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Medicaid Payments for Primary Care Services in Parity with Medicare
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.
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.
Review the AAFP Fact Sheet on the final regulation.
- Joint letter: AAFP to CMS regarding the primary care payment increase - May 7, 2013
- Joint letter: National Governors Association -- January 29, 2013
- Joint letter: National Association of Medicaid Directors -- January 29, 2013
- Letter: Children's Health Group Joint Letter to Congress -- December 12, 2012
- Letter: AAFP to US House of Representatives regarding Medicare/Medicaid Parity -- December 5, 2012
- Letter: AAFP to US Senate regarding Medicare/Medicaid Parity -- December 5, 2012
- AAFP Executive Summary: Medicaid Payments for Primary Care Services in Parity with Medicare & Charges for Vaccine Administration
- ANN article: AAFP Summarizes Provisions of Medicaid/Medicare Parity Regulation
- ANN article: CMS Releases Final Rule on Medicaid/Medicare Payment Parity
- AAFP Statement: AAFP Welcomes Medicaid Payment Parity with Medicare, Expresses Concern About the Short-Lived Payment Equity
- CMS FAQ on Increased Medicaid Payments for Primary Care Physicians (Medicaid.gov)
- CMS Press Release, November 1, 2012: "Health Care Law Delivers Higher Payments to Primary Care Physicians" (CMS.gov)
- CMS Fact Sheet: "Increased Medicaid Payment For Primary Care" (CMS.gov)
- Medicaid Provider Payments page, including helpful FAQs and summaries. (Medicaid.gov)
- AAFP Executive Summary of the changes proposed by CMS - May 2012 Medicaid Payments for Primary Care Services in Parity with Medicare & Charges for Vaccine Administration (4-page PDF; About PDFs)
- AAFP Recommendations to US Congress regarding Medicare Physician Payment Reform - June 2011
AAFP Response to the SGR Proposal (*PDF file)