Attest by April 1 for Medicaid Primary Care Pay Increase

To qualify for the full Medicaid primary care physician payment increase authorized by the Affordable Care Act, eligible physicians must submit an attestation form by April 1. Physicians who submit a form before April 1 will be eligible for retroactive payments from Jan. 1, 2013. Physicians who attest after the deadline will receive only retroactive payments from the date Texas Medicaid & Healthcare Partnership (TMHP) received the attestation. 

If a physician's attestation has a postmark before the deadline, TMHP must honor it, even if the form contains errors or omissions. TMHP has posted an updated list of physicians who have successfully attested as of Feb. 18. Additionally, TMHP recently posted a list of Frequently Asked Questions and Answers regarding the supplemental payments.

The health care reform law grants a rate increase for certain primary care physicians and their services from Jan. 1, 2013, through Dec. 31, 2014. To receive the higher payments, physicians must self-attest that they practice in an eligible specialty and that either:

  • They are board certified in family medicine, general internal medicine, pediatric medicine, or are a subspecialty within those designations as recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties, or 
  • Sixty percent of their Medicaid billings for the prior year were for eligible evaluation and management (E&M) services. Those eligible services are E&M codes 99201 through 99499 and services related to the administration of vaccines (90465, 90466, 90467, 90468, 90471, 90472, 90473, and 90474).  

Physicians who submitted a form but are not on the list should contact the TMHP call center at (800) 925-9126.

In March, Medicaid HMOs began paying supplemental payments to physicians who had successfully attested by Oct. 16, 2013. Initial payments are for eligible services provided in the first quarter of 2013.

For physicians who completed the attestation process between mid-October and mid-February, HMOs will begin issuing retroactive supplemental payments in late April. Once the initial supplemental payments have been made, HMOs will begin issuing periodic payments for all remaining eligible services provided through April 2014. Thereafter, payments will be made on a quarterly basis. 

The interim payment schedule will vary by HMO, so please contact the plans with which you contract for additional details. Please note that supplemental payments don't currently include vaccine administration fees or Texas Health Steps services billed by a group practice. Payments for those services must still be calculated and will be paid at a later date.

In April, TMHP will begin issuing supplemental payments for eligible fee-for-service claims retroactive to Jan. 1, 2013.

If Texas Medicaid inaccurately calculated a claim or omitted a claim from payment, please contact TMHP.

Action, March 14, 2014


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