Much-Delayed ACA Medicaid Payments in Process

[MMA News Now, July 10, 2014] According to the Department of Human Services (DHS), eligible physicians can expect to receive a bump in Medicaid managed care payments for primary care by mid-August. The increase was mandated by the Affordable Care Act (ACA).

To address concerns about access to primary care services following the ACA Medicaid expansion provision, the ACA required states to pay an enhanced rate, roughly equivalent to the Medicare rate, on primary care service claims with dates of service in 2013 and 2014. This enhanced rate was intended to apply to both Medicaid fee-for-service payments and to Medicaid managed care payments. The DHS began paying the enhanced rate on fee-for-service claims in August 2013, but finalizing the methodology and mechanisms for the managed care rates has been extremely slow despite continued MMA pressure.  

The Medicaid managed care payments are expected to be paid by mid-August for 2013 dates of service.  The enhanced payments for past 2014 dates of services are expected to reach physicians by mid-September.

Services eligible for the enhanced rate are defined as primary care service codes 99201-99499, and vaccine administration codes 90460-90461 and 90471-90474. 

Eligible physicians must currently practice in one of the following specialties, as defined by the American Board of Medical Specialties (ABMS), American Board of Physician Specialties (ABPS) or American Osteopathic Association (AOA): family medicine, general internal medicine, pediatric medicine, or any subspecialty of these listed specialties.

In addition to practicing in one of the above specialties, an eligible physician must meet one of the following:

•    The physician is certified by the ABMS, ABPS or AOA in one of the above specialties or subspecialties

•    At least 60 percent of Medicaid services for which the physician received payment were for the covered services listed above.

Eligible physicians must complete and sign an attestation form, which is available on the DHS website.  

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