CHA News Article

CMS Issues Final Rule on Medicaid Primary Care Payments

Today, the Centers for Medicare & Medicaid Services issued a final rule to implement increased payments for Medicaid primary care services, as mandated by the Affordable Care Act. To qualify for the increased payment, primary care services must be provided by a physician specializing in family medicine, general internal medicine or pediatric medicine. Board certified subspecialists, such as pediatric cardiologists, who provide primary care also qualify for the increased payment. Certain practitioners working under supervision of a qualifying physician may also qualify for the higher reimbursement. The final rule also allows for vaccine administration fees to be paid under the Vaccines for Children program up to a certain limit. There are multiple options in the final rule for states to use when implementing the enhanced payments in fee-for-service and managed care settings. The rule permits states to either “lock” rates at the level of the Medicare physician fee schedule in effect at the beginning of 2013 and 2014 or modify the rates in alignment with all updates by Medicare. CHA will work with the Department of Health Care Services to determine how implementation will impact the Medi-Cal program. The rule is attached.