Higher Medicaid Primary Care Payments Coming Next Year

Eligible primary care physicians in the Medicaid program should begin receiving higher payments by March 1, 2014, the program's director says in a letter to physicians. The Affordable Care Act authorizes the fees.

The higher fees will cover primary care physician visits and vaccine administration. The increase is temporary and covers services from Jan. 1, 2013, through Dec. 31, 2014. They apply to family physicians, general internists, and pediatricians in Medicaid. Specialists and subspecialists within those designations who are recognized by the American Board of Medical Specialties, the American Osteopathic Association, or the American Board of Physician Specialties also qualify.

When the initial payment is made, it will be retroactive to Jan. 1, 2013, if the physician has filed a self-attestation form with the Texas Medicaid & Health Care Partnership (TMHP) certifying that he or she is eligible to receive the increase. Physicians must complete an attestation form for each Medicaid Texas Provider Identifier (TPI). As part of the attestation, you must specify that you practice in an eligible specialty and are either board certified in that specialty and/or that 60 percent of your Medicaid claims for the prior year were for eligible services. After the initial payment, physicians will receive payments quarterly.

Thus far, 15,300 physicians have attested. TMA estimates as many as 25,000 Texas physicians are eligible. Over the coming months, watch the TMHP website for a posting of physicians who have successfully attested.

Payment of the higher fees has been delayed because state officials are waiting for Centers for Medicare & Medicaid Services (CMS) approval of their plan to increase primary care rates in the Medicaid managed care program. CMS, which previously approved raising primary care fee-for-service fees, has asked state officials for more information on the proposed managed care rate methodology. Other states have had similar issues. Texas' decision to forego Medicaid expansion does not affect implementation of the rate increase.

For more information, refer to TMA's Medicaid PCP Rate Increase Frequently Asked Questions or email TMA Director of Governmental Affairs Helen Kent Davis.


Action Special Report, Sept. 20, 2013


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