The Virginia School for the Deaf and the Blind strongly opposes the proposed changes to Medicaid billing.  We are in an unique setting with students from all over the state of Virginia.  Many of our students see multiple specialists, so seeking out his/her prescribing provider can be hard enough....even more so since we are hundreds of miles apart.  Then to require that the physician write a prescription and additionally sign the plan of care seems redundant.  All the while, this process undermines the RN's capabilities to take the physician order and create the plan within their scope of practice.  Also, with these new proposed changes, if the medication changes, another order AND plan of care is needed....why is the order not enough?  Why are these changes requiring this additional step?  This increases the workload to not only the physicians, but to the nurses and medicaid billing staff.  When can we take care of the children in the schools if we are constantly calling, faxing, scanning, emailing to get these new requirements done? 

These proposed changes would significantly impact our Medicaid reimbursement. We heavily depend of physicians to sign and return medication orders.  Physicians are going to get fed up with the constant paperwork that takes him or her away from his or her other patients just to meet a Medicaid reimbursement procedure...so the signatures will stop and the reimbursement process with come to an end!  Or the physicians will place a fee to have these forms completed and signed?  Who takes on the responsibility for that cost?  If the school does, we will start losing money!  If the parent becomes responsible for the cost, they will decline any billing.  My bigger fear is that if we keep "hounding" the physicians for all of these redundant signatures, when will they stop signing any or all of the required school forms??  What happens to the children when they nurses can't obtain written medication orders because the physicians are fed up with the additional paperwork!  Think about all of this for long term!  Is this process really sustainable??  No!

We need to look at how this negatively impacts the children in our schools!  Physicians and nurses want to take care of children and we can't do our jobs effectively if we spend all of our time focusing on the paperwork!  I guess the real question is, who is really benefitting from these proposed changes?