This was successfully posted to your pofile.
This box will close automatically in a few seconds. Close this window
We don't have an e-mail address on file for you. To use AAFP Connection, you must have an e-mail address in our records. Click Here
Despite Lagging Implementation of Parity Provision, Physicians Will See Full Medicaid Payment Boost
AAFP President Jeff Cain, M.D., of Denver, said the enhanced Medicaid rates (4-page PDF; About PDFs) will increase access to Medicaid services, resulting in higher quality and better controlled costs. "This is one part of the Affordable Care Act that helps primary care practices, improves payment rates and increases access to health care for the underserved," said Cain. "These are priorities for the AAFP."
- Most state Medicaid programs are not ready to implement a provision to bring Medicaid payment levels for primary care services up to Medicare levels for the next two years.
- The provision officially went into effect on Jan. 1, and states are responsible for retroactively paying qualifying physicians and other eligible health care professionals from that date forward.
- State Medicaid programs have until March 31 to submit a state plan amendment stating how they will implement the parity provision.
The document that addresses the provision of primary care services within Medicaid fee-for-service explains who qualifies for the enhanced payments and what eligible physicians and other health care professionals need to do to obtain the enhanced payments.
"The statute specifies that higher payment applies to primary care services delivered by a physician with a specialty designation of family medicine, general internal medicine or pediatric medicine," the document states. "The regulation specifies that specialists and subspecialists within those designations as recognized by the American Board of Medical Specialties, the American Osteopathic Association or the American Board of Physician Specialties also qualify for the enhanced payment."
According to the document, physicians are required to qualify for the increased payments by self-attesting that they are board-certified in family medicine, internal medicine or pediatrics, or they have to show that at least 60 percent of their billing for evaluation and management (E/M) codes is for primary care services.
The document poses and answers other questions as well. For example, it covers the 60 percent threshold for qualifying for the enhanced payment and whether that includes E/M codes and vaccine administration codes.
"The 60 percent threshold can be met by any combination of eligible E/M codes and vaccine administration codes," according to the document.
Another question in the managed care document asks whether managed care plans under contract with a state can use their own definitions of primary care health professionals and services for the purposes of complying with the rule.
"While we recognize that health plans may have unique definitions of primary care providers and services, the availability of the increased (payment) is limited to the scope of eligible primary care providers and primary care services as defined in (the) statute and implemented by this rule," the document states.
Despite Delays, FPs Can Expect Full Payment on Parity Provision