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Proposed Medicaid Parity Payments Should Apply Only to Primary Care, Says AAFP
Including Subspecialists in Program Not Intent of Law, Says Board Chair
By News Staff
In the proposed rule, CMS says it is interested in ensuring primary care physicians receive the benefit of the increased payment, a goal shared by the AAFP, Goertz says. However, he notes, the AAFP disagrees with a part of the proposed rule that would allow subspecialists to also qualify for the increased Medicaid payment. Inclusion of subspecialists is not the intent of the law, adds Goertz, and including them would perpetuate existing disparities in physician payment rates.
- In a letter to CMS, the AAFP expresses both support and concern about a proposed CMS regulation that would implement a Medicaid parity provision outlined in the Patient Protection and Affordable Care Act.
- The AAFP supports the overall intent of the parity law itself and certain provisions of the proposed regulation.
- However, the Academy disagrees with a part of the proposed regulation that would allow subspecialists to also qualify for the increased Medicaid payment.
- family medicine,
- general internal medicine or
- pediatric medicine.
"The AAFP recognizes that physician specialty alone does not necessarily define a primary care physician (because) many internal medicine and family physicians work as hospitalists or in emergency rooms. Many subspecialists also use their primary training designation in filing claims with CMS rather than their subspecialty training designation," says Goertz.
He adds that CMS should identify primary care physicians for the enhanced payment by looking for the definitional elements of primary care, which include first contact, continuity and comprehensiveness of care. However, if this should prove too difficult, Goertz suggests that CMS limit qualification for the payments to
- physicians with a primary specialty designation of family medicine, general internal medicine or pediatric medicine who are board-certified in these areas or
- who, if not board-certified, have at least 60 percent of their overall claims in primary care services.
CMS proposes to use the Medicare economic index to update the maximum administration fee based on the 1994 VFC value, notes Goertz. The regulation asks that states be required to compensate VFC providers at the lesser of the 2013-14 Medicare rates or the maximum regional VFC amount in those years.
"The AAFP supports this as a step in the right direction of supporting primary care physicians in their provision of this valuable public health service," Goertz says.