CMS releases Medicaid primary care physician payment rule

Posted on November 6, 2012 | No Comments

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Last week, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to implement increased payments to primary care physicians for specified Medicaid services, as forwarded by the Affordable Care Act (ACA). Under the ACA provision, certain physicians who provide eligible primary care services will be paid the Medicare rates (as opposed to the Medicaid rates currently in place) in 2013 and 2014. The payment increase applies to primary care services delivered by family medicine, general internal medicine, or pediatric medicine physicians or related subspecialists. States will receive 100 percent federal financial participation (FFP) for the difference between the Medicaid state plan payment amount as of July 1, 2009, and the applicable Medicare rate.

The rule includes information about the identification of eligible providers and services, how to meet the requirements when making these payments for managed care services, and how this policy applies to the Vaccines for Children (VFC) program.

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On November 6, 2012, the Centers for Medicare and Medicaid Services (CMS) published final rules (77 Fed. Reg. 66670-66701) implementing an Affordable Care Act (ACA) provision whose purpose is to temporarily increase state Medicaid payments for primary care services. The ACA requires that state Medicaid agencies pay for primary care furnished by physicians in 2013 and 2014 at least...
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