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On May 15, HHS released the final rule, Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses, which would reduce drug costs by allowing additional utilization management for protected classes.  HHS initially proposed three exceptions to the protected class policy that would (1) implement broader use of prior authorization (PA) and step therapy (ST) for protected class Part D drugs, including to determine use for protected class indications; (2) exclude a protected class Part D drug from a formulary if the drug represents only a new formulation of an existing single-source drug or biological product, regardless of whether the older formulation remains on the market; and (3) exclude a protected class Part D drug from a formulary if the price of the drug increased beyond a certain threshold over a specified loopback period.

In the end, HHS decided not to further weaken the Medicare Part D six protected classes (anticonvulsants, antidepressants, antineoplastics, antipsychotics, antiretrovirals, and immunosuppressants for the treatment of transplant rejection).  As a result of advocacy by organized psychiatry (APA in partnership with the MPS and other District Branches) and the mental health community, the rule only finalized one of the three proposed exceptions with a modification to the first exception related to PA and ST. The first exception permits Part D sponsors to use PA and ST for protected class Part D drugs. However, as modified, the exception is a codification of already existing policy and does not place additional limits on beneficiary access to medications. Specifically, the exception will permit PA and ST only for new starts (that is, enrollees initiating therapy), including to confirm the use is for a protected-class indication.  The rule takes effect on January 1.

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The APA is soliciting comments on its draft practice guideline for the treatment of schizophrenia. Feedback will be incorporated into the final version which must be approved by the APA Assembly. [You don’t have to specialize in the treatment of schizophrenia to comment on this draft.]  Please see the information below from Saul Levin, M.D.:

A PDF version of the draft is available on the APA website at https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines/review-draft-guidelinesThe deadline to comment is June 28.

The Guideline Writing Group drafted the guideline based on a systematic review of the available evidence.  Each statement (recommendation or suggestion) is separately rated according to the strength of the supporting research evidence and the balance of possible benefits and harms of the recommended or suggested actions.  In addition to specific statements, the draft guideline includes a review of strategies and caveats when implementing the recommendations and a discussion of the appropriateness of the recommendations to inform quality improvement activities.

Comments should be emailed to guidelines@psych.org using the online Microsoft Word comment form.  Please include the following information with each comment:

  • Reference each comment by page and line number and include a reference or rationale for your comment.
  • Disclose any relevant potential conflicts of interest, e.g., significant industry or other financial relationships you have that may be relevant to evaluating your comment.
  • Include an email address and/or phone number where we can contact you for additional information about your input, if necessary.
  • Everyone who submits comments can be acknowledged in the published guideline.  If you choose to be recognized, please list your name and academic degree or your organization name as you would like them to be listed.

Thank you in advance for contributing your time and expertise.  Please contact Jennifer Medicus, APA Practice Guidelines, at guidelines@psych.org with any questions.

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MPS News May 2019

In This Issue:
MPS Meeting Dates
MPS Annual Report
April Council Highlights
2019 MPS Election Results
New Medicaid ORP Provider
MPS Legislative Session Review
Malpractice Expert Qualification
PDMP, Formulary Bills Enacted
MedChi House of Delegates
Parity Coalition Medicaid Letter
Health Care Delivery Innovations
Call for Nominations
APA Assembly Preview
Review Open Payments Data

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The following members will serve in the positions noted for the 2019-2020 officer year.  These results from the 124 ballots cast were approved at the April Council meeting.

President Elect:
Mark Ehrenreich, M.D.

Secretary-Treasurer:
Virginia Ashley, M.D.

Councilor:
Jason Addison, M.D.
Jessica Merkel-Keller, M.D.
Carolina Vidal, M.D., M.P.H.
Crystal Watkins, M.D., Ph.D.

Resident-Fellow Member Councilor:
Jamie Spitzer, M.D.

Early Career Psychiatrist Councilor:
Marissa Flaherty, M.D.

APA Assembly Representative:
Annette Hanson, M.D.

Nominations & Elections Committee:
Elias Shaya, M.D.
Sally Waddington, M.D.

The Constitution & Bylaws change to allow electronic voting for MPS elections was approved by a wide margin.

