CMS Final Rule: Increased Medicaid Payment Rates for Primary Care

Earlier this year, the Department of Health and Human Services announced its proposed rule to implement the Affordable Care Act provision that Medicaid reimburse primary care providers at the same rate as Medicare. On November 1, 2012, CMS issued a final rule to implement this increased payment for calendar years 2013 and 2014. Effective January 1st 2013, eligible primary care providers will be paid at rates established by the Medicare fee schedule – rather than the state-established Medicaid rates (which are often lower – sometimes significantly lower – than the federally established Medicare rates). The matching rates apply to services provided by physicians and supervised non-physician providers (i.e. nurse practitioners) in the field of family medicine, general internal medicine, and pediatric medicine or related subspecialties. The federal government will be footing the bill for this expansion in payment, as 100 percent of the difference in payment between the state’s Medicaid rates and the Medicare rates will be paid for with federal dollars.

Other relevant changes for PCP’s include CMS’ final rule that recognizes the primary care physicians’ role in coordinating a patient’s care in the 30 days following a hospital or skilled nursing facility state. Physicians will now be eligible for reimbursement for care coordination.

CMS November 01, 2012 fact sheet: Increased Medicaid Payment for Primary Care
CMS November 01, 2012 fact sheet: Payments to Primary Care Physicians Increase in 2013