This should provide a significant increase for primary care providers that we hope will build more capacity for Medicaid services, and result in higher quality and better controlled costs.The increased payments will be retroactive to Jan. 1, 2013. The program is scheduled to run for calendar years 2013 and 2014.
The recent AAFP article
Despite Lagging Implementation of
Parity Provision, Physicians Will See Full Medicaid Payment Boost
explains national implications of the provision. According to AAFP President
Jeff Cain, MD, "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. These are priorities for the AAFP."
To qualify for
the increased payments you need to fill out a form and self-attest you are
board-certified in family medicine, internal medicine or pediatrics, and that at
least 60 percent of your billing for evaluation and management (E/M) codes is
for primary care services.
Each
state has until March 31 to send CMS their plan amendments. Kansas has decided to include increased payment
for coverage of children in the CHIP program, although that was not required by
CMS.
There
is a Kansas attestation form for you to complete to receive the Primary Care
Rate Increase. Click to access the CERTIFICATION ATTESTATION on the KAFP website.
We will stay in contact with the state and provide updates as available.
A
recent KDHE newsletter provides these points:· Effective with dates of service January 1, 2013, through December 31, 2014, Medicaid payment rates to primary care physicians for furnishing primary care services will be no less than 100% of Medicare payment rates for 2013 and 2014 respectively (or if greater, the Medicare payment rate in effect in July 1, 2009).
· Advanced practice clinicians under the personal supervision of an eligible physician may also be eligible and reimbursed at 75% of the increased rate.
· Increased payments do not apply to Rural Health Clinic and Federally Qualified Health Center services.
· For retro-active self-attestations, increased payments will be limited to the beginning of the quarter in which the attestation is submitted.
· CMS did not require Kansas to include increase payments to providers caring for CHIP children, but the state decided to do so anyway.
Self-Attestation Form: In addition to the KAFP website the Certification and Attestation for Primary Care Rate Increase form can be found under the Provider Information heading on the Forms page of the KMAP website.
Here are additional resources from CMS that you may find helpful for more information:
Q&A’s on the Increased Medicaid
Payment for Primary Care: http://www.medicaid.gov/State-Resource-Center/Frequently-Asked-Questions/Downloads/Q-and-A-on-Increased-Medicaid-Payments-for-PCPs.pdf
FAQ’s on Increased Medicaid Payment for
Medicaid Managed Care: http://www.medicaid.gov/State-Resource-Center/Frequently-Asked-Questions/Downloads/Q-and-A-on-Increased-Medicaid-Payments-for-PCPs-managed-care.pdf
