Are You on the Medicaid Fee Increase List?

The Texas Medicaid &Healthcare Partnership (TMHP) has compiled a list of primary care physicians eligible for the temporary fee increase for treating Medicaid patients that was authorized by the Affordable Care Act. On the list are the names of physicians who filed the required form by Oct. 16, attesting that they are eligible for the increase.  

Email TMHP if you submitted an attestation form but your name is not on the list or if the information is incorrect.   

The health reform law grants a rate increase for certain primary care providers and services from Jan. 1, 2013, through Dec. 31, 2014. Physicians must self-attest either that they are board certified in family medicine, general internal medicine, pediatric medicine or a subspecialist within those designations as recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties, or that 60 percent of their Medicaid billings for the prior year were for certain evaluation and management (E&M) services. Those services include E&M codes 99201 through 99499 and services related to the administration of vaccines (90465, 90466, 90467, 90468, 90471, 90472, 90473, and 90474).

The state plans to begin paying the rate increase as a supplemental quarterly payment for services rendered in January for Medicaid managed care and in April for Medicaid fee-for-service. Retrospective payments will be issued to Jan. 1, 2013, for physicians who self-attest between Jan. 1, 2013, and April 1, 2014. Physicians who wait until after April 1, 2014, to self-attest will qualify only for supplemental payments back to the date their attestation form was received. 

Eligible physicians must self-attest by completing the Texas Medicaid Attestation for ACA Primary Care Services Rate Increase form.


Action, Dec. 4, 2013


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