CHA News Article

DHCS Announces Process for ACA’s Physician Primary Care Rate Increase

Under provisions of the Affordable Care Act (ACA), physicians may be eligible for an increase in primary care payments from Medi-Cal. To be eligible, physicians must self-attest they are board certified in family medicine, general internal medicine, pediatric medicine or a related sub-specialty. Physicians may be eligible if 60 percent of the services billed to Medi-Cal fall within certain evaluation and management and vaccine administration codes. The increased reimbursement will also be provided to non-physician practitioners who work under the supervision of an eligible physician.

A draft attestation form and a detailed instruction form are attached. The final attestation form, which must be completed online, is expected to be available at www.medi-cal.ca.gov at the beginning of July. The California Department of Health Care Services (DHCS) will publish a provider bulletin with the final version. Because non-physician eligibility is tied strictly to the eligibility of their supervising physician, the supervising physician must designate them on the form when he or she attests.

Federal approval is currently under review by CMS but is expected to be finalized by July. Questions about the attestation should be directed to Jon Wunderlich, assistant deputy director for healthcare financing at DHCS, via e-mail at Jonathan.Wunderlich@dhcs.ca.gov or by phone at (916) 440-7800.

 

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