PPD benefits)
How long does an inpatient rehab program last?
Inpatient programs generally last for 30, 60, or 90 days, if not longer depending on a person’s needs. Even standard facilities may offer a variety of treatment approaches and additional services to participants. Although standard rehab facilities may have fewer luxury amenities, many still offer some of the best addiction treatment programs in ...
What is executive rehab?
Executive rehab centers are designed to suit the needs of high-profile clients, such as professional athletes, business professionals, CEOs, celebrities, and politicians in need of discreet yet functional addiction treatment. These facilities are ideal because they allow executives to continue to participate in their career duties during treatment.
How to determine the cost of treatment?
The price of treatment generally depends on the following: 1 Type of facility—for example, inpatient facilities tend to cost more than outpatient treatment programs because they provide meals and lodging in addition to therapeutic interventions and wellness activities. 2 Location of the facility—such as near home or not, or in the mountains or on a beach. 3 Size of the program—whether it’s a large program with more participants or a smaller, more intimate rehab. 4 Treatments provided—which may or may not include detoxification (detox), medication-assisted treatment, various therapy options, and comprehensive aftercare. 5 Length of the program —which can vary from 30-90 days depending on a person’s needs. 6 Amenities offered—such as a swimming pool, an on-site gym, massage therapy, nutrition counseling, and more.
What can you expect in an addiction treatment program?
Participants in any addiction treatment program can expect certain basic components. Inpatient participants— those who live at the facility during treatment —can expect to undergo an intake, assessment, and evaluation process; have access to qualified counselors; and have round-the-clock supervision from professionals. Outpatient participants can expect access to group therapy, individual therapy, family counseling, or a combination of these options when they are at the facility and live outside the facility when treatment sessions are completed for the day.
What to do if you don't have insurance?
If you don’t have insurance and have little or no money, you still have options for quality addiction treatment. Some neighborhood health clinics offer free treatment or sliding-scale fees for healthcare to people who don’t have health insurance.
Does insurance cover rehab?
Consultation with a treatment professional prior to choosing a rehab can help you determine if your addiction issues will be adequately addressed with outpatient approaches. Your insurance plan might not cover all of the services the facility offers, but certain treatment types are covered under many insurance plans.
What is luxury rehab?
Luxury rehab facilities focus on providing treatment in a tranquil, serene, highly confidential, and strikingly beautiful setting. These private rehab centers allow people in the public eye to maintain a low profile as they receive professional help for a SUD without giving up the luxuries they’re accustomed to.