CMS Plans Temporary Medicaid Fee Hike

Texas primary care physicians would receive a temporary fee increase in 2013-2014 for treating Medicaid patients if the Centers for Medicare & Medicaid Services (CMS) adopts a rule it proposed May 9. The proposal would make $11 billion available to states to increase Medicaid primary care reimbursement under the Patient Protection and Affordable Care Act.

The Texas Medical Association is analyzing the 78-page rule to determine its impact on Texas physicians. The proposal increases certain evaluation and management codes, including office visits, and vaccine administration fees to Medicare parity when billed by internists, family physicians, and pediatricians. The rule also would extend the higher payments to the subspecialists of those respective specialties. For example, a gastroenterologist or a pediatric cardiologist also would benefit from a higher fee when billing an office visit. The rules, as proposed, do not apply to services provided by nurse practitioners or physician assistants unless the service is billed under the physician's Medicaid number. The federal government will pay the entire cost of the higher payment rates.

Texas is simultaneously moving forward with its own plans to implement the federal initiative, says Helen Kent Davis, director of TMA's Office of Governmental Affairs. She added that the Texas Health and Human Services Commission has told the legislature that it will recommend increases for specialty services and physicians in the Children's Health Insurance Program.

Health and Human Services Secretary Kathleen Sebelius said the intent of the proposed increase is to encourage primary care physicians to provide checkups, preventive screenings, and vaccines to Medicaid beneficiaries and "help improve health and reduce costs by preventing illnesses before they happen and catching small problems before they turn into big ones."

Modern Healthcare reported that CMS officials will examine options for continuing the increase after 2014.


 Action, May 15, 2012


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