Qualifying for the Medicaid Primary Care Increases for 2013 and 2014
Pursuant to the Affordable Care Act, physicians who provide a majority of primary care services to Medicaid beneficiaries are eligible to receive increased reimbursement on these services for their Medicaid beneficiaries for 2013 and 2014. The Department of Community Health (DCH) is tasked with managing the administration of these increases and have just announced the final process for eligible physicians to attest that they qualify for these increased payments. Based on DCH’s final publication, the categories for qualifying for the Medicaid increases has widened; therefore, SHP encourages our clients to review the following categories to determine if you will qualify.
Physicians can qualify for the incentives in one of two ways:
1. Be Board certified (ABMS, ABPS, or AOA certifications accepted) in the following specialty or sub-specialty:
Adolescent Medicine Pediatric Internal Medicine
Allergy and Immunology Internal Medicine
Cardiology Internal Medicine Critical Care
Cardiovascular Disease Neonatology
Critical Care Medicine Neonatal-Perinatal Medicine
Diabetes Nephrology
Emergency Medicine Oncology
Endocrinology Pediatrics
Family Practice Pediatric Allergy
Family Practice Geriatric Medicine Pediatric Developmental & Behavior
Gastroenterology Pediatric Emergency Medicine
Geriatrics Pediatric Endocrinology
Hematology Pediatric Gastroenterology
Hematology/Oncology Pediatric Hematology/Oncology
Infectious Disease Pediatric Infectious Disease
2. For the most recent calendar year (2012), attest that 60% of your services to Medicaid beneficiaries have been either E&Ms or Vaccine Administration Codes.
If you will qualify, please see the notification below that was published by DCH as a guide to the attestation process, which opened on 5.1.2013 and will remain open for 90 days:
On May 1, 2013, currently enrolled and future Georgia Medicaid Provider’s will be able to utilize the Georgia Health Partnership Web Portal (located at https://www.mmis.georgia.gov) to submit the ACA Rate Increase Attestation or Board Certification. The ACA Rate Increase Attestation will also be available on paper for currently enrolled providers to submit and included in the paper enrollment applications for new providers enrolling in Georgia Medicaid for the first time.
There are three ACA Rate Increase Attestations:
Medical Billing
The Medical Billing Attestation should be submitted if the provider is not board certified by the American Board of Physician Specialties (ABPS), the American Osteopathic Association (AOA) or the American Board of Medical Specialties (ABMS) only and at least 60% of their total Medicaid billings are E & M and/or vaccine administration codes.
Board Certification
The Board Certification Attestation should be submitted if the provider is a physician and is board certified by the Board of Physician Specialties (ABPS), the American Osteopathic Association (AOA) or the American Board of Medical Specialties (ABMS) only.
Non-Physician Practitioner
The Non-Physician Practitioner Attestation should be submitted by an Advance Nurse Practitioner, a Physician Assistant or a Nurse Mid-Wife or a Physician who supervises an Advance Nurse Practitioner, a Physician Assistant or a Nurse Mid-Wife who wishes to receive the ACA Rate Increase. An Advance Nurse Practitioner, a Physician Assistant or a Nurse Mid-Wife must be supervised by an enrolled Georgia Medicaid provider. Please note, the Advance Nurse Practitioner, a Physician Assistant or a Nurse Mid-Wife must list the physician’s active Georgia Medicaid provider ID# on either the paper or web portal attestation. The Physician will also have to list the Advance Nurse Practitioner, a Physician Assistant or a Nurse Mid-Wife’s active Georgia Medicaid provider ID# on either the paper or web portal attestation.
Provider’s who are currently enrolled in Georgia Medicaid, can either submit the paper attestation or log into the secure side of the MMIS web portal using their username and password. The Provider Rate Increase request panel will be located under the Provider Enrollment – Provider Rate Increase Request link on the MMIS web portal; you will attest either board certified or medical billing. If you choose board certified, you will be able to upload the applicable board certification listed above with the submitted attestation.
Provider’s who are new applicants will be able to attest either by the paper enrollment application or on the MMIS web portal via the web application. New applicants who are board certified will need to submit the applicable board certification with either application. The paper attestations will be available on the MMIS website, https://www.mmis.georgia.gov, under the Provider Information, forms, enrollment drop-down box.