| Advisory opinion request regarding whether Dr. Craig Troxclair, as a licensed physician specializing in Psychiatry, can provide services as a physician advisor for both the Office of Behavioral Health and AmeriHealth Caritas. |
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The Department of Health and Hospitals (DHH) previously contracted with Magellan Behavioral Health (Magellan) to manage mental health services for Medicaid patients as well as indigent patients in Louisiana. Since Magellan's contract terminated on November 30, 2015, Medicaid patients have been divided among the five Bayou Health plans, while DHH's Office of Behavioral Health (OBH) is managing services for indigent patients. As a physician advisor for Magellan, prior to the termination of its contract, Dr. Craig Troxclair made determinations regarding the appropriate level of care for identified patients. His determinations were based on record reviews and peer-to-peer reviews with the facility proposing treatment for the patient.
Dr. Troxclair is currently employed, on a part-time basis, as a physician advisor for AmeriHealth Caritas, one of the five Bayou Health plans managing services for Medicaid patients. Additionally, he would provide the same services on behalf of OBH, as an independent contractor, for indigent patients assigned to him by OBH. There would be no overlap in which patients would be serviced by both AmeriHealth Caritas and OBH at the same time. However, a patient may, at one time or another, gain or lose Medicaid benefits and, therefore, move between the organizations. Nevertheless, as a physician advisor, Dr. Troxclair has no role in determining whether a patient is eligible for Medicaid benefits.
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La. R.S. 42:1111C(1)(a) prohibits a public servant from receiving any thing of economic value for any service, the subject matter of which is devoted substantially to the responsibilities, programs, or operations of his agency and in which he has participated.
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Adopt the proposed advisory opinion.
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| Assigned Attorney: |
Haley Williams |
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