• Update on Medicaid payment parity with Medicare

    Medicaid payments were supposed to rise to the level of Medicare this year, but chances are that you haven't seen it yet. Here's an update.

    Section 1202 of the Affordable Care Act increases Medicaid payments for specified primary care services to Medicare levels for certain primary care physicians in 2013 and 2014. The provision was nominally effective Jan. 1, 2013.

    However, the Centers for Medicare & Medicaid Services (CMS) gave states until March 31, 2013, to file the necessary state plan amendments. CMS then gave itself up to 90 days to review and approve those amendments.

    Last week, I participated in a conference call with staff from CMS to discuss implementation of this provision. The good news is that CMS staff reported that all of the states submitted the necessary state plan amendments by the March 31 deadline, and CMS expects that most will be approved in the 90-day timeframe allowed to CMS. The bad news is that, so far, CMS has approved only three.

    CMS has been clear that the provision is retroactive to Jan. 1, 2013, and states are required to give physicians two to three months to attest that they qualify to receive the enhanced payment once a) the state’s attestation process is operational AND b) the state has provided notice to physicians. Unfortunately, CMS is not tracking state efforts and deadlines in this regard, and CMS itself will not conduct any physician outreach on attestation. Instead, CMS will leave it to the states. 

    So, what do you need to do? First, if you accept Medicaid, contact your state Medicaid agency and the state chapter of your specialty society regarding the status of your state’s implementation of this provision. You want to be aware of when the attestation process begins and the deadline for attestation. Second, when that process is operational in your state, follow the procedures mandated by your state in the timeframe given.

    – Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

    Posted on Apr 26, 2013 by David Twiddy

    Disclaimer: The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.