Increased Medicaid PCP Payments for 2013 and 2014

A component of the healthcare reform legislation mandated that primary care physicians would receive an increase in reimbursement for Medicaid primary care services rendered in 2013 and 2014. For primary care physicians, these services will increase to the Medicare rates for 2013 and 2014. The Department of Health and Human Services (DHHS) did not release their final rule concerning the provision of these increases until November 2012. Under the final rule, each State has several options in determining how they will administer the rate increases. For example, a State can elect to pay the increases on an individual claims basis or make a quarterly payment based on the claims submitted by primary care physicians.

DHHS has given each State until March 31, 2013 to file their State Plan Amendments indicating how they are planning on administering these increased payments for 2013 and 2014. If the State Plan Amendment is filed by March 31, 2013, the federal government will provide the matching funds for these increases retroactive to January 1, 2013.

In addition to filing the State Plan Amendment with DHHS, Georgia will also have to develop a mechanism to allow physicians to self-attest as a primary care physician; i.e. that they are Board Certified in a primary care specialty or that a certain percentage of their charges to Medicaid fall under the eligible primary care services and vaccine administration codes.

SHP is continuing to monitor the status of these increases.