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Addictions Psychiatrist at Mountain Manor Treatment Center Baltimore Immediate Opening – Full-Time – Maryland Treatment Centers has been providing comprehensive substance abuse and mental health treatment for over 30 years. With locations throughout central Maryland, MTC provides a full continuum of levels of care to clients who struggle with chemical dependency as well as co-occurring psychiatric disorders. Our largest and most complex facility is Mountain Manor Treatment Center, a young adult / adult dual diagnosis/substance abuse treatment facility in Baltimore City. We offer a full continuum of levels of care, including inpatient, partial hospitalization, intensive outpatient, outpatient, outpatient mental health clinic. We also house a special education secondary school. We are licensed by the Maryland Department of Health and Mental Hygiene and accredited by the Joint Commission. The position features an opportunity to provide high quality mental health treatment featuring a collaborative, multi-disciplinary team approach, with mentorship and training by senior addiction psychiatrists. There are opportunities for research involvement if interested. Required:  Current Maryland license and DEA + waiver and Maryland CDS certification. Preferred: Experience in an inpatient setting and experience with substance abuse and dual diagnosis treatment. Competitive salary, malpractice insurance coverage. Full-time Benefits: 4 weeks PTO, 8 holidays, access to employee group health/dental/life, 401(k), supplemental insurance program. Contact: Craig Cutter, Corporate Director, Human Resources. Email: ccutter@marylandtreatment.org or call 240-409-7002. www.mountainmanor.org

University of Maryland School of Medicine: Part time Practice Opportunity Department of Psychiatry PA Faculty Practice – The University of Maryland School of Medicine Department of Psychiatry is seeking a qualified part-time psychiatrist to work in our Faculty Group Practice.  The Practice provides psychiatric evaluations and medication management for individuals 18 years and older and serves predominantly Faculty, Staff and their families on our campus. Opportunities to conduct fitness for duty and presurgical evaluations are available.  In addition, our practice is expanding its use of telepsychiatry to allow greater flexibility in scheduling and greater access for those we serve.  Please send CV to Louis Cohen MD at Lcohen@som.umaryland.edu All applicants are required to apply online at the UMB Taleo website at: https://umb.taleo.net/careersection/jobdetail.ftl?job=190000I6&lang=en  UMB is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law or policy.

Psychiatrist – Full or part-time psychiatrist wanted for a well-established, reputable, growing private practice in Anne Arundel County, MD.  Position includes premium office space, attractive compensation, comprehensive administrative support, professional freedom, and collegial interaction with a multi-disciplinary staff in a desirable location.  Opportunity to become involved in the TMS program (Transcranial Magnetic Stimulation) if desired.  For more information please visit www.spectrum-behavioral.com or call Scott E. Smith, Ph.D. at 410-757-2077 X 7102 or email to director@spectrum-behavioral.com.

White Marsh Psychiatric Associates, LLC (WMPA) is seeking an Adult and/or Child Psychiatrist to join our practice. WMPA is an established multi-disciplinary outpatient practice conveniently located off I-95 in White Marsh. We offer a collegial work environment with an excellent support staff, internal billing, and potential for profit sharing, WMPA has contracts with most major insurance carriers that facilitates excellent referral sources and quick caseload development. We are seeking full or part-time providers to join seventeen other professionals in a setting that values quality patient care and the freedom that comes from outpatient clinical practice. Please send your resume and cover letter to drfrank@whitemarshpsych.com and/or call Travis Frank, PsyD., President @ 410-931-9280.

CHILD AND ADULT PSYCHIATRY STAFF POSTIONS AVAILABLE JULY 2019 at The Rockford Center: A subsidiary of universal health services, Inc. INPATIENT BEHAVIORAL HEALTH HOSPITAL in Wilmington, Delaware. FACILITY IS ALSO J-1 Waiver Approved. BENEFITS INCLUDE:  COMPETITIVE COMPENSATION WITH INCENTIVE OPPORTUNITIES, MEDICAL/DENTAL/VISION, DISABILITY INSURANCE, MALPRACTICE COVERAGE, CME TIME-OFF AND REIMBURSEMENT, 401 K AND STOCK PURCHASE PLAN. OUR LOCATION BOASTS CLOSE PROXIMITY TO PHILADELPHIA, NYC, BALTIMORE, & DC; CHOICE OF CITY, SUBURBAN, RURAL, AND BEACH LIVING; MILES OF PRISTINE BEACHES AND FUN COASTAL TOWNS; TAX-FREE SHOPPING, FRIENDLY & FAMILY- ORIENTED COMMUNITIES. CONTACT: John McKenna, CEO: John.mckenna@uhsinc.com/302-893-4262 or Saurabh Gupta, MD, Medical Director: Saurabh.gupta@uhsinc.com/302- 892-4271

