Medicaid-Medicare Parity

Overview

On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) released the final regulation(www.gpo.gov) which implements Section 1202 of the Patient Protection and Affordable Care Act (ACA). This section increases Medicaid payments for specified primary care services to Medicare levels for certain primary care physicians in 2013 and 2014.

Medicaid Payment Increase

States will receive an estimated $5.8 billion in 2013 and $6.1 billion in 2014 in new federal funds to bolster their Medicaid primary care delivery systems. Unless Congress acts to extend and fund this provision permanently, a sudden return to disparate and inadequate payment for primary care services needed by Medicaid patients after only two years will again threaten to restrict their access to such needed services.

The final rule provides for higher payment in both the fee for service and managed care settings for specific primary care services furnished by:

  • Practicing physicians who self-attest that they are board certified with a specialty designation of family medicine, general internal medicine and pediatric medicine, or;
  • Subspecialists related to those specialty categories as recognized by the American Board of Medical Specialties, American Osteopathic Association, or the American Board of Physician Specialties who also self-attest that they are board certified, or;
  • Physicians related to the specialty categories of family medicine, internal medicine, and pediatrics who self-attest that at least 60 percent of all Medicaid services they bill or provide in a managed care environment are for the specified Evaluation & Management (E&M) and vaccine administration codes;
  • Advanced practice clinicians when the services are furnished under a physician’s personal supervision.

The final rule requires state governments to take further action prior to March 31, 2013, to implement this provision. The AAFP calls on states to act quickly once CMS issues an anticipated template for a state plan amendment so that low-income, working families and others can benefit immediately from this important provision.

In addition to the increases in Medicaid payments, this regulation also updates vaccine administration fee maximums that had not been updated since the Vaccines for Children (VFC) program was established in 1994. CMS will use the Medicare Economic Index (MEI) to update the maximums consistent with inflation.

About Medicaid Parity Attestation

Each state requires physicians to follow a uniqe attestation process in order to be eligible for the enhanced payment in the Medicaid program. Visit your state Medicaid website and follow attestation instructions provided to ensure that you have properly self-attested. Stay up-to-date on this vital information in your state to ensure that you receive the enhanced Medicaid payment for services provided to Medicaid patients.

If you are unable to loate your state's attestation information online, if your state does not have online attestation information, or if you cannot locate your state's parity information, you may contact your state Medicaid department or your AAFP State Chapter for assistance.

Additionally, the AAFP has created a checklist tool to help guide you through the process:

View the Medicaid Parity Attestation Checklist »(1 page PDF)


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