Medical Residents' Prescribing Woes in Virginia Helped by AAFP's Quick Action

November 13, 2013 12:13 pm News Staff

Virginia-based family medicine residents no longer will face an administrative roadblock when it comes to writing prescriptions and then having those prescriptions filled by their patients who rely on Medicaid.

[Stock photo of physician typing on keyboard]

Roger Hofford, M.D., associate professor of family medicine at the Carilion Clinic-Virginia Tech Carilion Family Medicine Residency in Roanoke, and author of a resolution that was adopted during the September AAFP Congress of Delegates in San Diego, told AAFP News Now that that he was very impressed with the speed at which a pressing problem was fixed.

"This really flew through the system," said Hofford.

At the heart of the problem was the state of Virginia's interpretation of a Medicaid fraud-fighting regulation that CMS finalized and published in the Federal Register( on Feb. 2, 2011. The rule requires medical residents to be enrolled in their states' Medicaid electronic databases before they can prescribe medications or medical supplies to Medicaid patients.

However, in Virginia, the electronic database wasn't ready to process residents' Medicaid enrollments. And, according to Hofford, some pharmacists in the state were refusing to fill prescriptions written by residents who weren't enrolled. Pharmacists were beginning to realize they wouldn't get paid if Medicaid claims processors denied coverage for those prescriptions, said Hofford.

Story highlights
  • Virginia-based family medicine residents who were not enrolled in the state's Medicaid database were having difficulty with pharmacies not filling prescriptions residents wrote for their Medicaid patients.
  • The Virginia AFP submitted a resolution asking the AAFP to help fix the problem, which was adopted during the September Congress of Delegates in San Diego.
  • The AAFP, the state academy and other agencies worked together for a quick resolution on the issue.

The resolution introduced by the Virginia AFP and adopted during the Academy's annual business meeting in September directed the AAFP to ask CMS to fix the problem.

On Oct. 24, AAFP Board Chair Jeff Cain, M.D., of Denver, sent a letter to CMS Administrator Marilyn Tavenner, M.A., that outlined the problem and suggested a solution.

"The AAFP believes that residents play an important role in caring for Medicaid fee-for-service and dual-eligible Medicaid patients in both inpatient and outpatient settings," said Cain. "Patient care in residency training requires that residents have the ability to prescribe medication and medical equipment for their patients."

Cain called on CMS to address the "unintended consequences" of its 2011 final rule that ultimately affected residents' ability to prescribe medications for their Medicaid patients.

"While the AAFP appreciates that CMS must verify all physicians' prescribing authority, our nation must simultaneously cope with a shortage of primary care physicians and prepare for the clinical needs of the influx of patients receiving insurance through Medicare, Medicaid, Children's Health Insurance Program, marketplaces and also private insurers," said Cain.

The AAFP requested that CMS "revise current regulations in order to allow state Medicaid programs a grace period for pharmacies to fill prescriptions written by residents, regardless of their Medicaid provider enrollment status," until state Medicaid programs are able to process the enrollment of any residents attempting to enroll in such databases.

According to Hofford, the quick action of the AAFP and others resulted in a positive outcome. He said that just days ago, the Virginia Department of Medical Assistance Services agreed to institute a 60- to 90-day grace period to give medical residents more time to complete enrollment in a database that only became fully functional in late October.

"It was good teamwork on the part of the AAFP, the state academy, CMS and our state Medicaid folks saying, 'Here's a problem, let's get someone's attention to address it,'" said Hofford.

"We got a hold of the right people at the right time to solve the problem and make sure our patients got taken care of," he added.

The Academy is in the process of alerting family medicine residency program directors nationwide about the potential for similar prescribing issues in their states.