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 increased Medicaid payments for specified primary care services to Medicare levels for certain primary care physicians in 2013 and 2014.

Medicaid Payment Increase

States have been receiving an estimated $12 billion in additional federal investment to bolster their Medicaid primary care delivery systems over the past two years. Unless Congress acts to fund this provision permanently, a seignificant cut will take place, with payment returning to prior disparate and inadequate reimbursement for primary care services. It is vital that Congress vote to extend—and fund—the provision permanently so that Medicaid patients continue to have access to primary care services.

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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