Lack of Information on Medicaid Parity Provision Prompts Query From AAFP

May 13, 2013 03:54 pm Matt Brown

The AAFP and several other physician organizations are calling on CMS to provide more information and clarification about how physicians can qualify for a provision in the health care reform law that will pay them more for providing Medicaid services in 2013 and 2014.

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The Patient Protection and Affordable Care Act put in place a provision to bring Medicaid rates for primary care services at least in line with Medicare levels in 2013 and 2014. To qualify for the parity provision, participating physicians are required to either self-attest that 60 percent of their claims billed to Medicaid are evaluation and management codes or that they are board-certified in one of the primary care specialties.

In a letter to CMS(1 page PDF), the AAFP, the AMA and other national primary care physician organizations are asking the agency to provide dates for when eligible physicians will be able to self-attest in each state and the date by which physicians must self-attest to qualify for the increased Medicaid payment.

"One overarching concern shared by our organizations is the lack of a coordinated plan to educate and communicate to eligible providers about the payment increase and steps physicians must take to participate," says the letter, addressed to Cindy Mann, director of Medicaid and Children's Health Insurance Program Services. "For example, we continue to hear reports from physicians having difficulty simply locating or accessing their state's self-attestation form.

"The parity provision went into effect on Jan. 1, but the vast majority of states are waiting for CMS to approve their state plan amendments -- plans that delineate how each state will implement the measure. All states submitted their plan amendments by March 31. States are required to retroactively pay physicians to Jan. 1.

"It is our understanding that states were required to include this information in their state plan amendments and, therefore, it is readily available to CMS staff," the letter says. "We strongly believe this information is necessary to help us effectively target our communications campaigns to our physician members."