Medical Director (Psychiatrist/Psychiatric Nurse Practitioner): Jewish Community Services (JCS) is seeking a 20-hour/week Medical Director (Psychiatrist or Psychiatric Nurse Practitioner) to provide direct service and oversight of our State-licensed Outpatient Mental Health Center. The Medical Director provides consultation to agency medication providers and direction to mental health and substance abuse services. The requirements for this position have recently changed, and practitioners may provide services off-site through telehealth. Responsibilities include: Provision of medical oversight and administrative direction to subordinate medical staff. Provision of individualized medication management services based on clinical assessment. Completion of all relevant clinical documentation in accordance with Agency and professional standards using the Agency’s electronic medical record system. Benefits: Health (@30 hrs/wk), Dental and Vision (20+ hrs/wk), Vacation and Sick Leave, Retirement matching. Requirements: Maryland licensure and Board Certification (Psychiatrist – MD; Psychiatric Board Eligibility/Psychiatric Nurse Practitioner; RN; Psychiatric NP certification), DEA certification, Liability Insurance. Qualified Applicants should apply via: http://bit.ly/PsychiatristJCS (preferably). Or send to: Human Resources, Jewish Community Services. 5750 Park Heights Avenue Baltimore, MD 21215. Or fax resume to 443.200.6108. Cover letters can be sent to recruitment@jcsbaltimore.org  EOE Employer. To learn more about Jewish Community Services, visit www.jcsbaltimore.org.

Baltimore and Jessup Centurion (MHM Services) – Practicing correctional psychiatry provides a career that is extremely rewarding, professionally fascinating, and is sure to exceed your expectations. MHM Services is a leading provider of healthcare services to correctional facilities, state hospitals, and community health centers nationwide. Today we employ over 7,000 healthcare professionals across 16 states. Since 2005, we have proudly served as the exclusive provider of psychiatric services to the Maryland Department of Public Safety & Correctional Services. Full-time, Part-Time, and Per Diem opportunities available. Our Providers Enjoy: 
*One of the Most Secure Patient Settings in Healthcare
*Exceptional Compensation & Company Paid Malpractice Insurance
*Having a Positive Impact on Public Health
*Serving a Population in Great Need
For more information contact our in-house physician recruiter Jane Dierberger: 844-477-6420 or Jane@teamcenturion.com or  www.centurionjobs.com | Equal Opportunity Employer

Rewarding Opportunities for Psychiatrists Across Maryland: Sheppard Pratt Health System is seeking psychiatrists to work in multiple Sheppard Pratt programs across Maryland:

  • Geriatric medical director, Sheppard Pratt-Towson Campus, Baltimore County
  • Child & adolescent psychiatrist, Sheppard Pratt-Towson Campus, Baltimore County
  • Trauma disorders psychiatrist, Sheppard Pratt-Towson Campus, Baltimore County
  • Adult psychiatrist, Sheppard Pratt-Towson Campus, Baltimore County
  • School psychiatrist – autism focus, position serves multiple locations

Requirements:

  • Must be board-certified or board-eligible
  • Must have a current license to practice in Maryland at the time of hire
  • Individuals hired for inpatient, PHP, and residential school services participate in a call schedule

Why Sheppard Pratt Health System?

  • Physician-led organization
  • Generous compensation package with comprehensive benefits, including medical, dental, vision, and life insurance; an extensive wellness program; and ample leave
  • Relocation assistance
  • Sign-on bonus
  • A network of the brightest minds in psychiatry
  • Grand rounds, CME opportunities, on-site lectures
  • State-of-the-art research and technology
  • Cross-discipline collaboration

About Sheppard Pratt Health System

Consistently ranked as one of the top ten psychiatric hospitals by U.S. News & World Report, Sheppard Pratt is the nation’s largest private, non-profit provider of mental health, substance use, special education, and social services. We employ more than 95 doctors who all share a passion for providing the best care to those we serve. To learn more about our services, visit www.sheppardpratt.org. EOE. For more information, please contact Kathleen Hilzendeger, Director of Professional Services, at 410.938.3460 or khilzendeger@sheppardpratt.org.

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BETHESDA: Offices for rent in psychotherapy suite. Furnished space available for flexible blocks of time. Lots of amenities: free WiFi, beverages, color copier. Very friendly and professional clinicians. Contact Keith Miller: 202-360-9996 or keith@keithmillercounseling.com.

Ellicott City: Furnished and unfurnished offices available in mental health suite. Part time/full time. Ample parking. Handicapped accessible. Private staff bathrooms. Kitchen area and workroom with copier and fax. Opportunities for networking and referrals. Located close to Route #40, #29, #70 and 1-695. Contact Dr. Michael Boyle (410)-465-2500.

Ellicott City/Waverly Woods/Columbia: Near Rt. 70, Rt. 32 and Rt. 29. Office and Group Room are in a beautiful suite ready for immediate occupancy. Includes large fully furnished office with 2 windows, large beautifully decorated waiting room, receptionist/file room, 2 bathrooms, kitchen and a warm community of other therapists who cross refer. WiFi and fax available. Free ample parking. Contact Jenniferplassnig@gmail.com or 410-203-2411.

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In response to the concerns we raised last year, the MPS has been notified that Medicaid now allows Ordering, Referring, and Prescribing (ORP) provider enrollment for those who contract privately with patients.  This is instead of enrolling as a rendering provider (and accepting Medicaid contract terms), which they had insisted on previously.  The ORP option accommodates psychiatrists having private pay arrangements with patients while Medicaid pays for the labs and prescriptions they order.  This new option is somewhat similar to opting out of Medicare but, according to Medicaid Provider Services, there is no 2-year minimum requirement, i.e. someone can sign up for ORP one week and then change to a provider the next week.  Also, there is no Medicaid requirement for a signed written agreement with the patient, although that would be best practice.

As a reminder, last year Medicaid began rejecting payment for prescriptions if the prescriber was not enrolled as a provider in the Medicaid program.  This practice was put on hold after the MPS raised alarm that some psychiatric patients were no longer able to obtain their medicines.  As a precaution, some non-enrolled psychiatrists referred their patients to other psychiatrists who participate in Medicaid.  Others continued seeing their Medicaid patients during the hiatus.  Those who waited now have their answer:  enrolling as an ORP provider by October 1 will enable the treatment relationship to be preserved as well as the labs and prescriptions to be covered.

It’s important to note that you must enroll as an ORP or as a rendering provider for prescriptions to be paid after October 1.  One or the other is required or payment for prescriptions and labs will be rejected again.

There is some screening with the ORP enrollment via ePREP (e.g. licensure, etc), which is the same as required for enrolling as a provider, but there is no provider agreement and no contractual relationship with Medicaid.  The ePREP process may be confusing so there are webinars scheduled and there are other online resources.  Please use the ORP application on ePREP.   The enrollment instructions help get into the portal on the correct path, but continue as appropriate to your situation as the rest of the steps depend somewhat how you complete the form.  Please contact mdh.rxenroll@maryland.gov with questions about ORP policies or enrollment.

After initial enrollment, the provider will need to upload when the medical license renews and revalidate every 5 years.

Please note:  Each year many Marylanders enroll in Medicaid as one of the options on the health insurance exchange established under the Affordable Care Act.  Be sure to ask all private pay patients whether they use Medicaid to cover their medicines and labs.  If so, you must be enrolled as ORP to enable reimbursement.

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The Maryland Psychiatric Society Council voted on March 12 to give the 2019 Lifetime of Service Award to Arthur Hildreth, M.D. for decades of devoted service to the organization and related groups. The award will be presented at the April 25 annual meeting. Dr. Hildreth served as 1992-1993 MPS President. His MPS committee service includes Membership Chair 1975-1981 and 1986-1989, inaugural Managed Care Chair 1989-1992, Program & CME Chair 1991-1992 and member for 15 years, and Distinguished Fellowship Committee member 1997 – present, among others. In addition, he has served six years on the board of the Maryland Foundation for Psychiatry, including four as Vice-President.

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This year the MPS Academic Psychiatry Committee’s poster competition for Resident-Fellow Members had several outstanding entries.  The committee worked with a score sheet to identify the top three posters, which will be on display at the April 25 annual dinner meeting.  All three winners will receive a cash prize.  Congratulations to the following members who are this year’s winners:

First Place: Katherine Skimming, M.D., Department of Psychiatry, University of Maryland School of Medicine

Evaluating Child and Adolescent Fellows’ Knowledge and Level of Comfort Conducting Youth Violence Assessments Before and After a Case Guided Didactic

Finalist: Idris Leppla, M.D., Department of Psychiatry and Behavioral Sciences, Johns Hopkins

Extended Requirement of Granulocyte Colony-Stimulating Factor for Clozapine-Associated Neutropenia

Finalist: Shapir Rosenberg, M.D., Department of Psychiatry, University of Maryland School of Medicine

A Trainee-led Cancer Therapy Group: Benefiting Patients and Learners

 

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The annual MPS Academic Psychiatry Committee “best paper” award recognizes outstanding papers authored by young psychiatrists that are published or in press in the immediately preceding year.  The selection subcommittee reviewed several submissions of excellent papers.   Congratulations to this year’s winners who will receive cash prizes and be recognized at the April 25 annual meeting:

Resident/Fellow:  Viviana Alvarez-Toro, M.D.
Revisiting the False Confession Problem
 

Early Career: Traci Speed, M.D., Ph.D.
An Innovative Perioperative Pain Program for Chronic Opioid Users

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